Background: The practice of pathology in the developing world presents challenges in terms of limited resources, shortages of trained personnel, and lack of continuing education programs. Telepathology holds promise as a means of diagnostic and educational support.Methods: We donated multiheaded teaching microscopes equipped with digital cameras to four hospitals in Eastern Africa and trained local pathologists on their use. Static images of challenging cases were posted on a web-based telepathology platform. A U.S.-based pathologist reviewed images in consultation with subspecialist colleagues.Results: Over a period of 40 months, 109 cases were submitted for second opinion consultation, including 29 dermatopathology cases (26.6%), 14 hematopathology cases (12.8%), and 13 cases each (11.9%) in cytopathology and bone and soft tissue pathology. Static images enabled a complete or partial diagnosis in 100/109 cases (91.7%). Factors precluding a definitive diagnosis included absence of confirmatory immunophenotyping, technical issues, or lack of clinical history. Case responses included a diagnosis and discussion, including differential diagnosis, references, and treatment recommendations.Conclusion: Static digital telepathology is a simple, cost-effective, reliable and efficient means to provide diagnostic and educational support to pathologists in the developing world. Additional training may help overcome technical factors precluding a definitive diagnosis in certain cases.