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Path of Logic: Durangoan Brings Aid to Uganda

Back in May of 2016, local Durangoan Nichole Baker, a PA in pathology at Mercy Regional Medical Center, found herself in Haiti after responding to a job ad asking for help with setting up a pathology laboratory. She was tasked with installing equipment and instructing Haitian physicians on the preparation of slides and blocks used to inspect tissue and diagnose maladies such as cancer.

“When I got out there, it was just a disaster,” Baker recalls.

Theoretically, the idea was sound. At its core, establishing a remote pathology lab would enable locals to process tissue onsite and then send digitals scans to the U.S. or elsewhere for diagnosis. This would expedite the process, critical to catching disease and cancer in early—more treatable—stages, and provide locals with access to trained pathologists outside of the country.

In practice, however, it wasn’t viable. The physician who had obtained the project grant and coordinated efforts didn’t have a background in pathology and grossly overestimated the available infrastructure in Haiti.

He hired a company in the U.S. “to stock an entire laboratory with equipment that we would use [in the U.S., and they shipped it all to Haiti,” where electricity came from generators that couldn’t sustain steady electricity, Baker said.

“So, all of the equipment shorted out—and it was about 80,000 dollars worth of equipment,” she said. “It wasn’t broken by the time I had left, but within a year I don’t see it lasting.”

Even when the equipment was up and running, the internet connection wasn’t strong enough to send the slide scans abroad, meaning they could process the tissue and prepare it, but no trained pathologists had access to even see and diagnose the tissue.

As if the project wasn’t doomed enough, the day Baker arrived in Haiti the physicians went on strike in response to political turmoil. She considers the project a complete failure.

“When I got home I was really upset, and I felt like I may have done more harm than good because I was teaching dissections and I didn’t feel like they had the proper sterilizing equipment . . . I liked being over their, and the connections and people were amazing, but they just didn’t have the infrastructure for what we were trying to do there,” Baker said.

So she decided that she wouldn’t work for another non-profit that had her trusting the logistics and planning to someone else. If she was going to do it again she’d do it on her terms, and only after properly assessing the situation and gauging viability. She had to start her own non-profit.

The Path of Logic

The Path of Logic

The Wild Women's Project, created by Amanda Goad, brought women together for a weekend retreat at Opus Hut in the summer of 2016. Nichole Baker, founder of Path of Logic, is second from the left in the second row.
photo courtesy Amanda Goad/Bold Brew

Fast forward to the summer after Haiti, when Baker found herself alongside fifteen other women at Opus Hut, high in the mountains between Ophir and Silverton.

It was the inaugural retreat of the Wild Women’s Project, which tasked itself with bringing together influential women in the outdoor industry for a weekend of inspiration and empowerment.

I had the distinct pleasure of interviewing Wild Women’s Project founder Amanda Goad around this time last year when I wrote “Where the Wild Women Are: How a cross-country upheaval started a movement”:

“There were women who worked for Outdoor Industry Association that started a lunch-in at the Summer Outdoor Retailer [trade show] that was about ethnic diversity and social impact in the outdoor industry, how we can have a better hold on that and be better leaders about that. We talked about entrepreneurship and building your business as a woman. Women connected on new conservation ideas and initiatives, and women that didn’t know much about conservation were learning from pros who were conservationists. Women started their own non-profits after the inspiration that they got.”

One such woman, a pathologist in Durango, began a non-profit through her ambassadorship with Yeti Cycles. Using funds she earns by selling her bikes each year and money won at competitions, she travels to Africa for pathology trips to help make an impact there.

That woman was Nichole Baker, whose non-profit, Path of Logic, is now working to establish better pathology protocols in Mbarara, Uganda.

“I had been really excited to start a non-profit, but the idea of it while working full time and being really busy—I was scared that I would take on too much,” Baker said. “At the Wild Women’s Project, you’re just surrounded by these awesome, influential ladies who are all compacting their lives with multiple projects . . . I told these women that I was really excited about starting a nonprofit at some point.”

“I think the encouragement, and then the stories of all the women that were doing extraordinary things, gave me the push to say ‘You know, there’s no right time to start an organization. You just do it and hope that your community can help bolster that process, and if not, you just go slower’,” she said.

The Uganda Connection

After bringing Path of Logic to life, she began her search for opportunities through which she could share her expertise and passion.

“So I started looking for teaching jobs that I could do abroad, and my goal was to search until I could find a place that had the infrastructure to actually implement changes and [that would be] receptive to those changes,” Baker said.

She found an opportunity, through Harvard and Massachusetts General Hospital, teaching gross dissection for the diagnosis of cancer at the Mbarara University of Science & Technology (MUST). After connecting with Doctor Drucilla Roberts, MD, the pathologist who had been seeking assistance, Baker saw incredible potential for Path of Logic to get involved.

“They had had a functional laboratory for over 10 years in Uganda, so I knew that they at least had the infrastructure for a pathology lab to work,” Baker said. “[Dr. Roberts] had pointed out a whole lot of weaknesses in that pathology lab, but they were processing tissue, they were getting diagnoses, it was associated with the medical school and it just felt like a good fit to go and give another place a shot.”

She traveled to Uganda for 27 days this past January 2017, for her teaching job and began assessing their laboratory and needs. Her experience--with the people, the teaching and the lab--confirmed the potential for her to implement real positive change.

Uganda had so much potential, in fact, that Baker has modified her original plan: create a standard curriculum and travel to apply it at a new destination yearly. Instead, Baker projects that she’ll continue working with Uganda for the next five to six years, allowing her to build critical rapport with the locals along the way.

Not only is Uganda well equipped for the kind of change that Baker wants to see, but the country also has a demonstrably profound need. There are only 18 pathologists serving a population of over 37 million, in large part due to a government incentive program that provides about $2,500 in living expense stipends for primary care doctors.

According to Baker, this means that many potential pathologists opt to go into primary care, which Baker criticizes for treating symptoms rather than investigating the root cause of illness, instead of pursuing pathology.

With so few resident pathologists in the country, it’s difficult to get in to see one. Right now, patients go in for a biopsy or surgery and get sent home with their organ tissue, with the responsibility to preserve it themselves until it can go in for dissection and processing by a pathologist.

“They give the patients the tissue, usually in a bag, and the patient goes home and says ‘well, what can I put this in’. Then they go to the pharmacy, maybe, if they have the money, and they buy preservative. Then whenever they make it back to the hospital, which could take a long period of time depending on where they live, they bring this tissue that has been out of the body and without fixative for, sometimes, days.”

The pathologists are only dissecting and processing these tissues once per week, so it could take as much as a week before they realized that the tissue was stored in nothing more than water, rather than the relatively expensive preservative it was supposed to be fixed with.

“By the time it gets to the microscope, [the tissue] is really degraded. When cells become necrotic, or essentially die, because they’re not being fixed properly, something called ghosting happens,” Baker said.

This ghosting prevents the stain, a pigment that allows the pathologist to evaluate the tissue under a microscope, from penetrating the cells, making it difficult to accurately assess the specimen.

The real tragedy is that, in the same hospital where the surgery happens, there is a downstairs lab with formaldehyde powder that could fix the tissue properly. Typically, patients just don’t go down there because they don’t have a proper container to store everything in. Proper fixing requires a 20 to one ratio of fluid to tissue, and that requires a large container.

Even the downstairs lab has its problem, though. Should a patient have a container big enough, the lab doesn’t have the equipment to precisely mix the formaldehyde, and if the ratios are off the tissue risks deteriorating.

The 2018 Solution

The 2018 Solution

Baker, a Yeti Ambassador, has harnessed the biking industry in her efforts to establish better pathology practices abroad.
photo courtesy Nichole Baker

This upcoming January, Baker is traveling to Uganda for three weeks, by herself, with solutions to each of these issues.

“On Baker's January 2018 trip to Mbarara, she's excited to present new, reusable vessels to the laboratory staff. This simple tool has a 100-percent chance of preserving tissue appropriately, says Baker,” according to a press release from Path of Logic. “She'll also bring a hydrometer, to create a reproducible concentration and a proper fixation recipe to make sure formaldehyde measurements are no longer guessed but accurate and consistent.”

If they’re able to preserve the tissue better, the slide quality will improve and provide resident pathologists with better learning opportunities and a greater rate of successful diagnoses, Baker said.

“Beyond the equipment, she'll also provide onsite instruction and training for laboratory staff, students, and the pathology residents.  As well, Baker is bringing over hundreds of solar-powered Luci Lights to distribute to the rural villages, hospitals and schools surrounding Mbarara that don't have electricity,” according to the press release.

As far as helping support more pathologists, she’s arranged to pay for a full year’s living expenses on behalf of three resident pathologists. Path of Logic is contributing roughly $3,000-$3,500 to each resident.

“The doctors that are there right now, they chose to go into pathology knowing that their living expenses would not be covered,” Baker said. “So one of them, the youngest, has a five-hour drive to Kampala, which is the capital, he’ll work the weekend in primary care and then come home.”

Each resident is also part of the MUST medical school, meaning they’re collectively teaching, learning and working other jobs to make ends meet. The Path of Logic donation will allow them to focus their efforts entirely on their studies and practice.

Mountain Biking for Uganda

Mountain Biking for Uganda

Baker will be traveling to Uganda this upcoming January with her hardtail mountain bike to set a bike touring route through the beautiful, mountainous regions around Mbarara.
photo courtesy Nichole Baker

Besides being a PA in pathology and running a fledgling non-profit, Baker is also a Yeti Cycles Ambassador.

“When she's not raising awareness and funds for Path of Logic, or working her full-time job at Mercy Regional Medical Center, Baker is following her other great passion: mountain biking,” according to the press release. “Beyond putting that unforgettable smile on her face, cycling provides a creative fundraising tool for Baker. For instance, she rode this year's Yeti Beti model to fulfill her contract and sold it in October for $5,000. All proceeds went directly to Path of Logic.”

Baker is looking forward to applying that passion in Uganda as well.

“On Baker's January journey, she'll take her beloved carbon hardtail bike to scout a potential adventure fundraising bike tour of Southwest Uganda. She's stripped the bike of any labels and will cover the all-black frame instead with stickers from local businesses and individuals supporting Path of Logic's efforts in Mbarara. This symbolic gesture will remind Baker of the local support following her to Africa in spirit.”

During her first weekend there, this coming January, she’ll be attempting to place a 250-mile bike loop that’ll hit Lake Mburo National Park and Queen Elizabeth National Park, a great destination for seeing African wildlife, before looping back to Mbarara.

She hopes to build relationships with locals along the way, with intentions to guide future bike tours in Uganda to help continue raising funds for her cause and build more tourism interest for the country.

The first guided trip, a trial run of the route she places, could happen as early as May, 2019.

Looking Ahead

Up until now, Baker hasn’t asked for any money to help support her cause. It’s been entirely fueled by her own money and a sing, but substantial, anonymous donation.

This year, she tasked herself with raising $15,000, an amount that has already been surpassed. Now, with more funds than she anticipated and a fundraiser still on the way, she can start to think about expanding her plans in Uganda.

The fundraiser, a silent auction at Ska Brewing World Headquarters on November 17, will feature cycling-centric items from over 25 adventure brands.

With enough funds, she’ll begin working out how to update their collection of textbooks, giving them access to more up-to-date information.

She’s also already considering projects for next year. Currently, the hospital she works with keeps all of its patient records in massive books, which makes it impractical to look up past results and operations, because computers are expensive and prone to theft. Baker hopes to investigate security measures and digitize their records with computers in 2019.

The big, long-term dream is to develop an antibody cocktail to diagnose a lymphoma that’s highly prevalent in children in Uganda. It can be treated relatively easy but is fatal if it goes undetected.

“It might be a goal next year to write a grant and team up with some drug companies to create a cocktail of several different antibodies that be able to rapidly diagnose Burkitt lymphoma,” she said. “If we could do that a very, very large number of pediatric deaths would be reduced.”

Baker would like to invite all of Durango to participate in the November 17 silent auction at Ska, from 6:30 p.m. - 9:30 p.m. All proceeds support the efforts of Path of Logic to improve the diagnoses of treatable cancers in Uganda.

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