Tamunomieibi Wakama, MD, is a visiting physician at Roswell Park Cancer Institute (RPCI) thanks to a Visitor Training Program (VTP) grant from ASH that was awarded to Vishala Neppalli, MD, assistant professor of oncology in the Department of Pathology & Laboratory Medicine at RPCI. Twenty such grants are awarded by ASH each year, enabling talented hematologists, scientists, and/or laboratory staff from developing countries to receive training on a specific hematology topic or technique under the mentorship of an ASH member at institutions where both resources and staff are readily available. The program’s goal is to build hematology capacity in developing countries and to improve research and patient care globally. Dr. Neppalli developed the 12-week curriculum to address the clinical and educational needs of Dr. Wakama and his institution in Nigeria. The training program is supported by grants from ASH and the National Hospital, Abuja. In Nigeria, Dr. Wakama is a fellow of the National Postgraduate Medical College of Nigeria and works as a consultant at the National Hospital, Abuja, where he cares for patients with diverse hematologic disorders, including hematologic malignancies. He also trains residents, fellows, and clinical laboratory staff. At RPCI, Dr. Wakama has become proficient in several aspects of diagnostic hematopathology, with particular emphasis on flow cytometry and integrated diagnosis in neoplastic hematopathology. “Diagnosis of hematologic malignancies is complex,” says Dr. Neppalli. “But it is easy to take for granted at centers such as RPCI, where we have a sizeable pathology department with dedicated hematopathologists, in addition to highly specialized ancillary laboratories devoted to bone marrow, lymph node pathology, flow cytometry, cytogenetics, and molecular studies.” In Nigeria, Dr. Wakama serves as both clinician and pathologist to his patients. The responsibility for determining the specific leukemia type or hematologic disorder rests on his shoulders. “At my hospital, diagnostic hematopathology is very limited and relies mainly on morphology examination of tissue, blood, and bone marrow, with minimal ancillary tests,” explains Dr. Wakama. “Where such tests are required, we must send them elsewhere with a resultant long turnaround time and high cost, which have a negative impact on proper and prompt patient care.”
Other challenges he faces at his home institution include the lack of an integrated approach to specimen handling and reporting of diagnostic information. The tissue specimens, including bone marrow core biopsies, are processed and reported by surgical pathology, independent of hematology correlation with concurrent diagnostic specimens. Gaps in the interpretation and integration of these diagnostic tests can lead to diagnostic inaccuracies and erroneous treatment plans. An integral aspect of the VTP is for the mentor to devise a program for the trainee that encompasses specific techniques and knowledge that the trainee will be able to implement at his or her home institution and that will lead directly to better patient care and/or research. Dr. Wakama’s hospital in Nigeria has already purchased the equipment to establish and implement flow cytometry services. With the collaboration of Dr. Neppalli, Dr. Paul Wallace (director, Department of Flow & Image Cytometry), and Dr. George Deeb (associate director, Laboratory of Clinical Flow Cytometry), Dr. Wakama learned to develop cost-effective flow cytometry panels and strategies that he will be able to implement upon his return home. He will then train his colleagues and other personnel, further improving hematopathology capabilities and patient care. “I will also have the ongoing benefit of the established contact with Dr. Neppalli and RPCI, which will continue to bridge knowledge gaps.” In addition, Dr. Wakama participated in RPCI’s clinical educational programs for technologists as well as the lymphoma multidisciplinary tumor board, initiated and directed by Dr. Neppalli. “I experienced firsthand the importance of these conferences and how they create common diagnostic ground and establish effective communication across the hospital laboratories. I hope to start similar programs when I return home to bring about a sustainable and knowledge-driven change in our work flow.” “It is an honor to be selected as a mentor to train an international physician through ASH,” says Dr. Neppalli. “Institutions and the mentors selected are recognized for their expertise at the international level, and it highlights the quality of education and clinical expertise RPCI faculty bring to the field of hematology. I thank my colleagues, specifically Dr. George Deeb and Dr. Paul Wallace, who contributed to the training modules, as well as the clinical technologists who made this possible.” One aspect of his training at RPCI that Dr. Wakama won’t likely need in Nigeria is his experience coping with snow such as the historic storm that buried Western New York in several feet of snow in November 2014. “I had seen snow before in Europe, but nothing of this magnitude,” says Dr. Wakama. “I woke in the middle of the night to see only white all over and the atmosphere aglow. It was a beauty to behold and I was delighted to be part of history. It was an experience I won’t soon forget.”
