Pathology is complex and effective communication has helped me pivot my research career.
Dr. Edwin Oloo Walong is a Lecturer at the Anatomic Pathology Unit, Department of Human Pathology, School of Medicine, at the University of Nairobi. In addition to teaching and instruction, he provides clinical service as a pathologist in Kenyatta National Hospital, Nairobi and serves as the lead trainer at Minimally Invasive Tissue Sampling (MITS) Centre. He is a recurring trainee at the Training Centre in Communication (TCC Africa) having first attended the training on Scholarly Communication in 2010 and then 2020 for training on Science communication and communicating to non-scientists.
TCC Africa: Could you tell us more about yourself and the work you do?
Thanks for having me. I am a pathologist, specifically, that refers to a medical doctor who has specialized in the broad field of pathology that deals with characterization of disease within the laboratory sphere, and mainly providing evidence needed for diagnosis of diseases. As a pathologist there are many areas I practice, but my main area of interest is autopsy. In autopsy, the focus is on identifying the cause of death, which if correctly done, the manner of death, meaning the circumstantial aspects surrounding that death can be determined and if that is done then there are various downstream effects, such as medical legal actions and of course, linkage to public health which we refer to loosely as data to action. I would say that my practice is to provide the diagnostic support needed for the efficient execution of the medial sciences of treatments of therapeutics and also to provide information needed for public health surveillance which overall will work towards keeping people safe. I do this through the back office meaning I spend a lot of time in the mortuary examining deceased persons to unravel what disease truly caused their death. By doing that, we learn looking at it from policy and medical education.
I’m also a medical educator, I teach undergraduates and graduate students in the science of pathology. While there are mainly medical students in my classes, I do have sessions with psychologists taking them through processes related to death and severe diseases, so that they can provide good psychological support whenever traumatic events that lead to death occur. Lastly, I provide service to the community through both public and private practice. In the public sphere, I provide consultation at Kenyatta National Hospital and in the private sphere, for Nairobi South hospital for routine diagnosis of disease.
Currently, my research area is on Covid related mortality. I’m a Lead Minimally Invasive Tissue Sampling trainer, where we identify causes of death without doing the full autopsy by minimally sampling certain parts of the body for pathology testing. I’m using that technique specifically for Covid related mortality in two sites in Nairobi and two in Nyanza. I collaborate broadly with many researcher groups on those areas.
TCC Africa: Why did you choose pathology as a research area?
When studying medicine during my undergraduate studies, I was first exposed to pathology in my second year. I had a really good professor who unfortunately passed on from breast cancer, Prof. Faisal Rana. She left a lasting impression when she described exactly what pathology is and supports the medical field. She was quite passionate; she would lead what we called tumor boards where she would invite various doctors through pathology during discussion on cancers and infections. She was also one of the early local scientists who were unraveling the HIV pandemic, by performing autopsies and identifying the actual disease process that constitutes AIDS and because of her work and that of people like her there is treatment for a lot of diseases that constitutes AIDS and now we are looking at the cure for HIV as we go forward.
I also come from a family of scientists. My father is an entomologist and as a child, he would take me to the laboratory and I would observe tsetse flies under a microscope. I was definitely fascinated by the laboratories, disease and naturally gravitated towards pathology. My interest in pathology was also strengthened when I got an observorship position sponsored by a pediatric team who took me to Wellcome Trust in Kilifi where there is a lot of ongoing work on malaria related pathology particularly affecting children. While there, I realized that having strength in the pathology aspects of disease is definitely an advantage and I could bring insights to some of these diseases because we saw a lot of suffering related to them but we really didn’t look at the mechanisms that were causing this and how to mitigate.
During my first internship, I was in a busy facility in Kisumu which had lots of complex disease cases, now called Jaramogi Oginga Odinga Teaching and Referral Hospital. It was hospital of provided cancer care to children and I realized that looking at the outcomes we had, pathology was quite distinctly missing, not only in its practice in autopsy but also laboratory practice. I made the decision then that I must study pathology and when I got an opportunity to do my project, I decided to go back to Kisumu and received good mentorship and support from Prof. Elizabeth Bukusi Kenya’s top researcher in, obstetrics and gynecology, and global health. She offered me a competitive ,which, I won and went to Kisumu to do my research.
When we met at my first TCC Africa training, I was presenting data from Kisumu. It was quite complex data looking at deep immunological mechanisms by which HIV is transmitted from women to men as a hypothesis. I had a challenge in communicating it because I was totally new to that field of deep immunology and TCC Africa was definitely instrumental in helping me put together the discussions and conclusions and eventually synthesizing it into a manuscript which of course was challenging to publish, lots of rejections but through the journey I learnt quite a bit. Without TCC Africa my scientific career would have gone in a different direction.
TCC Africa: Take us through how you were able to take advantage of the training to help propel your career, especially when it came to disseminating the research results and how did it support you in looking at ways in which you could help early career researchers in disseminating their work.
During the TCC Africa training, we learnt a lot and I was fortunate to learn about the actual basics of communication. I realized that I had not really fully grasped the concept earlier on. I remember one of the facilitators who described basic word construction and style, sentence and paragraph design and with that I could organize my thoughts into words and provide information while simplifying jargon and when to avoid its usage. When I wrote my initial dissertation and submitted, I was finally able to synthesis difficult concepts and make them understandable.
One thing I failed to mention about my journey; I focused so much on immunology and less on autopsy that in my finals I got an F and had to redo it. While redoing my autopsy training, I performed so many autopsies and actually identified a few rare diseases, one of which we decided to publish . Because of the information I had from TCC Africa, I was able to put together a manuscript, a very basic case report. I worked closely with my supervisor and a medical student who is now a medical practitioner. We put the manuscript through the review process and it was accepted and eventually published. This manuscript eventually became one of my most defining academic papers because it described a case of primary immune deficiency where children are born without the ability to fight infections usually inherited and before that there was no evidence that these diseases actually existed especially in East Africa. That simple case report became the basis for certain action groups eventually culminating to the development of what is currently called the ‘A’ Project that is a patient support group for those with primary immune deficiencies and initiatives to strengthen how these diseases are diagnosed and managed. So, without TCC Africa I’d probably have not written that report and having published it in 2014 and initially gaining traction and leadership in 2017, to the point that action groups were created , is, one of those unexpected and fortunately positive results from this kind of work.
With that as I was focusing on autopsy, I brought along my colleague Dr. Anne Barasa to additional training in immune deficiencies which I had realized I was not the right candidate for to provide clinical direction. We put together additional manuscripts which we published relating to immune deficiencies and with that her career developed a life of its own.
The other thing is that I have also managed to write some publications with some medical students exposing them to scientific writing , not, just undergraduate but also graduate students in getting their dissertations projects through and writing up manuscripts, which has put them on a good career path. We are now receiving more papers in the field of pathology and with that seeing a good public health impact.
Right now, I act as an editor (a lot of people do send their manuscripts for me to review and advice on style and presentation to obtain wide readership). TCC Africa put me in the right path in scientific writing and communication which is often a challenge in pathology and I was able to introduce my colleagues who participated in other trainings.
TCC Africa: After 2010, you came for a training in 2020 whose objective was communication to non-scientists. What prompted you to come for this other training, did you feel the need to improve your communication skills or was it a refresher course for you?
I needed to improve on communication to ,first, my colleagues because as mentioned knowledge on pathology is complex and may pose a challenge while communicating in my routine written diagnostic reports as well as oral communication. I was also getting into a new partnership with a Gates Foundation funded initiative called Minimally Invasive Tissue Sampling Alliance as the Lead Trainer in Kenya. Most of our trainees were non pathologists who we were introducing into performing procedures traditionally performed by pathologists to obtain critical tissues from deceased persons for the purpose of diagnostic formulation and cause of death determination. My trainees then were from Rwanda, Ethiopia, and Argentina and as the lead trainer I felt the need to have the right skills to impart my knowledge in a simplified manner especially when discussing pediatric aspects of pathology. We were looking at stillbirths and identifying the causes which are usually difficult as they need a lot of technical approach.
During the Covid-19 pandemic I was invited by different media to discuss various aspects of the disease with the public in certain forums hence I realized I needed to communicate with the style of media practitioners.
The other reason is that we wanted to provide sensitization about our current studies on Covid-19 related mortality and thought we may need to use mass media to conduct interviews and provide information to journalists without them having to paraphrase and for that the training was particularly important.
At that point, a colleague of mine who is an illustrious pathologist, Dr. Ahmed Kalebi, was running the Lancet laboratories and there were a lot of problems with communication relating to testing to the point that he had to present information on testing to the parliamentary committee. I think there is certain information that he presented that was perceived differently from what was intended and I realized that we need to learn how to properly communicate and write our own stories in a way that can attract wide readership. This is why I decided to participate in the course and I learnt how to write media briefs and can say that this is one of the strongest skillsets that I have.
TCC Africa: This is exciting you have done quite well.
TCC Africa: The nature of your work, unfortunately means that you have continuous access to loss through death. Could you share with us some of the highlights of your career you were involved in, which, unfortunately there was a national loss to the country and how you went about it as well as how you were able to handle it?
Of course, in my daily life as a pathologist, I deal with families who have lost their loved ones. However, there are few instances in my career, where I have participated in massive disasters. The first one was the Garissa University attack where there were 140 fatalities of young people who had suffered horrific injuries and a number of them had undergone quite severe postmortem changes and their identification was quite difficult. At that point what compounded our difficulty was that our disaster victim identification was quite weak and the decisions being made were emanating from security services asking the families to identify their next of kin. As a consequence of that there were missteps in the process and eventually, we had to sit down as a group of pathologists with the security services and fortunately the International Committee of the Red Cross (ICRC) was there to support us and we managed to put up protocols in place.
I have also participated in a few others, fortunately, these are not common events. One that stands out was a callout by the department of defense concerning the death of military servicemen where again we saw quite horrific injuries. What keeps us going in such situations is the knowledge that the work we do, identifying the causes of death, the victims and providing documentation goes a long way into reconciling that individual with the information provided by their next of kin to the point that we can properly close each case and provide information needed for medical legal downstream processes such as prosecutions and so on. Also, if you do the work with a high level of professionalism, this goes a long way to deterring similar events in future.
Though the cases are difficult to handle, I definitely work closely with a psychologist friend of mine, colleague and collaborator who provides us with an informal way of dealing with grief. Overall, what keeps us going is the knowledge that what we do helps keep people safe and we’re happy with that.
TCC Africa: You have done quite a bit in your career from where you started, the milestones you’ve gained and how you’re supporting early career researchers based on the trainings that you’ve taken through us on scholarly and science communication. Thank you so much for your time and we wish you the best.