Guatemala Pathology Initiative

Boat in water in front of Guatemalan volcano

Project Summary

 

The Guatemala Pathology Initiative was born as a result of a strong desire to improve healthcare abroad by two UVA Pathology residents, Ashley Volaric and Sara Zadeh (who is a current UVA Pathology faculty member). This 4-week rotation provides residents with a unique opportunity to learn and practice pathology in an under-funded and low-resource regional public hospital serving multiple surrounding cities. By participating, residents will refine their diagnostic acumen by previewing and signing out cases without access to ancillary tests such as immunohistochemistry, cytogenetics, or molecular testing. In the absence of these histologic “life-lines”, morphologic assessment becomes paramount and crucial for accurate interpretation of surgical pathology specimens. A wide variety of tissue types are processed at this lab and are heavily represented by gynecologic specimens but also include gastrointestinal, hematolymphoid, neuropathology, dermatopathology, and cytology specimens, among many others. The pathologists with whom residents will work are eager to discuss cases and foster a strong learning environment. Trainees are also encouraged to hold a journal club session on a topic of interest and/or bring teaching slide sets to give educational slide sessions to the pathologists during the rotation.

Since the start of this program, we have developed a telepathology program whereby consult cases from Guatemala are discussed via teleconferences on a monthly basis. Another long-term goal that was initiated by two residents, Joe Coppock and Anna Dusenbery, was optimizing the histology laboratory through improving tissue processing and the H&E staining process in the lab. Other goals include validating a basic immunohistochemical panel, and establishing a cervical cancer screening campaign. Our experience in establishing this rotation has taught us a vast amount from diagnostics to laboratory development and management that will be an asset to us in our future practices. As a bonus, it is personally fulfilling to collaborate with pathologists in Guatemala who truly care about their laboratory and welcome any help with open arms. Residents also have the opportunity to gain significant language and cultural experience during their time in Guatemala. Please let us know if you have any questions about this project. We would be happy to talk with you about our experience!

Location

Map of Guatemala

 

People

From Left: Henry Frierson, MD (Project mentor and attending); Sara Zadeh, MD (PGY-4); Ashley Volaric, MD (PGY-3); Boanerges Rodas, MD (Pathology Chair at Xela Hospital)

 

Residents rotating with Guatemalan pathologists

Weeks 2-4 are spent working directly with a local pathologist, Dr. Rodas (pictured on the left), as well as his associate, Dr. Granados (pictured on right), who is a pathologist recently out of training and now working with and continuing to learn from Dr. Rodas.

Project DesignProject description
The Rotation

Rotation description

 

  • Semi-independent sign-out of ~120 surgical pathology and cytology cases
  • Typical Day:
    • 8AM- 12PM: Sign-out cases with Dr. Rodas and/or Dr. Gradano
      • Interaction with clinical colleagues, expedited cases
      • Teaching, literature review
    • 12PM- 1PM: Lunch
    • 1PM- 2PM: Gross
    • 2PM – 4PM: Preview cases, independent study

 

Hospital Regional de Occidente in Guatemala

 

Residents spend the first week of the four week rotation taking in-person Spanish lessons at the local Celas Maya Spanish School. Students are then welcome to continue participating in activities organized through Celas Maya and use the study space with WiFi for the duration of their stay.

 

Unique Cases

Microscopes

    • Majority GYN: placenta, products of conception, molar pregnancies, cervix (dysplasia, adenocarcinoma), uterus (benign and malignant neoplasms), ovary (sex-cord stromal tumors)
    • Heme: lymphomas (NK/T-cell lymphoma, DLBCL), bone marrow (MDS)
    • Endocrine: thyroid (PTC, tall-cell variant)
    • GI: esophagus (squamous cell carcinoma), stomach (linitus plastica), colon (adenocarcinoma)
    • CNS: cereb
    • ellum (medulloblastoma)
Multi-headed microscope

A multi-headed microscope donated by UVA Pathology allows residents to work interactively with Dr. Rodas on cases. Additionally, a microscope camera donated by UVA Pathology allows residents to consult with UVA while on the rotation, as well as to hold video conferences between UVA and Guatemala during months when residents are not in Guatemala.

Research

Residents have the opportunity to participate in quality improvement projects and research during their time in Guatemala. We are always open to hearing more ideas!

Research poster

Poster presented at UVA Medical Alumni Association Conference, 2018
Poster awarded Best Qualitative Research Award

 

Research poster

Poster presented at CAP Annual Meeting, 2019

Cultural Immersion

Xela sign Home-stay

Residents participate in a home-stay for the duration of the rotation. Each resident is provided with three meals per day and a private room. The home-stay offers the opportunity to experience Guatemalan culture more fully as well as gain additional Spanish language practice.

On the weekends, you will have the opportunity to explore the city of Quetzaltenango and the surrounding regions of Guatemala.

 

Trainee Requirements

Microscopic image

 

  • Two trainees per month-long elective rotation, twice a year.
  • Would like to have residents/fellows with various levels of experience travel together:
    • Must be PGY2 year or greater and only one PGY2 resident per rotation cycle
    • PGY2 + PGY3 or PGY4 or fellow
    • PGY3 + PGY4 or fellow
    • PGY3 + PGY3 or fellow
    • PGY4 + PGY4 or fellow
  • Must complete UVA-GI specific requirements including pre-departure readings and online Spanish classes.
  • Currently (as of 2021), the abroad rotation is on hold due to the COVID-19 pandemic. However, the monthly telepathology conferences are ongoing. Any trainees/faculty members who have previously rotated attend, and trainees interested in going in the future are also welcome to attend these virtual conferences.