While in graduate school, before I knew anything about laboratory medicine or pathology, I served as a translator for a medical team in Haiti. The team traveled from village to village setting up temporary clinics that consisted of little more than several chairs set up for the physicians and patients. A makeshift pharmacy of donated medications – NSAIDs, vitamins, basic broad-coverage antibiotics, mostly – set up in the corner completed the clinic. While translating for patients, hearing their complaints, and hearing the physician attempt a diagnosis based on clinical signs, I was profoundly struck by how the lack of laboratory diagnostics complicated establishing a diagnosis. It was this poignant awareness that led me to the field of laboratory medicine and clinical chemistry.
Laboratory medicine is a vital part of public health. It is important for detection of disease in individuals and populations. Laboratory tests are also important for detection of environmental toxins such as lead. As we laboratory professionals know well, for a lab test to be useful is has to be available and accurate. For most of the United States, this is not a problem. There are 18,000 pathologists in the U.S. – around 5.7 per 100,000 people – plus clinical laboratory scientists such as clinical chemists and microbiologists. There are over 250,000 accredited clinical laboratories.
However, in the developing world, there is a severe shortage of both quality laboratories and laboratory professionals. For example, all sub-Saharan countries, except Botswana and South Africa, have less than one pathologist for every 500,000 people. Haiti, a country of over 1 million, has only 7 pathologists. Diagnostic testing is offered by the occasional network of unregistered laboratories, operating without regulatory oversight. A survey of 954 labs in Kampala, Uganda, revealed 688 unregistered labs completely unknown to the Ministry of Health. Lack of professional direction and oversight might contribute to poor quality tests, misguided use of tests, and faulty interpretation of results. In fact, the WHO estimates 80% of suspected malaria cases are treated without confirmatory test results, in part due to lack of availability and in part due to physician mistrust of inadequate testing.
Because the gap is so big, it’s easy for me to tell you about the differences in access to quality lab testing in the developing world compared to the US. But it would be remiss of me to not mention the public health burden here at home, and how expansion of laboratory programs within our own boarders could help alleviate the problem. For instance, could a lead screening program have caught the lead exposure in Flint, Michigan earlier?
Global health – a healthy global population – needs quality laboratories and dedicated laboratory professionals both at home and abroad. It’s our responsibility to stay abreast of the issues, to stay active in advancing the field, and to educate those in healthcare, public health, and policy formation about what labs can do. This blog will explore applications of laboratory medicine to global health. Stay tuned!
-Sarah Brown, PhD, DABCC, is an Assistant Professor of Pediatrics and Pathology and Immunology at Washington University in St. Louis School of Medicine. She is passionate about bringing the lab out of the basement and into the forefront of global health.