Pathology technicians at work in the new laboratory at John F. Kennedy Medical Center in Monrovia, Liberia.
The only pathology laboratory in Liberia recently opened, thanks to a collaboration led by Ann Marie Beddoe, MD, MPH, Director of Global Women’s Health and Associate Professor of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai. The laboratory, which became operational in October 2019, is a crucial step in rebuilding the health infrastructure in Liberia after years of civil war. “The impetus for founding this laboratory was our mission to improve women’s health,” Dr. Beddoe says. “But this is not just for women or for cancer. This is something that will benefit the entire country.”
In an event attended by President George Weah of Liberia, the 4,000-square-foot laboratory at the John F. Kennedy Medical Center in Monrovia, Liberia, was dedicated in July 2019, along with an imaging center donated by the National Institutes of Health and an infectious disease center donated by the United States Agency for International Development. The new facilities are part of an overarching mission to provide evidence-based care in Liberia, which was wracked by civil wars for more than a decade. Around 2006, Ellen Johnson Sirleaf, then president of Liberia, noted that only 50 physicians were left in the nation of more than 4 million people, and she sent out a call for volunteers to help restore health care. In 2008, Dr. Beddoe was part of a group from Mount Sinai who answered that call, led by Jeffrey S. Freed, MD, Clinical Professor of Surgery, Icahn School of Medicine at Mount Sinai; and Eileen Solomon, Senior Director, Special Events, Mount Sinai Health System. “Our early teams recognized the need for gynecologic oncology services, and Dr. Beddoe had the courage and fortitude to make it happen,” says Dr. Freed, who has made many trips to Liberia to care for patients there.
From the beginning, Dr. Beddoe was struck by the prevalence of cervical cancer in Liberia. “Women would walk to the clinic, or come in strapped to motorbikes, and when we examined them, we found they were dying of cervical cancer,” she says. “I couldn’t walk away from this.” Low-income nations bear most of the burden of cervical cancer because industrialized nations benefit from widespread prevention, screening, and early treatment. For example, among more than 500,000 new cases of cervical cancer each year, only 14,000 are in the United States, Dr. Beddoe says. In addition, cancer carries a stigma in Liberia. “We couldn’t really treat these patients,” she says. “Nobody even acknowledged that they had cancer.”
Over the years, she has returned to Liberia every few months to work with physicians there to improve the diagnosis and treatment of cancer. The first step in securing any health care funding from the Liberian government is building a registry to document the nation’s cancer burden, Dr. Beddoe says. The creation of the pathology laboratory, where diseases can be diagnosed through the analysis of body fluids and tissues, is integral to this effort.
Ann Marie Beddoe, MD, MPH, at the dedication of the laboratory with Jerry Brown, MD, Chief Executive Officer of the John F. Kennedy Medical Center.
The $250,000 facility was built in a suite of storage rooms at JFK Medical Center and funded partly by The Women Global Cancer Initiative, a nonprofit led by Dr. Beddoe. Sakura Finetek USA, a pathology supply company, donated equipment, including a tissue processor and slide stainer, and Mount Sinai donated computers and printers, and a year’s worth of “consumable” supplies, such as reagents, alcohol, blades, and gloves.
Staffing the laboratory presented a challenge. Licensed clinical laboratory technicians—known as histotechnicians—are crucial to a pathology laboratory, and there were none in Liberia. So in 2019, four Liberians were trained by the American Society of Clinical Pathology, a crucial partner in the project. JFK Medical Center hired two physicians specializing in pathology, and other physicians at the hospital are being trained in handling and labeling specimens and in the discipline of evidence-based medicine.
“I am 99 percent sure that when I see a cervical cancer, it’s a cervical cancer, but that is not the way to introduce cancer care to a country that is trying to do things right,” Dr. Beddoe says. “Having pathology, and good diagnoses, will start generating more research, which is what you need to provide good medicine.”
Mount Sinai’s Division of Global Women’s Health focuses on the long term in its overall mission to improve research and clinical care. “We try to do a lot of capacity building—training people, and focusing on ongoing, sustainable projects,” Dr. Beddoe says. Her years of dedication were acknowledged at the ceremony in July, when the pathology laboratory was dedicated in her name.