Melanie Johncilla, MD
Fellow in BWH Pathology
PGY 5
Fellow in BWH Pathology
PGY 5
I left Trinidad when I was 18
years old. I’ve never worked in the country and since I left it’s always
been a place I equate with vacation, beaches, sleeping in late and having
home-cooked food. Given my experience working with folks in other “lower
resource” settings like Rwanda and Haiti, I began investigating Trinidad as one
of those ‘settings’. After a small needs based assessment, I decided to
do a project that would bridge very evident knowledge and practice gaps in the
country.
Showing Dr. Greaves and his house officer Kavita the telepathology system (the iphone is attached to the camera and I'm uploading it on to Ipath for outside consultation). |
And here I am. In a
room in San Juan, Trinidad with blue walls and a rectangular window waiting for
my turn with the one microscope (I gave it to ‘my house officer’ who is
previewing some unknowns I brought from the Brigham for a teaching session
later this week). The microscope has no light filter, no 2 or 20x objective
and - I’ve mentioned this already - there’s only one of them. I need it
to attach my one (donated) iphone so I can then project slide images onto my
laptop and begin teaching. It’s different from having my pick of the
litter at the Brigham (objectives, filters, microscopes..) but oddly enough I
love it. I know I only have one microscope and I know that my old high
school friends are leaving work early to go the bar or a carnival fete (it’s
what Trinidadians call a party). But I don’t think I’ve ever been this
excited about a project before.
I could spend time on this
blog regaling readers with tales of mistaken diagnoses, maltreatment based on
diagnoses from the four (total!) pathologists here (the best of whom completed
their training in the early 90’s and didn’t ‘believe’ in immunohistochemistry
until a few years ago). I could detail the story of the one
pathologist who diagnosed a 17cm mass in a decompensating 70 y/o man with the
words “cells, staining for CD20, CD5 and CD3, clinical correlation is
needed”. But I, embarrassingly, expected that practice type. What I
did not expect is my colleague, Wesley Greaves, MD, FCAP who maintains the
integrity, professionalism and knowledge base he built while at MD Anderson and
Brown and then brought that essence to his practice in Trinidad. Though
severely restricted in terms of resources, his practice of pathology rivals
that of the Brigham. His staff is beyond motivated, beyond innovative and
frankly, had they been based in the US with grants to apply for, courses to
take, they would be among the best, if not the best. Resource restriction
is quite a thing.
The entire experience is not
without its negatives (on my part). As I sat in my one hour traffic
filled commute, I momentarily lapsed into a line of thinking probably
fueled by the frustration of just getting to the lab. Here I am, I
thought, a fellow in Boston with arguably unlimited access to resources and
connections and here I go, to a lab with three immunostains and one microscope,
what am I doing here? The gap is wide and after sitting here for four
days and recovering from my commute, I feel my own privilege and my own
entitlement and that’s also quite a thing.
The grossing station at the lab. |
I needed a few minutes to
write this, but cases, patients and house officers await. The practice of
Pathology is different here. It’s dynamic, engaging and developing.
And, four days in, I love it.
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