The Pathology Network: Improving Access to Healthcare Through Digital Pathology

Interview with Dr Joshua Kibera, CEO and co-founder of The Pathology Network (TPN).

Who is The Pathology Network (TPN)?

TPN is a Kenyan registered company that brings together pathologists into a working group and uses a membership-like business model to recruit hospitals that need pathology services - which is basically all hospitals. The pathology network recruits hospitals into its network as members, and uses a very unique business system to allow these hospitals to access our network of pathologists.

TPN Interview

The field of pathology is confusing to many, with some associating it only with autopsies. Can you help us demystify the field of pathology?

Pathology is a branch in medical practice, just like surgery, gynaecology, or paediatrics. It is specific to the identification of disease in the living and in the dead. In the dead, forensic pathology focuses on the identification of disease that caused death - the cause of death is a disease process, and sometimes it's trauma or something else. But a lot of pathology, actually, focuses on the identification of disease in the living.

“Pathology is a branch in medical practice, just like surgery, gynaecology, or pediatrics… [that] is specific to the identification of disease.”

There are pathologists who look at diseases of the blood (hematopathologists), those who look at chemical changes in the blood (clinical pathologists), and there are pathologists like me who look at tissue pathology, which includes solid diseases like cancers and tumors, growths, etc. (anatomical pathologists). These are all different branches of pathology, and each of them is a specialization on its own. It usually takes four or five years after graduating as a doctor to specialize in any one of them.

Does TPN focus on any particular one of these branches, or does it cover the whole spectrum?

I started TPN to basically address the challenges that we faced in our branch of  pathology, anatomical pathology. A tumor is any growth in the body and it can be cancerous or non-cancerous. You can have something like tuberculosis that can cause a growth, or find that some fat accumulation in the body looks like a growth, which oftentimes can be worrisome. So how do you differentiate that from cancer? I think those of us who practice anatomical pathology are less than 100 in Kenya. How do you distribute all the work across the country equally among these 100 people? This is the problem we were trying to address, and so we brought some of these pathologists on board into TPN so that we could distribute the work within the community in the network (our members). We then realized that the network that we've created can be used to solve the problems other branches of pathology face but, at the moment, we haven't optimized it for those branches yet. We wanted to make it work for anatomical pathology first.

“We are opting to look at quality first before looking at scale.”

What would it take to optimize TPN for other types of pathology?

It will take quite a bit of funding. Pathology is a very scientific discipline which needs vigorous testing, sometimes expensive equipment, and time to test systems to make sure that we are providing results of adequate quality. It's not something that you can move quickly into without first having identified the right people who have the right skills, and systems to make sure that they will deliver appropriate quality at scale. You also have to ensure that there is a mechanism for detecting when this quality begins to fall below standards so that you maintain those adequate standards. If we say that somebody has cancer, and they don't have it, that would be a very big blow to The Pathology Network. These are some of the reasons why we are opting to look at quality first before looking at scale.

What is the role of pathology generally in healthcare?

Pathology is the foundation of healthcare. Pathology is like your Excel program in  finance - it helps you to make sense of the numbers that you're seeing. We're the ones who work in the background to make sure all those calculations are correct. If it was in the automotive industry, pathology would be the engine. It's hidden away in a compartment but is the thing that is able to help the car move. 

In the medical profession, nothing can happen without a lab diagnosis. Without a properly functioning lab in the background there is no way of practicing good medicine, because you won't know what you're treating. Without pathology, a doctor can't make sense of what the patient is suffering from.

“Pathology is the foundation of healthcare… Without a properly functioning lab in the background there is no way of practicing good medicine, because you won't know what you're treating.”

What challenges in pathology is TPN trying to address, and how severe are they?

The unavailability of a pathologist delays access to treatment. Where it used to take a month to process a sample and deliver results, TPN has reduced that to 7 days (a 75% reduction in turnaround time). This then allows for discussions on treatment between patients and doctors to begin. Delays in diagnosis are very costly for patients. By the time a biopsy is collected, the patient was already unwell. As the patient is waiting for results, the tumor continues to grow. Delay in treatment increases the burden of cancer and death due to late treatment. It also makes treatment more expensive. 

Why is digital pathology important? Who is likely going to benefit the most from this solution? What outcome do you want to achieve with this solution?

In the ‘80s and ‘90s, Kenya trained very few pathologists and the practice did not develop at par with other medical disciplines. As a result, there is currently a shortage of pathologists. Digital pathology addresses this problem. Through our system, 30 full-time pathologists could serve the whole of East Africa. Digital pathology allows for pathology to be practiced remotely while removing the need for a microscope. In some countries like the US and in Europe, digital pathology has been exclusively practiced for the last three years. 

What are some of the successes you have had so far in addressing these challenges?

We identified the obstacles on the path to diagnosis and built software that links hospitals, labs, and pathologists in response. We convert a tissue into a report that is delivered to the doctor and the patient. This is achieved through a lean workflow process and a monitoring system that can accommodate large volumes of work but still maintain good quality and short turnaround times. We are currently serving 20 facilities at 500 tests per month, but we have the capacity to absorb much more work and we can analyse pap smears and complex samples like brain tumours.

Are there any key partners that have supported the delivery of this solution?

Joining the Villgro Africa incubation program gave us a huge boost in self confidence; it said that someone believed in us. Then there was the funding,  which didn’t come with noise. There was no dictation of terms to us but we got asked a lot of critical questions that helped us to think through our work. We also got sales training and investment readiness support including financial modelling. All this has brought us closer to maturity. 

Are there any challenges that you have encountered in your service delivery?

Getting the business model right was tough, especially as pioneers. Keeping the company running as we iterated and pivoted was also not easy. Creating the structures for rapid scaling has been challenging (i.e. building the software systems and finding the right talent). Also, hardware is quite expensive. For instance, a scanner costs $80,000 a piece, and many investors don’t understand the space, which has made fundraising difficult.

Who are the main competitors in your space?

Any lab out there is an indirect competitor, but it could also be a partner.

What do you hope to achieve in the next 5 years?

We would like to be in 11 countries in 5 years. In 10 years, we hope to be so entrenched in the market that we become like Google in our space.

Could you share some key learnings that you have picked up in your entrepreneurial journey and what advice would you give to a fellow entrepreneur in the healthcare sector?

Entrepreneurship is not for the fainthearted. Struggles will come. There was a moment I almost closed the company and returned to employment. As an entrepreneur, you will face that pivotal moment when you will have to decide to quit or stay the course. I had to decide that I will do this until it works. 

Make sure you’re solving a real problem. Stay hungry to learn more. Walk with the right people. Finding the right co-founders and staff is striking gold because you can’t go it alone. Don’t be selfish with equity and power. Develop yourself. Go for entrepreneurship training. I attended an excellent entrepreneurship course by WYLDE that really enlightened me.  Read books. Built to Last is a must read. I’ve also attended excellent entrepreneurship courses from the “university” of Youtube. There is so much good content  you can find there. I’ve enjoyed listening to the likes of Eric Saintz and Reid Hoffman. There is no formula for success, there are only principles. 

“Entrepreneurship is not for the fainthearted. Struggles will come… Make sure you’re solving a real problem. Stay hungry to learn more. Walk with the right people… Develop yourself.”