Pathology is an often-overlooked but crucial aspect of medicine. It serves as the foundation for accurate diagnosis, disease surveillance, and forensic investigations. Hidden in laboratories away from public view, pathologists serve as medicine’s ultimate detectives, uncovering the microscopic truth of disease, while most patients and the general public alike, remain unaware of their critical contributions.
In this revealing interview with the B&FT’s Ebenezer Chike Adjei Njoku and Nvame’s Makafui Aikins, Prof. Paul Poku Sampene Ossei—a distinguished Forensic Pathologist—pulls back the curtain on a discipline that literally determines life and death outcomes across Ghana’s healthcare system.
Through vivid examples, Prof. Ossei demonstrates how pathology’s unseen hand guides clinical decisions, unveils disease patterns, and delivers justice in forensic investigations.
His personal journey illuminates this profound, yet scarcely understood field.
As the nation faces a growing burden of chronic diseases alongside persistent infectious threats, Prof. Ossei’s candid assessment reveals both troubling gaps in the country’s pathology infrastructure and promising pathways forward.
His insights expose the dangerous consequences of pathology’s underutilisation: misdiagnoses, delayed treatments, miscarriages of justice, and preventable deaths.
Below, we explore how strengthening this foundational medical discipline could transform healthcare outcomes across Ghana, while examining the complex interplay of cultural beliefs, technological advancements, and policy challenges that shape pathology’s future in West Africa.
B&FT, NVAME: As a world-renowned pathologist, how would you define the role of pathology in medicine?
Prof. Ossei: Pathology is the cornerstone of medical diagnosis. It is the study of disease at the cellular, tissue, and organ levels, providing critical insights that guide clinical decision-making. Every definitive diagnosis—whether of cancer, infections, or other conditions—relies on pathological examination. Without pathology, medical treatment would largely be based on assumptions rather than scientific evidence.
Physicians depend on pathologists for accurate laboratory results to confirm or rule out diseases. This includes everything from biopsies for cancer diagnosis to autopsies that determine causes of death. In essence, pathology connects medical science with clinical practice, ensuring that treatment is precise and tailored to the specific needs of patients.
B&FT, NVAME: How does pathology contribute to public health and disease surveillance?
Prof. Ossei: Pathology plays a pivotal role in identifying disease patterns and outbreaks. A notable example is when a so-called ‘mysterious disease’ caused regrettable deaths in a number of students at Kumasi Academy Senior High School in 2014-2015. Upon undertaking autopsies on the bodies, I was able to accurately reveal the cause of deaths to be swine flu. Indeed, these laboratory analyses I undertook provided clear evidence of the disease, allowing health authorities to implement appropriate interventions, thereby saving many of these young lives from similar eventualities.
Similarly, during the COVID-19 pandemic, autopsies I spearheaded provided critical insights. Our findings showed that comorbidities—such as diabetes and hypertension—were the primary drivers of mortality, rather than the virus itself. This was a significant revelation that helped shape Ghana’s public health response and contributed to global medical knowledge.
Beyond pandemics, pathology aids in tracking the prevalence of non-communicable diseases such as cancer. By analysing tissue samples, we can identify trends in cancer cases, which is vital for developing national cancer control programmes.
B&FT, NVAME: Despite its significance, pathology often remains the unsung hero of medicine. Why do you think this is the case?
Prof. Ossei: Pathology is largely diagnostic, meaning that pathologists typically work in laboratories rather than at the patient’s bedside. This makes the discipline less visible to the public compared to frontline healthcare professionals like surgeons and general practitioners.
Additionally, pathology is highly specialised and technical, which can make it difficult for non-medical audiences to appreciate its contributions. Most people only encounter pathology when they undergo medical tests, without fully understanding the complex processes behind those tests.
There is also a general lack of awareness about forensic pathology, which plays a crucial role in criminal investigations and medicolegal cases. In many instances, forensic pathologists provide critical evidence in court proceedings, yet their work is rarely highlighted in public discourse.
B&FT, NVAME: Many people seem to associate pathology exclusively with autopsies and death. Have you experienced misconceptions about your profession?
Prof. Ossei: This is a persistent challenge we face as pathologists. For instance, in my early professional years, word got to my mother that I had chosen to specialise in pathology. Needless to say, she was devastated, for the explanation wrongfully given her was that I had become a doctor who only dealt with dead bodies. And this misconception, I must say, is not limited to the general public alone—even within the medical community, there is a surprising level of miseducation on the role of the pathologist.
When I announced my intention to specialise in pathology during my medical training, my colleagues looked at me with confusion and sometimes pity. Some openly questioned why I would “waste” my medical education on the dead when I could be treating living patients. What they failed to understand is that pathology is fundamentally about life and improving healthcare outcomes.
Even today, at social gatherings, I notice how people’s demeanour changes when they learn I am a pathologist. Many become awkwardly curious, asking if I “enjoy” working with dead bodies—completely missing that over 90 percent of pathology work involves living patients, not the dead.
The truth is that pathology encompasses a vast field that includes histopathology, haematology, chemical pathology, microbiology, immunology, and molecular biology—all critical to diagnosing and treating diseases in living patients. Autopsies constitute only a small portion of pathology practice. Every time a patient undergoes a biopsy, blood test, or other laboratory investigation, they are benefiting from the field of pathology.
This misconception has real consequences for our field. It deters promising medical students from considering pathology as a specialty and contributes to the shortage of pathologists in Ghana. It also diminishes public appreciation for the critical role pathology plays in healthcare delivery. Until we correct this misunderstanding, pathology will continue to be undervalued and under-resourced. This, consequently, negatively impacts the overall health outcomes of our country.
B&FT, NVAME: What other challenges does the field of pathology face in Ghana?
Prof. Ossei: The primary challenges include inadequate funding, limited infrastructure, and a shortage of trained professionals. Many pathology laboratories in Ghana lack modern diagnostic equipment, which affects the speed and accuracy of test results. This can lead to delays in treatment, particularly for conditions like cancer, where early diagnosis is critical.
Moreover, there are too few trained pathologists in the country. Pathology is a demanding field that requires years of specialised training, yet it does not receive as much attention as other medical disciplines. The limited number of professionals means that existing pathologists have a high workload, which can affect efficiency and turnaround times for test results.
In addition, forensic pathology in Ghana faces significant hurdles. Many forensic cases require advanced toxicology and histological analyses, but there are insufficient resources to conduct these tests locally. As a result, samples often have to be sent abroad, delaying investigations and increasing costs.
B&FT, NVAME: There is an increasing prevalence of lifestyle diseases such as hypertension, diabetes, and non-communicable diseases like cancer in Ghana. Do you foresee this trend continuing? Could other health conditions overtake these as the leading concerns?
Prof. Ossei: Indeed, if care is not taken, these conditions will continue on an upward trajectory in the country and the rest of the African continent. A major cause of concern is the public’s misunderstanding of chronic illnesses like diabetes and hypertension. Many people believe these diseases can be permanently cured, rather than managed over a lifetime. This has led to the rise of unregulated remedies promoted across media platforms and even in public spaces. Unfortunately, some of these treatments exacerbate the conditions rather than alleviate them.
Another challenge is cultural perception. Unlike HIV, which has benefited from extensive public education, lifestyle diseases are often misinterpreted. When individuals receive a diabetes or hypertension diagnosis, rather than following medical guidance, they may turn to unscientific explanations and baseless superstitions. Many wrongfully choose to believe that they have been afflicted with a curse rather than seek the truth. They abandon proper medical management for alternative solutions that lack scientific validation.
If this trend continues, we are unlikely to see a reduction in these diseases in the foreseeable future. However, if we can strengthen public education, ensuring that individuals understand the scientific basis of their illnesses and adhere to proper treatment regimens, we may begin to see improvement.
B&FT, NVAME: You have discussed health and disease extensively, but pathology also plays a critical role in forensic investigations. Can you elaborate on its importance in the justice system?
Prof. Ossei: Pathology, particularly forensic pathology, is essential in criminal investigations and legal medicine. As a trained forensic pathologist, my work also focuses on unnatural deaths, including accidents, homicides, drownings, and suicides. The role of forensic pathology is to provide scientific evidence that aids the judiciary in determining the exact cause and manner of death.
Pathologists analyse factors such as the time of death, underlying medical conditions, and external injuries. Through forensic investigations, we can establish whether a death was natural or the result of criminal activity. This discipline is vital for justice, ensuring that deaths are not misclassified and that legal proceedings are informed by scientific findings.
B&FT, NVAME: How well integrated is forensic pathology in Ghana’s justice system?
Prof. Ossei: Regrettably, forensic pathology remains underutilised in our justice system. Unlike in countries with established medical examiner systems, Ghana lacks structured forensic investigations. In many cases, the police will call any available doctor to sign a death certificate without a thorough forensic examination. As a result, critical evidence may be overlooked, and wrongful deaths may go undetected.
Another challenge is the legal profession’s limited understanding of forensic science. When I testify in court, I often find that lawyers lack the necessary knowledge to interrogate forensic evidence effectively. This weakens the investigative process and can allow criminals to evade justice.
If Ghana is to improve its forensic capabilities, we need investment in training and infrastructure. This includes establishing a formal medical examiner system, equipping forensic laboratories, and educating legal professionals on the importance of forensic pathology in criminal investigations.
B&FT, NVAME: Given these challenges, what steps should be taken to strengthen forensic pathology in Ghana?
Prof. Ossei: First of all, we need to formalise forensic pathology as a critical component of the legal and law enforcement framework. This means mandating forensic autopsies in all unnatural deaths and ensuring that qualified forensic pathologists, rather than general practitioners, conduct these examinations.
In second place, public and professional education is crucial. Law enforcement officers, lawyers, and judges must be trained to understand and utilise forensic evidence effectively. Without this knowledge, critical cases may be mishandled, leading to miscarriages of justice.
Finally, investment in forensic laboratories and technology is essential. Advanced techniques such as toxicology screening, DNA analysis, and histopathological examinations can significantly enhance our ability to determine causes of death with precision.
If these measures are implemented, forensic pathology can become a powerful tool in Ghana’s justice system, ensuring that cases are properly investigated and that scientific evidence informs judicial outcomes.
B&FT, NVAME: How do you foresee Artificial Intelligence (AI) shaping the future of pathology?
Prof. Ossei: AI has arrived at the right time to revolutionise pathology. Even before AI, the field was evolving through multi-headed microscopy, where multiple pathologists could examine a single tissue sample simultaneously to ensure quality assurance. The introduction of AI enhances this process further. Now, a digital slide can be screened and shared globally, enabling real-time collaboration among pathologists, regardless of their physical location.
AI significantly improves diagnostic accuracy and efficiency. High-quality pathology specialists can review cases remotely, contributing their expertise to ensure precise diagnoses. Essentially, AI is transforming traditional microscopy into a digital format, making pathology more accessible and reliable.
However, AI has its limitations. Tasks such as tissue sampling, preserving specimens in formalin, and certain pathological assessments require human expertise. While AI is instrumental in refining diagnostics, human involvement remains crucial in sample collection and preservation. By integrating AI into pathology, we enhance the quality and efficiency of diagnoses while maintaining the irreplaceable role of human expertise in critical areas of the discipline.
B&FT, NVAME: Could you share an example of how research in pathology has directly influenced healthcare in Ghana?
Prof. Ossei: A personal experience highlights the importance of pathology research. My own son tragically passed away from an unknown disease. Seeking answers, I obtained consent from my wife to conduct an autopsy on the body. This led to the identification of a condition affecting infants, an invaluable scientific finding which was subsequently published in a reputable medical journal.
Following this discovery, my hospital adopted new measures to mitigate similar cases, ultimately saving many lives. This example underscores the need for evidence-based medical interventions. If similar research had been conducted earlier, we could have prevented many avoidable deaths—my son’s included.
In many African settings, stillbirths are often buried without an investigation into their cause of deaths. If we took the time to study these cases, as I did with my son, we could uncover patterns and implement preventive strategies. Implementing findings from pathology research can significantly improve healthcare, just as it has in developed countries where life expectancy has increased due to science-driven medical advancements.
B&FT, NVAME: What policy recommendations would you suggest to strengthen pathology education, research, and practice in Ghana?
Prof. Ossei: Strengthening pathology education and research requires deliberate policy interventions. First, pathology and laboratory medicine must be actively promoted. Young doctors should be encouraged to specialise in pathology to address the shortage of experts in the field. Increasing awareness about the critical role of pathology in medical diagnostics is essential.
Furthermore, the general public and medical professionals must understand that pathology provides the definitive diagnosis for most medical conditions. Recognising pathology as the gold standard in medical investigations would drive demand for specialised expertise and investment in the field.
Continuous professional development (CPD) should also be prioritised. Organising congresses, conferences, and seminars will facilitate knowledge exchange and research collaborations. The integration of research findings into practice is vital for addressing health conditions unique to Africa, such as malaria and Buruli ulcer. Encouraging and funding research focused on these conditions will lead to tailored medical solutions for the region.
Collaboration with international stakeholders is another key policy area. Engaging with developed nations and institutions for knowledge transfer and joint research initiatives will enhance Ghana’s pathology capacity. Leveraging expertise from established research institutions will enable the country to implement best practices and improve healthcare outcomes—and consequently attain our long-desired goal of providing universal health coverage (UHC) for each and every Ghanaian.
B&FT, NVAME: Similarly, what steps should be taken to enhance the role of pathology in Ghana’s healthcare system?
Prof. Ossei: There are three key areas where improvement is needed: investment, training, and awareness.
At the fundamental level, the government and private sector must allocate more resources to pathology services. This includes upgrading laboratory equipment, improving infrastructure, and ensuring that pathology units in hospitals are well-equipped to handle a growing number of cases.
More medical students should be encouraged to specialise in pathology. Offering scholarships, mentorship programmes, and incentives can help attract young doctors to the field. Additionally, local training programmes should be strengthened to reduce dependence on foreign institutions for advanced pathology education.
These must be complemented by raising public awareness. Educating both healthcare professionals and the general public about the importance of pathology is crucial. This can be done through medical conferences, public lectures, and media engagements that highlight the field’s contributions to healthcare.
Furthermore, integrating pathology into national healthcare policies will ensure that disease diagnosis and surveillance receive the attention they deserve. This will ultimately lead to improved health outcomes and a more efficient healthcare system.
B&FT, NVAME: What final thoughts would you like to share regarding the future of pathology in Ghana?
Prof. Ossei: Pathology is at the heart of medical diagnostics, and its development is crucial to the advancement of Ghana’s healthcare system. We must actively promote the discipline, invest in research, and ensure the continuous training of pathologists. Policymakers must prioritise laboratory medicine as a fundamental component of healthcare and encourage interdisciplinary collaborations.
There is also the need for a structured approach to integrating AI into pathology, ensuring that while technology enhances efficiency, human expertise remains central to the process. By fostering a culture of research and embracing technological advancements, we can build a more robust healthcare system that adequately addresses the needs of our population.
The future of pathology in Ghana is promising, but it requires commitment from stakeholders at all levels. With the right policies, investments, and collaborations, pathology will continue to play a vital role in improving health outcomes, saving lives, and as noted, contributing to the nation’s attainment of universal health coverage (UHC).
