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The Practice of Histopathology in a Developing Country: Difficulties and Challenges.Plus a discussion on the terrible disease burden we carry.
  1. Zubair Ahmad (zubair.ahmad{at}aku.edu)
  1. Aga Khan Univeristy Karachi, Pakistan
    1. Asim Qureshi (asim.qureshi{at}aku.edu)
    1. Aga Khan Univeristy Karachi, Pakistan
      1. Amna Khurshid (amna.khurshid{at}aku.edu)
      1. Aga Khan Univeristy Karachi, Pakistan

        Abstract

        Histopathology as a science is still evolving in Pakistan. A majority of lesions which should be biopsied are actually never biopsied, and even many resection specimens are never sent for histopathological examination. For a population of one hundred and sixty million people, there are only three to four centers of note where meaningful histopathology is practiced. We work as consultant histopathologsits at the Department of Pathology, Aga Khan University (AKU), in Karachi, Pakistan’s largest city. The Section of Histopathology at the Department of Pathology, AKU is the largest center for histopathology in Pakistan. Other major centers for Histopathology in the country include the Shaukat Khanum Memorial Cancer Hospital (SKMCH) in Lahore, and the Armed Forces Institute of Pathology (AFIP) in Rawalpindi. In addition, there are a few smaller centers in various cities which can be counted on fingers. In the vast majority of clinical laboratories across the country, histopathology facilities are very primitive and on a very small scale. There is a great dearth of qualified histopathologists, and basic tools for accurate histopathological diagnosis (especially facilities for immunohistochemistry which is the most valuable adjunct to H&E staining in diagnostic histopathology), are not available at more than half a dozen centers. Even in the larger centers, issues of costing and expenditures have led to slashing of budgets and rising costs of histopathology with resultant losses to the centers, and increased cost to the patients. Hence, most laboratories and pathology centers in the country are reluctant and not too keen to provide optimum histopathology facilities, which as mentioned above, are rather primitive in nature. In addition, many clinicians (both physicians and surgeons) especially those practicing in smaller sities and towns across the country are unaware (or unwilling) to accept the importance of a histopathological evaluation in the diagnosis and management of disease. In many cases, tissues are not sent for histopathological examination, because patients are poor and cannot afford the costs. Government healthcare is generally poor, the large majority of the population has no health cover, and government pathology centers often lack both the proper facilities for histopathology as well as qualified histopathologists. Hence, people have no alternative but to turn to private pathology centers especially for reporting of histopathology specimens, which are obviously expensive.

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