Dr. Daisy Alapat became the director of HVO’s hematology project in Dar es Salaam, Tanzania in early 2025. She had already volunteered for several years with the project in Peru, which she found profoundly rewarding. “I am currently a professor at the University of Arkansas, and I always enjoy teaching, especially those who are really eager to learn,” she shared. “I enjoy teaching people. In the U.S., you have a lot of facilities, resources, and opportunities to perform testing. But there are areas in the world that have limited resources and have to make decisions on diagnoses under those limited scenarios. Personally, I enjoy creating policies based on limited resources so that laboratories and hospitals can eliminate unnecessary waste. With my expertise, I can help people functioning with limited resources.”
After several years of volunteering both in-person and virtually with the Peru project, Dr. Alapat met Dr. Jared Block, HVO volunteer and former project director in Tanzania, at the American Society of Hematology annual meeting. Their conversation led Dr. Alapat to visit Muhimbili National Hospital, where she was impressed with the enthusiasm of the students and excited by what she felt she could contribute. When Dr. Block stepped down as project director, Dr. Alapat took on the role. While she is still in contact with her colleagues in Peru for case consultations, her main focus has shifted to her work in Tanzania.
“All the students in Tanzania, they are eager to learn,” said Dr. Alapat. “While I was in Tanzania, I could help them improve their skills with bone marrow biopsy with aspiration, training them to make aspirate smears and staining the smears, evaluation of CBC with peripheral blood smear review, and flow cytometry.” To maintain skills, she believes it is important that students have a lecture or other type of teaching at least once a month: “They have complicated and difficult cases, so to keep up with knowledge, it is important to be constantly in touch and to get to know the students. We decided to set up monthly lectures and case conferences where we discuss difficulty and the accuracy of diagnosis and the treatment approach. Additionally, I can learn from their case conferences and presentations.”
These monthly lectures and case conferences have been running since April. Dr. Alapat has recruited colleagues to help teach areas in which students are in need of guidance, such as molecular pathology, transfusion medicine, patient management, and hematopathology. She has also been working to connect students with mentors to help with individual research projects they are required to complete with the goal of publishing and sharing knowledge.
Recently, Dr. Alapat gave a lecture on myelodysplasia (MDS) – a disorder that causes abnormal production of blood cells in the bone marrow. “Diagnosing myelodysplasia is not that easy,” said Dr. Alapat. “Here, in the U.S., we do a lot of different ancillary testing to finalize the diagnosis. But in Tanzania, since their resources are limited, I try to teach them when to suspect MDS in a patient based on clinical symptoms. What are the CBC parameters that need to be evaluated that would lead the clinician to suspect MDS? What are the morphological features in peripheral blood and bone marrow aspirate smears that could trigger the differential diagnosis of MDS? What is the minimum one might see in a bone marrow biopsy that would make one think of MDS? A provider must also know how to rule out other disorders with similar features. I lectured on how to approach a patient when you suspect MDS based on the clinical picture.”
Tanzania has the fifth highest rate of sickle cell disease in the world, and many of these patients have an enlarged spleen- splenomegaly- with cytopenia. It is important that students receive training on this topic because splenomegaly could be a clinical feature of MDS or other hematological malignancies including lymphoma. “One interesting thing I noticed,” said Dr. Alapat, “is that almost every day while I was on site, at least one of the patients we discussed had splenomegaly. Since it is complicated and difficult to do a biopsy on a spleen, we have to use other testing modalities, such as bone marrow biopsies, to diagnose the cause of splenomegaly. A big spleen could be due to sickle cell disease, but it can also be due to lots of other diseases, including other easily treatable hematopoietic neoplasms. Diagnosing and treating quickly can make a patient’s life better. Currently, they do have trouble diagnosing causes of splenomegaly using a bone marrow biopsy. Some patients may have other hematopoietic neoplasms such as lymphoma or myeloproliferative neoplasms.” Dr. Alapat’s lectures inspired one of her students to focus his required research project on how to approach and diagnose a patient with splenomegaly. Dr. Alapat is now mentoring him and helping him apply for funding.
Thanks to volunteer lectures and consultations, Dr. Alapat feels that staff and students now have a better understanding of key topics, including bone marrow biopsies and staining of bone marrow aspirates. “They told me they’ve improved a lot,” she said. “And they are now better at recognizing cell morphology and making more correct diagnoses. They were having a tough time differentiating between lymphocytes and nuclear red blood cells. They can look similar. But since we started the case conferences and lectures with interactive questions, they are doing much better. This means they will have more accurate diagnoses for patients. Knowing the difference leads to the right diagnosis and the appropriate treatment.” Dr. Alapat believes in interacting with students rather than only lecturing, and she has seen students respond positively and noticeably improve their skills.
The case consultations can also save lives. During one session, Tanzanian colleagues asked to consult on a patient for whom they had recently done a bone marrow biopsy that seemed to show hypoplasia. However, they had taken the biopsy from the wrong location: “In this case, they had done the biopsy in the wrong place, and it only looked like bone marrow hypoplasia. They had the wrong picture, and the wrong picture gives you the wrong diagnosis. I told them how to redo it in the right place, and I brought in another volunteer to help teach how to treat the patient.” While Dr. Alapat does not have an update on the outcome for this patient, we know that he and future patients will receive a more accurate diagnosis thanks to her teaching.
Looking forward, Dr. Alapat hopes to recruit more volunteers with expertise in molecular pathology, patient management, transfusion medicine, nursing, and lab technology. Meanwhile, she won’t stop teaching: “I love teaching people who want to listen. This is very fulfilling for me. They make small achievements feel big. I’m still in contact with the Peruvians as well. Whenever they have complicated cases, their pathologist calls me and asks for my opinion. When I am teaching, and I see them listening and making better judgements because of it, that is very satisfying. My father was a teacher all his life. He enjoyed teaching, and I was brought up that way. In my family, we have so many teachers. That’s in our blood.
This life is about paying it forward. You give it, you get it back. Whether you like it or not. Knowledge is not like money where you give it, and it goes away. Knowledge is such that you give it, and it multiplies. You give a lecture, and students ask interesting questions. It makes you think, makes you go back and read more. It gives you mental growth. Knowledge multiplies whenever you give it away.”
If you are interested in learning more about opportunities with our hematology program, contact Program Manager Lauren Franklin.