Bridging a historic divide for the advancement of pathology
At a Glance
- The Congress of the Cuban Division of the International Academy of Pathology in November 2016 welcomed, for the first time, an official US delegation
- This “first” was spearheaded by the American Registry of Pathology (ARP) in an effort to cultivate medical education exchanges between the two countries
- A previous attempt for visa entry into the restricted country had been denied, but perseverance paid off and a portion of the 2016 Congress program was delivered by the American delegation
- This landmark occurrence has truly opened up the dialogue between these two countries and provided an important opportunity for mutual learning, sharing of knowledge and improved patient care
“While it is no easy task, it is my responsibility to update you on the development of our specialty in our country,”* explained Professor Israel Borrajero Martinez, President of the Organizing Committee of Patología 2016. A routine, even blasé, reporting for many medical leaders, this unveiling of the state of pathology in Cuba was remarkable and awe-inspiring. I was fortunate enough to be seated on the dais at the Palacio de Convenciones in Havana, Cuba when Borrajero spoke these words in November 2016.
Cultivating Cuban-US relations
The Congress of the Cuban Division of the International Academy of Pathology, or Patología, was not a new endeavor. In fact, this is the fourth time this biennial event was held. It was the first time, however, that the United States attended as a delegation since there has been a move toward normalization in relations between Cuba and the US. This delegation was conceived and led by the American Registry of Pathology (ARP).
Agustin Chong Lopez, President of the Sociedad Cubana de Anatomía Patología, in opening the medical conclave, explained that participation from American colleagues took many years to materialize.
In fact, about seven years ago, William A. Gardner, Jr., ARP Executive Director, casually mentioned that he thought it would be a great idea for the ARP to travel to Havana to communicate with Cuban pathologists. Gardner was a whirlwind of ideas, especially when it came to the global sharing of pathology knowledge. ARP, under his direction, donated its Atlas of Tumor Pathology and Atlas of Non-Tumor Pathology to areas of the world where access to such information was difficult to come by. Now he wanted to assemble a group of prominent American pathologists to enter a restricted country. He tasked me and my firm, Auburn Health Strategies, as his accomplice.
While we are accustomed to devising and implementing big ideas, this one involved two countries that were not particularly interested in normalizing relations for the sake of pathology. This did not inhibit Gardner’s enthusiasm, though; on the contrary, it incited it. So, we went to work in establishing crucial relationships with Cuban pathologists and diplomats, creating a roster of potential US pathologists to invite, and beginning the process of obtaining visas to travel. Despite these efforts, our request to travel was denied.
So, Gardner vowed to try again, but he passed away before his mission was accomplished. ARP, its Board of Directors and new Executive Director, Cynthia Thomas, agreed to continue the quest.
The ARP is known in the pathology community for its support of preeminent collections of pathology specimens, scientific peer review and educational programs and publications. Its vision is to expand global knowledge of pathology and science. Its role in Patología 2016 was to present and share scientific topics with colleagues from Cuba and other Latin and South American countries.
Members of the ARP delegation making presentations included Peter Burger, Stephen Cina, Brad Goskowicz, Charla Marshall, Dennis O’Malley, Elizabeth Montgomery, Stuart Schnitt, and Robin Stombler. Topics ranged from pathologic diagnosis of central nervous system tumors; medical autopsies; infectious disease standards; best practices and emerging trends in DNA analysis; lymphomas; myeloproliferative disorders; spindle cell tumors of the gastrointestinal tract; breast lumpectomy margin evaluation; and laboratory quality. G. Frederick Worsham and Thomas rounded out the delegation.
Out of mutual respect for pathology education, ARP presented to Cuban colleagues a significant number of fascicles from its Atlas of Tumor Pathology and Atlas of Non-tumor Pathology. In underwriting this gift, Microbiologics, a Minnesota-based company, noted that “its mission to create a safer, healthier world just expanded through this important collaboration.”
The state of pathology in Cuba
Borrajero, who was declared a national hero in Cuba for his tenured work in the science sector, explained that while some medical specialties flourished in the period prior to 1959, anatomic pathology in Cuba was only represented through 13 laboratories or departments, of which seven were for autopsies. These departments were distributed in the provinces of Santiago de Cuba, Camagüey, Holguín and La Habana. He noted how these departments were directed by autodidact pathologists. Some, through intelligence and dedication, rose to the status of professors.
In the 1960s and 70s, a process of creating and strengthening hospital centers in Cuba began. New hospitals in various provinces emerged with new departments of anatomic pathology. In parallel, an accelerated program for the training of medical and technical staff was developed. Consequently, in 1963, a restructuring of the undergraduate teaching of the discipline was carried out in the Escuela de Medicina de la Universidad de La Habana. Those young interns and student assistants at the time, who remained in the country, formed the foundation for the new age of pathology. Many are the senior leaders of the profession today.
With the development of these new medical faculties, hospitals and health programs, a growth in the qualitative and quantitative approach to anatomic pathology was realized. Twenty-eight departments of anatomic pathology were created by 1965 as well as the first official residency program for anatomic pathology and a training program for laboratorians, which we refer to as medical laboratory scientists. By 1986, there were 78 departments, which we would refer to as laboratories, in the country and 190 pathologists. And today, Cuba boasts 236 anatomic pathology specialists and an increasing number of residents.
Sharing goals and gains
Both ARP and the Cuban pathologists have expressed an interest in continuing this important dialogue. While pathology and laboratory programs in each country are structured differently, there is a common thirst for knowledge.
We can learn from one another. Per capita, it appears that Cuba performs more autopsies than the United States, and uses that knowledge to improve clinical care for the living. Stephen Cina, CEO of Cina & Cina Forensic Consulting in Loveland, Colorado, explained, “Cuba maintains a national medical autopsy rate of 50-60 percent, which is 20 times higher than our own. They recognize the value of the autopsy for patient’s families and the advancement of medicine.”
Yet, molecular pathology, as utilized by American pathologists, is a relatively new field for Cuba. Dennis O’Malley, Adjunct Associate Professor at MD Anderson Cancer Center/University of Texas and a Pathologist with Neogenomics Laboratories, noted the “clear interest in innovation” from Cuban pathologists.
G. Frederick Worsham, President of Charleston Pathology in Charleston, South Carolina, remarked on the similarities between US and Cuban pathologists noting both “see their role as central and essential to cancer management.”
As Borrajero summed up, “We now have the responsibility to look to the future. The integration of classical and modern technology with the principle that diseased cells and tissues are the responsibility of the pathologist.”* He added that the true duty of pathology is the patient. To that end, we can all agree.
*Translated from Spanish
Robin E. Stombler is President of Auburn Health Strategies, LLC. She also serves as Vice Chair of the A2LA Board of Directors.