At present, there are only two hospitals with an operating electron microscope facility, both based in MetroManila, and only two pathologists-electron microscopists for this country of 70 million Filipinos spread over 7,l00 islands. Both were set up in the mid-1990s. Prior to this, there was an EM facility at a local government veterans' hospital, but for the past several years this has not been operational.

When St. Luke's Medical Center decided to get an electron microscope, there was no local facility where I could obtain training. The hospital had to send me to the United States where I trained under Dr. Elizabeth Hammond and Dr. Robert Erlandson.

Being one of only two EM facilities in the country, in the three years since I returned from training in the United States, I have seen a considerable variety of cases many of which I had not encounter during my fellowship. Many of the cases are the usual renal biopsies, cardiomyopathies, Langerhans' cases and various tumors. But, in addition, I have had interesting referrals involving bullous skin diseases, neuromuscular biopsies, requests for virus identification, and confirmation of hairy cell leukemias, most of which I had not encountered during my training.

Practicing in a third world country has special problems. Local pathologists are not yet in the habit of setting aside tissue in glutaraldehyde for EM studies of potentially difficult cases. Outside tumor referrals are usually formalin-fixed or paraffin blocks. This type of material gives poor results as formalin is not buffered in some local hospitals and may even be recycled. I may have to look at several sections to see a single reasonably preserved cell!

We get two to three referrals a week. A limiting factor is the expense of the procedure. The reagents cost more in the Philippines, since we have to import them from the United States. We have tried to keep the cost down to less than the equivalent of US$l50. The majority of the population, however, does not have health insurance and with the daily minimum wage of about US$5, only middle and upper class Filipinos can afford the procedure. The recent Asian economic crisis has pushed operating costs even higher.

Despite the problems of doing EM work in a third world country, as one of only two pathologists doing electron microscopy work here, there is the satisfaction of knowing you are providing an invaluable service in the Philippine medical field.