In July 2012 I traveled to Dushanbe, Tajikistan as part of a team that conducted initial site visits and needs assessments at laboratories around the country. Clearly it has been a couple of years since that visit and I must admit that I haven’t done a good job at keeping up on any developments. I am sure there is much we did not see, and did not learn and various items that were lost in translation, and I realize that one visit does not an expert make. All that being said, however, I wanted to share my impressions from that visit, as I was surprised by the differences between the challenges laboratory services face in Tajikistan (and reportedly much of the Central Asia region) and those faced in many countries in Africa. In many African countries, challenges related to laboratory services and infrastructure can be linked to lack of resources, materials, testing supplies, supply chain issues and difficulty for rural patients to access the laboratory.
In Tajikistan, at the time of our visit, there was a severe lack of reagents needed to continue running multiple tests. This was due to a delay in receiving a specific international source of funding dedicated to purchasing these reagents. In general, however, the laboratories we visited appeared to be better supplied and stocked than many I have seen in various African countries.
To me, the most striking observation was how the structure of the laboratory system made it difficult for patients to obtain the appropriate testing and care. There was one lab for TB tests, and one lab for routine CBC’s, and another one for HIV tests, etc. Some of this separation was due to different sources of funding for the labs, which restricted those funds to be used only for specific tests (an issue for sure, but one related more to international aid and funding than the Tajik structure). Another explanation we received was that some of the separation was due to bygone practices from the communist era government where many services were very siloed. No matter the explanation, however, it could be challenging; a patient who needed multiple tests had to traipse around to numerous locations in order to have samples taken for each test.
Imagine what that would be like as a patient. Would you follow through on doctor’s orders if it was going to take all day and multiple stops? I’d like to think I would, but perhaps not if it was too much of a challenge.
-Marie Levy spent over five years working at American Society for Clinical Pathology in the Global Outreach department.