College of American Pathologists
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  Jungle favor—remote Amazon lab bolstered by grant


CAP Today




February 2009
Feature Story

The CAP Foundation in 2007 gave a $10,000 grant to the Los Angeles Society of Pathologists education fund, which is a fund within the Foundation devoted to training pathologists in underdeveloped countries. James Keefe, MD, coordinator of the education fund, and Victor W. Lee, MD, PhD, of Pathologists Overseas, identified a pathologist to receive this training last year—Arturo Rafael Heredia, MD, who works in a small city in the Amazon jungle of eastern Peru. Dr. Rafael, 30, had finished his pathology residency in Lima and started the first pathology practice in the remote village of Pucallpa.

He traveled to Los Angeles to improve his medical skills while volunteers from Pathologists Overseas covered his practice in Peru for six months. Most of Dr. Rafael’s time was spent at LAC+USC Medical Center under the supervision of Parakrama Chandrasoma, MD, and Juan Felix, MD, in anatomic pathology.

Money raised by the Los Angeles pathology society for its education fund along with the $10,000 CAP Foundation grant paid for Dr. Rafael’s travel and covered living expenses during his stay in Los Angeles from July through December 2008. As Dr. Rafael was completing his sabbatical in December, he answered a few questions from Sara Vlajcic of the CAP Foundation.

  • What did you hope to accomplish in the U.S.?
  • My goal was to improve my knowledge of diagnosing tumors. While studying in the U.S., I saw a lot of difficult cases in surgical pathology and cytology. When I was in Peru, I would send difficult malignant neoplastic cases to Lima for diagnosis, which delayed treatment and is expensive for patients. With the training I received in Los Angeles, I now have improved my system of work and management of information for the treatment of these patients. I also developed a network of friends who can help me with my professional work in the future. I will stay in touch via the Internet.

  • What is your practice like in Peru?
  • I work in surgical pathology and cytology because in Peru clinical pathology and surgical pathology are separate, with three years’ training required for each program. I enjoy working in gyn and GI pathology, and cytology too, but I could not choose just one because I am the only surgical pathologist in my hospital, the Amazonico Hospital of Yarinacocha—Pucallpa.

  • What skills have you been working on since you arrived?
  • I have been reading slides and performing diagnostic work using low power on a microscope. I have been learning about different staining techniques that are available in difficult cases. I organized slides from difficult cases in a study box for consultation. Previously, I had no experience with fine-needle aspiration. I have been learning this skill and will now be able to perform this technique in the future. I also improved my skills in grossing and in doing special stains. Because we do not have an experienced histology technician in Pucallpa, Dr. Lee recommended that I go in early to the histology lab at LAC+USC for the last three weeks to spend time learning basic histotechnology—from 5 AM until 9 AM before attending the morning conferences.

  • What challenges do you face in Peru, and what do you plan to do when you return?
  • Research in cervical and gastric cancer is challenging because we do not have the technology pathologists have here. For example, we process our tissue by hand, and we do not have immunostains. I would like to implement an FNA clinic in Peru. In addition, while we have 120,000 women in the entire region my hospital serves, only 7,000 have had Pap smears. My goal is to improve and expand the system for processing and interpreting Pap smears in gyn cytology.

    I would like to create an accurate registration of information regionally for research and teaching, and to continue the study box and classification of slides I started to accumulate here. I hope to perform research in the treatment of cancer, conduct trials in tissue culture, and possibly report cases in medical journals. Because my father and my sister died of cancer, my dream is to create a unit of oncology for treating such cases.

  • Will you take lab equipment with you when you return?
  • Pathologists Overseas arranged for the donation of a microscope and digital camera, which one of the volunteer pathologists, Harriet Fremland, MD, took with her to my hospital in Peru. I will return with a lot of books, one laptop, and, thanks to Dr. Lee, one camera.