Live from Kyrgyzstan

Greetings from Bishkek, Kyrgyzstan! And Happy St. Patrick’s Day to those of you with Irish heritage and those who just think they’re a bit’o’Irish on this day! I have been in Bishkek, Kyrgyzstan the past week, joining colleagues to work with the Kyrgyzstan laboratories on preanalytical processes and phlebotomy techniques that are so important in patient safety and specimen integrity. Over the two weeks we are here, we are working with more than sixty people and have a very full agenda. I’m scrambling to refresh my Russian/Kyrgyz greetings and phrases, but oddly enough it’s coming back. I doubt I’ll ever master the Cyrillic alphabet, but the accents are growing more familiar.

We began last week with full-on challenges: agenda changes, delayed supplies and the ‘usual’ need to be flexible and unflappable. Our shipped supplies and materials were delayed in customs for two days, so we were “working without a net.” Our team works well together and we have been well received by our Kyrgyz colleagues so that diminishes difficulties. They are a lively and vocal group, giving us lots of opportunity for dialogue which is always a pleasure. We are finding that their knowledge is strong but their experience and skills with the standard equipment used to collect blood is lacking. Some of them have never seen or used devices we take for granted—evacuated disposable tubes and safe, sterile needles are often not available in rural parts of the country—and some of the statistics shared with us by their national infection control director are staggering. Some of the examples shared: uncapped, reused glass tubes for transport of serum to reference lab testing sites; rubber-stoppered pipettes reused after rinsing in water or alcohol; requisitions rolled up and used as “tube stuffers” that served as caps to specimen bottles; confusion on the difference between serum and plasma; single digit numbers written in wax pencil as the second (an in some cases, first) patient identifier. All are challenges they are facing in rural collection sites for lack of resources and training. Fortunately the groups we are working with are in position to change that, and it is energizing to see how much they really want safety and progress for their healthcare workers and patients. As always, I learn much more than I teach…and this week has been no exception. In between training weeks, we spent Saturday with a high level group facilitating and mentoring a country-wide process improvement project, and helping to identify and outline next steps. Working side by side with our CDC partners was an opportunity to learn and hopefully to contribute to the discussions and strategies ahead. This is where change will happen, and it’s exciting to see it up close and personal.

Next time I hope to share some customer service experiences with you, as we gather stories and experiences from our Kyrgyzstani colleagues about how they address and resolve issues at the point of service to patients. If you’d like me to ask our colleagues any questions while I’m here, email me at bsumwalt@pacbell.net . It’s a different world, but in so many ways it’s the same issues we face in our laboratories back home.