It's plain sailing for instant diagnosis

UK pathology expertise can now be transported straight into Africa

Patients in developing nations are now receiving instant diagnoses from UK clinical experts while they are still on the operating table onboard a Mercy Ship off the coast of Africa.
Mercy Ships, a global charity, operates a growing fleet of non-governmental hospital ships for developing nations. Since 1978, Mercy Ships has delivered more than $21 million of medical equipment and supplies, and completed close to 350 construction and agriculture projects. The charity has treated a wide variety of health and medical problems, including surgery for cataracts, orthopaedics, cleft lips, palates, and women’s reproductive health operations in 95 ports across 53 nations.

The mercy ship Anastasis is part of a growing fleet that has delivered more than $21 million of medical equipment and supplies.

Lord Ian McColl, Vice Chairman of Mercy Ships, and Professor of Surgery at Guy’s Hospital in London has been deeply moved by the cases he had seen and the difference Mercy Ships is making to people’s lives. “There was a little girl of about 12 who was kidnapped by the rebels in Sierra Leone and raped and tortured. She was doubly incontinent, but made her way to our ship and we were able to give her an operation to help her.” Without the operation the girl would probably have faced a very difficult life in her community, where incontinence is viewed as dirty and the victims are often shunned without any prospect of work or marriage.

Until now surgeons would have to send histological samples overseas, delaying the turn around times for results by up to three weeks. However, thanks to Lord Ian McColl’s recent purchase of an eye-pieceless microscope known as a Nikon Coolscope, volunteer staff can load samples obtained from patients on to the Internet. Authorised experts in the UK, who log in to a secure and dedicated webpage, then gain access to the samples and provide immediate diagnoses or consultation.

The Coolscope is the latest development in the field of telepathology (the practice of pathology via remote telecommunications) and, such is its sophistication, that a pathologist can not only view the live image, but can even control the microscope itself. The system is particularly effective because the user-friendly technology allows voluntary crew to capture excellent images with minimal training. The only additional equipment required is a monitor and mouse. Once slides have been loaded there is no need for optical alignment, as the Coolscope automatically adjusts illumination intensity, contrast and focus. With the image displayed on the monitor, the remote user needs only to move the mouse to navigate his way through the specimen, while geography and distance become irrelevant.

In a discussion regarding the project, Lord McColl commented, “Nikon’s Coolscope will greatly assist Mercy Ships in its endeavour to bring world-class, free-of-charge medical assistance, relief, training and education to developing nations where such would be otherwise unavailable or unaffordable. For the first time, expert pathology consultations can be made remotely, providing immediate and accurate diagnosis”.

Consultant Pathologist, Dr Edward Sheffield of the Frenchay Hospital, first became interested in the charity when he visited a Mercy ship while it was docked in Bristol. After seeing the pathology lab he sought to help the charity and soon travelled to Cotonou, Africa, providing Mercy Ships with its first ever on-site histology service. Since returning to his work with the NHS in Bristol, Dr Sheffield has continued to voluntarily support the Mercy Ships with his expertise in his own time from both his office and his home thanks to the new equipment.

Since the Mercy Ship arrived in Cotonou, Dr Sheffield has used the Coolscope to examine and diagnose over 100 patient samples, including: salivary gland tumours, pleomorphic adenomas, mucoepidermoid carcinomas, thyroid lumps such as nodular goitres and papillary carcinoma, as well as lymphoma, squamous cell carcinomas, skin tumours, and many maxillary and mandibular cysts and tumours such as ameloblastomas, ossifying fibromas, fibrous dysplasia, and dental cysts.

“We use the Coolscope in two ways” explained Dr Sheffield, “one is to use the system to take still images which are sent by email together with the clinical history, which I view and then provide my diagnosis and comments via email. The other way is to arrange an immediate ‘live’ session. These intra-operative sessions are often performed on an emergency basis, as the request for pathology is often a response to unexpected findings during an operation”.

The Mercy Ship has an efficient satellite communication system allowing Dr Sheffield to be contacted by telephone in order to arrange screening sessions, and to be contacted quickly in an intra-operative situation. Dr Sheffield has carried out nearly all of the still consultations as well as a ‘live’ session from his own home.

At the outset of each assignment, Mercy Ships volunteers book a local football pitch for screening-sessions to examine those that attend in order to decide who they can help with free onboard operations. About 2500-3000 patients arrived at the screening-session in Cotonou, Benin at the beginning of November, 2004.

In November 2004, Dr. Gary Parker, Chief Medical Officer and principal maxillofacial surgeon, was operating on nine-year-old Oldie, a local of Cotonou with a large mandibular tumour. During the operation Dr Parker encountered a pocket of suspicious tissue. He used the Coolscope to instantly relay a cell smear to Dr Sheffield in Bristol. With remote access to clear digital images and comprehensive information, Dr Sheffield was able to immediately inform Dr Parker that Oldie required a conservative rather than radical treatment, including a mandible resection. Since her operation, Oldie has made a very strong recovery and has suffered from no further problems.

One of the reasons Mercy Ships accomplishes so much is because career and short-term volunteers raise their own support and pay crew fees to serve. Dr Parker and Sheffield are amongst 850 career staff and over 1600 short-term volunteers from over 40 nations who support Mercy Ships by bringing hope and healing to the needy in some of the world’s poorest nations.
Mercy Ships welcomes volunteers who would like to give their time, efforts and expertise. Short-term volunteers can participate from two weeks to a year with Mercy Ships, while others may choose to serve in a career capacity.

Mercy Ships is the leader in using a growing fleet of hospital ships to deliver free world class health care services to the poor. If you are interested in getting involved with the work of Mercy Ships further information is available from www.mercyships.org.uk.

By Alexandra Bailey, Editor, Laboratory News