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The day started out routine enough. We had a few trays of cases. Some of the cases I remember of hand: Kaposi Sarcoma on the big toe, mixed cellularity Hodgkins, leiomyoma, fibroadenoma, complete mole, invasive ductal carcinoma, unremarkable duodenum, gastric perforation with serositis, and some lesions I have never seen in the United States (17cm sacrococcygeal teratoma from a 5 month old child). After we had finished I headed to the gross room. I asked about the jaw tumor from yesterday and I was told they had placed it in decalcifying solution (Excellent). I opened the container and found it to still be in one piece (Bogus). I went to Isaac’s office (pathology resident) with one of the histotechnologists and suggested that we could improve the histology, fixation, and speed of decalcification if we cut the jaw instead.

One of the advantages of doing an elective overseas is that on your days off there are new unique opportunities available. This weekend Dr Wester and I decided to make the 7 hour trek north to Ghana’s Mole National Park. Joe from the hospital volunteered to be our driver for the weekend and we asked him if he wanted to bring his oldest son Carlos along. Carlos is a teenager and Joe had to ask to be sure (Hey you want to go to a national park with two strange American doctors and your dad?). I’m not sure exactly how Joe phrased it, but Carlos came along. The trip up is five hours on the main north south road. Then two hours on a gravel road that has a large number of surface deficiencies.

When there are no more slides to read I head outside and downstairs to the gross room and histology. The gross room and histology are more closets than rooms. They are decorated with the same light green concrete walls but blue ceilings to make you think you are outside. There is a nice exhaust fan and a fume hood that can be used for grossing. The only grossing station is in the corner under the fan and consists of a sink half covered with a sheet of wood. It’s not fancy, but it works. The last few days have been special as we have a room full of laboratory technical students with us. The students are eager to learn and I think they enjoyed me talking a bit about each specimen we received. There is no dictation system so all gross descriptions are written on the back of the requisition form by the technologist. While I dissected the tissues, I explained some of the pathology, normal anatomy, what sections I took, why I took those sections, and how I would like them embedded. To the right is a picture Isaac in blue with a group of students. When Isaac is using the sink I use the hood and gross “cleaner” specimen on newspaper or a scrap of cardboard. (cardboard for today in image 1)

Sorry, no pictures today. I was spending Tuesday afternoon reviewing cases with the attending (now Dr. Wester) when we were asked if either one of us could do a FNA. The local pathologist said that there were two women who were sent from the hospital to pathology for breast FNA. The two senior pathologists had not done the procedure recently and both deferred to me. I did quite a few needle aspirations as a medical student and a few more in residency. I said I was uncomfortable reviewing the microscopic without assistance as I have not seen many breast FNA slides. Both pathologists said they were comfortable signing out the sample if I would acquire it for them. Since one of the goals of pathology overseas is to set up a functioning cytology service in Kumasi, I agreed.

Sorry, no pictures today. I was spending Tuesday afternoon reviewing cases with the attending (now Dr. Wester) when we were asked if either one of us could do a FNA. The local pathologist said that there were two women who were sent from the hospital to pathology for breast FNA. The two senior pathologists had not done the procedure recently and both deferred to me. I did quite a few needle aspirations as a medical student and a few more in residency. I said I was uncomfortable reviewing the microscopic without assistance as I have not seen many breast FNA slides. Both pathologists said they were comfortable signing out the sample if I would acquire it for them. Since one of the goals of pathology overseas is to set up a functioning cytology service in Kumasi, I agreed.

Work I

I thought many of you would like to see what was behind door #2 at the KATH Department of Pathology. I have put together a small picture tour of the current pathology overseas office. As you can see the first picture is the resident half of the office. It is decorated with a wonderful concrete wall with a lovely shade of green. The department directory is posted in the upper left hand corner and is slightly askew. The desk is constructed from a sturdy wood and does the job well. My two favorite references so far are placed near my scope on the left. Rosai is for images while the Washington Manual of Surgical Pathology is a good source of staging and grading. Pending cases are at the upper left with notes (BONUS DIAGNOSIS: 5 year old, distal colon resection, one end is dilated, no ganglion cells identified, waiting on additional sections from proximal end). The scope does the job, but I do wish I had my nice familiar Olympus.

After a few days at the house it became evident that we needed to go shopping for a few things. I brought a box of pop-tarts for breakfast, and Dr. Frus liked to have toast. The only problem was we didn’t have a toaster. In addition, the AC in the house is mounted in the ceiling and has to be accessed with a remote. I found the remote, but it lacked AAA batteries. We hailed a cab and went on our way to the market. The cab driver told us most “stores” were closed on Sunday, but we might get lucky.

After my first week of pathology I decided to get out and see some of the area around Kumasi. Saturday’s trip was a short 30km (one hour) drive out to Lake Bosumtwi. We packed light, but had all the necessities.

If you forget anything a local Super Mall is available on the way for your shopping convenience.

We arrived at a small lake town and were promply greeted by a man who said he is the local tour guide. He gave a brief history of the lake and town and offered to take us on a boat ride if we wished. (~$1 per minute)

After a good 14 hour ‘nap’ I was met by the driver and we made our way to the hospital. The trip was a few miles and it took 20 minutes (ants again).

I arrived at the old pathology building and found the facility different but strangely familiar. Everyone in the department is extremely friendly and helpful. They showed me around and I soon found myself settled in behind my microscope with my cases. The first office on the left is for the department head (Dr. Quason). The pathology overseas volunteers share the middle office and the end of the hall is an office for the administrative staff. The two doors across the hall are the morgue and the bathroom.

After asking Dr. Green many questions and getting the go ahead from my wife I have finally arrived in Ghana. The trip over from St. Louis was long, but it wasn’t too bad. On the flight over I sat next to a Canadian(French) who has worked in Accra for three years and she helped me out with a few tips. You have to understand that I am a novice traveler. I have only been out of the United States once, and that was to Germany. I made good time thanks to a tailwind and we were going to get into Accra an hour early. When asked what I would do for an hour while waiting for the driver I naively suggested I would get a coffee at the airport and have a seat. My brief Canadian(still French) guide turned to me and said with a blank stare, ‘you have never been to Kotoka Airport.’

....So the tiny plane landed in the dusty little town called Timbuctu...
Nope. that does not sound romantic at all. Timbuctu is a place where one
should make long and hard treks, over dangerous terrains, not a quick
airplane trip. Though, to be truthful, the plane ride was quite difficult to
arrange, expensive, on again off again, unpredictable and long and bumpy.
So, in a way, I did pay my dues...

Like most of you, I too have been watching the Olympic games on TV with my
Ghanaian friends. I noticed a tremendous solidarity amongst all african
nations and recognition of a pan-african, transcontinental identity- an 'us
vs them' mentality - almost like 'we brothers have to band together, the
non africans don't understand our problems and blame us for all things...'
In TV, they will talk about 'africa's' medal count, not individual

...the other day I was explaining to my resident that a lesion made up of
polymorphous population of cells (inflammatory, epithelial, stromal etc) is
usually benign, non neoplastic, whereas a monomorphous monoclonal population
of cells usually means a neoplasia. My resident brightly said, "I get it. A
village market filled with men, women, children, rich, poor, buyers,
sellers--that is safe, and good. But a troop of uniformed soldiers--that is

Disease wise, malaria is THE commonest, with TB being #2. Among parasites,
Oncocerca seems to be the commonest, next to GI worms. HIV-AIDS is
surprisingly low 7%, compared to rest of africa. Amongst cancers, breast
cancer has overtaken cervix in women. In men, aggressive prostate ca seems
the commonest, next being hepatomas due to hep B,C etc. Very surprisingly,
lung cancer is quite rare!. Smoking is not common, in fact I have not seen a

...flying in to accra from amsterdam, the airport lounge was absolutely
packed with returning ghanaians excitedly chattering in twi and lugging all
shapes and sizes of bags and bundles. I tried to edge into a seat and was
immediately assaulted with strong BO! A thing that I had almost forgotten to
prepare myself and something that no guidebook tells you about. Tired and
alone, and feeling a bit nauseated, I was almost feeling sorry for myself,

Fufu, Banku, Redred, Groundnut soup, plantains, Jollof rice and Meat Pies

Fufu is mashed casava and plantain. It is made in a large mortar and pestle (try as i might i could not get anyone to agree to a photo of them making it). It has the consistency of mashed potatoes that have been made with an electric mixer.. you know when they get kind-of tough? Anyhow they eat it with soup or stew. its shown here with green soup which is made of kontoumori (sp?) which basically tastes like spinach.

As I prepare to leave I reflect on my experiences here. Ghana is a very safe country, filled with people who are surprisingly helpful and kind. When i think of the people in Ghana I think of smiles. Smiles of friends meeting, smiles of children yelling "Obroni", and smiles in farewell. Farewell, Ghana.

Madagascar memories.

A lemur in a tree.

Anti-AIDS (SIDA) campaign. Outpatient clinic in Tana.

The Akan people, the predominant tribe of Ghana, have a tradition of naming their children for the day of the week that they were born on. There are variations on these names but apparently this tradition has spread as wide as Jamaica during the slave trade. Some of these names will probably sound pretty familiar... like Kofi for instance.

My name would have been Akosua since i was born on a Sunday. Anyways this was a frequent question that i got asked here. and i had to go online to look up what day of the week my birthday fell on. I suppose my mother would have known right out!

Adrian and I went out with a few of the folks from the department as a farewell from Adrian to the staff of the department

Here are a few photos from the evening the first is of Samuel, Gilbert, Olivia (Emmanuel's wife) and Emmanuel. Samuel and Emmanuel are histotechnologists, and if you volunteer here they will soon become your "go-to" men. Gilbert is the person who types all of the reports, he is also very helpful.

Dr Adrian Gologan left last friday to return home to Montreal. He signed out 162 cases while he was here and took several back to Canada for further work up.

Here are some interesting images from around the hospital...

The specimens come in whatever container is available. In this case lidocaine bottles are used to ship biopsies.

Grossing is perfomed by dictating to a person sitting behind you who writes down what you say. Here is a shot of Dr. Isaac Siaw, the pathology resident and George a med tech at work

Another gorgeous chameleon.

Our first pathology residents Drs, Lalao, Rakouth and Marcel. Tana 6/99