Saudi Arabia is one of the quickly developing countries of the Middle East. The last two decades witnessed a remarkable development in the area of health care development. For a population of 18 million, currently there are 50 electron microscopy (EM) units.

I am a Jordanian pathologist (ER) who is working now in Saudi Arabia as part of a study leave from the Jordan University of Science and Technology where I hold an Associate Professor post in the Department of Pathology and Laboratory Medicine. Here in the section of Anatomic Pathology I work with another pathologist (Dr. L Abdullah) and six histotechnologists, one of which is Mr. Hugh Anger a British citizen who is the Senior EM Technologist in our unit. In Saudi Arabia we have the pleasure of working with people from different nationalities and wide range of previous experiences.

At King Khalid National Guard Hospital-Jeddah, we deal with almost the entire range of EM diagnostic services. Using a Zeiss EM 10 model, this includes renal biopsies, tumors, bullous skin diseases, Langerhan cell detection, amyloidosis, virus detection ,and subtyping some of the leukemias, such as M7 megakaryocytic leukemia and hairy cell leukemia. Regarding muscle and nerve biopsies, we send the material to a specialized center for neuromuscular diseases. Currently, our Pathology Department is preparing to provide diagnostic services for a new comprehensive Oncology Center, which will cover the western third of Saudi Arabia. This will definitely increase the volume and variety of work in the unit. Therefore I am interested in developing more knowledge and experience in that field. Only recently I came to know about the Society for Ultrastructural Pathology, thanks to the Internet. On the research side, we are running a study on the use of EM in the early diagnosis of rotavirus gastrointestinal infections compared with microbiological methods. The preliminary results are encouraging. Bilharziasis, malaria and Leishmaniasis are among the diseases commonly seen in this country where EM has participated in understanding the mechanism of the disease and host parasite interactions. These studies were done at various research centers in the kingdom.

Practicing in a country with a relatively high income per capita and where almost all the population are adequately insured medically, getting access to EM diagnostic service is not a problem. However, there are different types of problems. The first one is keeping the above 50 units continuously well maintained when the manufacturer is situated far away. Many hospitals suffer from lapses in maintenance due to the high expense of keeping such contracts especially at the current periods where oil prices are in the low range and that Saudi Arabia depends on oil revenue as its main income. The second problem is to find adequately trained EM technologists who can operate the unit. There is a big deficiency in that skill in Saudi Arabia. Some units stay non-operating for months to years waiting to recruit appropriate staff. The third problem is the lack of local Continuing Medical Education programs in electron microscopic diagnosis. In Saudi Arabia, only very few pathologists are experienced in that field. Therefore, we would like to take the opportunity while writing this article to invite channels of communications with all centers interested in electron microscopy. Similar patterns of practice are observed in surrounding countries such Oman, where Mr Anger previously worked.

ELECTRON MICROSCOPY IN THE GULF STATE OF OMAN
There are three electron microscopes in Oman, all in the University. Two TEMS are in the College of Medicine and one SEM in the Faculty of Earth Sciences in the College of Science. The Sultan Qaboos University was completed in the late 1980s and the original plan was for the first TEM, a JEOL 1200 CX with EDAX, to be used by the university. It was not long before the associated University Hospital asked for the EM staff to help in the area of diagnostics. At this time the EMs were not on service contract and early problems resulted in the JEOL being "down" for some time. As a result, the University Hospital decide to purchase their own EM and a Zeiss 600 was acquired and all machines put on service contracts.

The range of work was quite wide and a service extended to all hospitals in the Capital area. The bulk of work was made up from renal, muscle and skin biopsies. Other samples came from lung, liver, lymph node, tumors and rectal biopsies. Microbiology supplied a regular stream of stool, CSF and vesicular fluids for virus studies. The most samples in a year were 1200. Collaborative work was undertaken with other faculties notably with Fisheries, Plant and Animal Sciences, in the College of Agriculture. There was an on-going teaching awareness program involving medical students, science students and trainee Medical Laboratory Scientists.
Staff levels at the peak were one Chief Technologists, two Senior Technologists, all expatriates, and one Omani trainee who successfully graduated from Glasgow, UK with a B.Sc. in Medical Laboratory Sciences.

Dr. Raweily is Head Section of Anatomic Pathology and Mr. Anger is EM Senior Technologist,
King Khalid National Guard Hospital