title: Diagnosis of cancer in rural Rwanda: early outcomes of a phased approach to implement anatomic pathology services in resource-limited settings.
abstract: OBJECTIVE
  Adequate pathology services are a prerequisite to accurate cancer diagnoses and tailoring appropriate treatment. Limitations in skilled personnel and infrastructure are among the challenges faced by developing countries. We describe a stepwise implementation of anatomic pathology laboratory services at Butaro District Hospital, designated as a Cancer Center of Excellence in rural Rwanda.
  
  
  METHODS
  The phased approach to developing pathology services up to December 2012 is described. A retrospective review of specimens submitted to Butaro District Hospital between July 1, 2012, and December 31, 2012, was conducted. Patient clinical characteristics and sociodemographics are also described.
  
  
  RESULTS
  During the study period, a total of 437 tissue specimens were submitted. Among these, 143 (32.7%) were from male patients, 244 (55.8%) were confirmed as malignant, 163 (37.3%) were benign, 28 (6.4%) were inconclusive, and two (0.5%) results were not available at the time of analysis. The median time from specimen receipt at Butaro to final reporting was 32 days (range, 7-193 days; interquartile range, 23-44 days).
  
  
  CONCLUSIONS
  Our experience demonstrates that anatomic pathology services can be established in resource-limited settings and local capacity can be built to support accurate diagnoses. Our approach included leveraging partnerships, volunteer experts, and task shifting and will be expanded to include telepathology.
authors.affiliation: From the Ministry of Health, Kigali, Rwanda; University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda; dmpunga537@gmail.com.
authors.forename: Tharcisse
authors.initials: T
authors.lastname: Mpunga
authors.affiliation: Partners In Health/Rwanda, Kigali, Rwanda; Brigham and Women's Hospital, Boston, MA;
authors.forename: Neo
authors.initials: N
authors.lastname: Tapela
authors.affiliation: University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda; Partners In Health/Rwanda, Kigali, Rwanda; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA; and.
authors.forename: Bethany L
authors.initials: BL
authors.lastname: Hedt-Gauthier
authors.affiliation: Brigham and Women's Hospital, Boston, MA;
authors.forename: Dan
authors.initials: D
authors.lastname: Milner
authors.affiliation: From the Ministry of Health, Kigali, Rwanda;
authors.forename: Irénée
authors.initials: I
authors.lastname: Nshimiyimana
authors.affiliation: From the Ministry of Health, Kigali, Rwanda;
authors.forename: Gaspard
authors.initials: G
authors.lastname: Muvugabigwi
authors.affiliation: Partners In Health/Rwanda, Kigali, Rwanda;
authors.forename: Molly
authors.initials: M
authors.lastname: Moore
authors.affiliation: Partners In Health/Rwanda, Kigali, Rwanda;
authors.forename: David S
authors.initials: DS
authors.lastname: Shulman
authors.affiliation: Partners In Health/Rwanda, Kigali, Rwanda; Brigham and Women's Hospital, Boston, MA;
authors.forename: James R
authors.initials: JR
authors.lastname: Pepoon
authors.affiliation: Dana-Farber Cancer Institute, Boston, MA.
authors.forename: Lawrence N
authors.initials: LN
authors.lastname: Shulman
mesh_terms: D000293:Adolescent; D000328:Adult; D064790:Clinical Laboratory Services; D003906:Developing Countries; D005260:Female; D006282:Health Personnel / Q000193:education; D006295:Health Resources; D006801:Humans; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D009369:Neoplasms / Q000473:pathology*; D010043:Outcome and Process Assessment, Health Care; D012189:Retrospective Studies; D019035:Rural Health Services; D012432:Rwanda; D055815:Young Adult
keywords: Butaro District Hospital; Cancer; Capacity building; North-South partnerships; Pathology services; Rwanda