Pathologist Aims to Boost Interest in Laboratory Medicine in African Country that Desperately Needs It

By Susan Montgomery - June 04, 2024

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For more than 25 years, the West African nation of Sierra Leone has experienced a drastic shortage of anatomic pathologists and hematologists. Sierra Leone has only two anatomic pathologists and one hematologist (now retired) who serve a population of approximately eight million.  

The lack of anatomic pathologists is largely due to a mass exodus of the civilian population during and after a 10-year civil war that ended in 2002. Most never returned. A lack of interest among current students in pursuing pathology as a career and a lack of mentors to support trainees is another significant factor.  

Until 2021, pathology specimens in Sierra Leone had to be shipped abroad for testing, meaning that only a privileged few could afford diagnostic testing. Even then, it would take weeks or months for a diagnosis to be reported.  

Sierra Leone’s rugged terrain and weak infrastructure present major challenges to the healthcare system and exacerbate disparities between urban and rural communities. The situation can be especially dire during the rainy season, when heavy downpours and flooding make travel difficult, and sometimes impossible. This isn’t just an issue in remote villages; even the capital city of Freetown can become cut off from the country’s primary international airport, disrupting the delivery of medical supplies and the movement of healthcare workers. For many patients, especially those in remote areas, getting to a clinic or hospital can be an arduous journey. 

Enter pathologist Babatunde Duduyemi, MD, who hopes to turn the tide and boost interest in entering pathology and laboratory medicine in an area that desperately needs people in the field. Dr. Duduyemi was recruited in 2021 by the University of Sierra Leone Teaching Hospitals Complex (USLTHC) for Service, Training, and Research to establish a pathology residency program.  

“The knowledge of anatomic and clinical pathology here is very shallow,” says Dr. Duduyemi, a longtime volunteer subject matter expert for various ASCP education programs. “Most students believe that pathology is just about autopsy. Since I started here, I have been engaging medical students to understand anatomic pathology through teaching, laboratory demonstrations, and one-on-one discussions, which have been fruitful. I have some students and doctors on my mentorship drive who are willing to take pathology as their choice for residency.” 

Dr. Duduyemi brings a wealth of expertise to his post. He completed a medical degree and residency training in Nigeria in 1997 and 2009, respectively. He began practicing anatomic pathology as a consultant and lecturer in 2009. He worked in Nigeria and Ghana until 2020 and then joined the University of Sierra Leone Teaching Hospitals Complex a year later. He augmented his education training and experience in North America, the United Kingdom, and Europe, and been involved in residency training in Nigeria and Ghana. 

At present, he and other colleagues have just drafted the curriculum for the pathology residency program at the University of Sierra Leone Teaching Hospitals where he chairs the committee that oversees the program. While the program has not yet officially begun, he has recruited two students who are currently in their PGY3 and PGY4 years in medical school in Nigeria. They will join the new residency program as trainers when they finish their training. “We are currently supporting the training of residents from Internal Medicine, Obgyn and Family Medicine who are on rotation for one to two months in our department,” he says. “This was supposed to be done outside of the country. It is worthy of note that our effort has contributed immensely to the accreditation of residency program in Internal Medicine, Surgery, O&G and Family Medicine in the university teaching hospital.”   

Over the next five years, Dr. Duduyemi hopes to have the program up and running efficiently and effectively. The challenges in starting a residency program from the scratch in an under-resourced country like Sierra Leone are huge. These include, but are not limited to personnel, funding and infrastructure, and the need for residents to be exposed to advanced laboratory techniques like Immunohistochemistry, Florescent in situ hybridization, Polymerase chain reaction, Flow cytometry, etc.  

Overcoming challenges   

A major challenge in establishing the residency program has been a shortage of trainers, including chemical pathologists and clinical microbiologists. Inadequate infrastructure in terms of equipment, laboratory information management system, lack of cooperation, and funding issues are hampering the launch of the program. “We have decided that part of the residency program training will include sending candidates to do rotations in chemical pathology (also referred to as clinical biochemistry) and microbiology in an accredited institution outside the country,” Dr. Duduyemi explains. 

The president of the Sierra Leone College of Physicians and Surgeons has been very supportive in seeking collaboration to overcoming some of these challenges. Additionally, there is a need to upgrade the clinical laboratory in terms of space, equipment, and laboratory personnel. The Child Health and Mortality Prevention Surveillance (CHAMPS) project of the Centers for Disease Control and Prevention (CDC) in Atlanta, GA, which started more than five years ago in Sierra Leone, has been a major contributor to the running of the laboratory in terms of providing equipment, reagent and consumables, according to Dr. Duduyemi. 

Dr. Duduyemi is at the forefront addressing the pathologist workforce shortage in Africa. In fact, his strong desire to address this shortage is one of the reasons he accepted his previous job in Ghana as well as his current position in Sierra Leone. He is a member of the Education Committee of the West African Division of International Academy of Pathology where he has advocated for the need to address this shortage. The committee is presently working on identifying the modalities to tackle this issue. Dr. Duduyemi has also been in conversation with the president of International Academy of Pathology (IAP), who is a both a colleague and a friend, on how to strengthen pathology practice in Africa as well as at a group at Harvard Medical School (Partners) to solicit their support. 

As part of its Memorandum of Understanding with the Hospital, ASCP is supporting the new anatomic pathology laboratory for the residency program at the University of Sierra Leone Teaching Hospitals, and recently donated a tissue processor. Dr. Duduyemi greatly values the partnership with ASCP and is open to having other organizations join in with their support as well. 

“We will need ASCP and other collaborators to support our residency program and the training of laboratory professionals. We are willing to share the draft curriculum with all willing collaborators for their input and advice,” he says. 

Dr. Duduyemi’s next steps include encouraging the hospital to recruit more trainers through advocacy efforts and to advocate for the improvement in the supply chain of reagents and consumables. He will continue to mentor and inspire doctors and students to develop interest in pathology and continue discussions with partners such as ASCP, the IAP, and others to support the training program through observership in the more established laboratories abroad and the provision of resource persons who could visit during their annual leave to help in the training of resident and lab professionals. 

“This program will address a fundamental need of the country, as the proper diagnosis is crucial to optimal management of our patients,” he says. “As it often is said, a healthcare system without pathology is like a ship without a rudder. I am inspired by the fact that the last three years have shown great success in the management of patients especially cancers. This residency program, when commenced, will definitely bring relief to the suffering masses as pathology services will not be limited to Freetown as it is today. I hope to develop the unit in all the regional hospitals across the country,” he says, adding, “I believe that the efforts that we have made through advocacy with other partners mentioned earlier should really help in achieving our dream.” 


Susan Montgomery

ASCP communications writer