The anniversary of my 29th birthday in Frankfurt, Germany.
My birthday dessert, Frankfurt, Germany.
In the wake of the September 21st shootings and hostage takings at the Nairobi Westgate Mall I have found it difficult to write about the minutiae of laboratory medicine and the details of running a laboratory in the developing world. Instead, my mind wanders to my own personal experiences in Kenya and Nairobi and the people I have encountered in my travels.
In all my times on the African continent I have only been to Nairobi twice (not counting transiting through the airport, which would take the number up to at least ten). My first time in Nairobi was for one day as I made my way to a six month volunteer position in Tanzania. I landed at the Nairobi airport, an intimidated 25-year-old, all alone. I was scared and nervous but incredibly excited. My memory of the city that time is hazy but I can still smell the distinct scent of the air upon exiting the airplane, and I can still feel the knot of nervous excitement in my stomach.
By my second trip to Nairobi, years later, I was much more accustomed to East Africa. This time I was there with an ASCP colleague and volunteer to conduct laboratory assessments at level I and II labs throughout the city. We spent a week driving all over Nairobi and the surrounding suburbs visiting multiple labs. We saw a lab being run out of a container, and another that was inaccessible by car, it was so tucked away in one of the poorer areas of the city that the road was too narrow for anything but foot traffic. We saw labs in desperate need of basic supplies and electricity. We met lab techs who were working hard to do their best with the few available resources.
As we drove around the city we not only had the opportunity to visit these labs and conduct our assessments but, while mired in the worst traffic jams I have ever experienced, we had time to observe the city. We watched women and men working, shopping, socializing; children playing, and running to and from school. We saw an energetic city with millions of people going about their daily lives. People who I imagine are touched by this tragedy. People I have been thinking about these past couple of weeks.
While my heart breaks for those who suffered and lost loved ones, a tragedy like this reminds me why the work of global outreach is so important. With injuries (both catastrophic and not) the lab is an important part of overall health care. A situation like this reminds us of the importance of having well-run, safe, accurate blood banks to treat the wounded and sick.
I’m sure you’re anxious to hear what happened to my little suitcase packed for two continents and extremes in weather—part of my “Adventures In Travel” as an ASCP Consultant. We left the little rogue somewhere in Amsterdam with several airline baggage officers giving chase in multiple languages. My hotel concierge in Kazakhstan was very sympathetic to my plight, and they sent me in a car to the city’s one shopping mall. Remember it’s about -30 degrees, and so they dropped me off to find what I needed and would pick me up in two hours. I have a very good friend I’ve worked with internationally who would call that “power shopping.” I needed professional clothing and shoes to work in, a few essentials, and definitely a coat, hat and gloves. It should be noted that, with rare exceptions, body sizes differ across the globe….and the language of sizes is a challenge. One kind store clerk kept bringing me black pants to try on that would have fit Twiggy (and if you know who that is, well, you know the root cause of my problem!). Finally in sign language, she convinced me that “these were the biggest sizes she had” and with no other choices available I set my goal for lighter breakfast in the weeks ahead. The coat was another matter. After looking in every store I found the ONLY one in the entire mall that actually fit me, and was warm enough, and was not a men’s musher’s parka. Of course, it was not on the bargain rack, but it was worth every KZT tenge!
My suitcase caught up with me the last two days in northern Kazakhstan just in time to board the plane for our next few days in southern Kazakhstan. One of my travel companions shared a furry lambs’ wool hat with me and I had the rest of my travel wear for the next few days. At the end of our time in Kazakhstan I was headed for Namibia for another week of work in the summer sun with our colleagues there, and en route I had a 2 day layover in Frankfurt, Germany, where I celebrated my birthday! Armed with my coat and hat and gloves and boots on my body, I boarded the plane for Frankfurt. Due to the size of the plane they would not allow me to carry on my little rogue suitcase, but I figured what could possibly happen? We’re not stopping anywhere. I reluctantly gave it to the baggage handler. It made it to Frankfurt according to the computer, but was somewhere inside the Frankfurt air terminal and they “couldn’t exactly locate it just now.” Well … it caught up with me again just as I was leaving the hotel to board the plane to Namibia. By this time I’m having fun with this little game, and happily checked it at the airport wondering where in the world it would travel without me this time! Lo and behold, it didn’t make it to Namibia either … no surprise. It probably missed the last plane from Johannesburg to Windhoek (which I’ve almost done several times myself!) You can imagine that my new coat and hat and boots are a bit overdressed for the Namibia summer climate, so I was glad I had “layered” my working outfit in the bottom of my backpack—and I was good to go, but I had quite a story to share with my ASCP colleagues and Namibia classmates about lost luggage.
My little rogue suitcase finally caught up with me in Ondangwa the next day, so I was now well dressed for the remainder of my trip; I actually had too many clothes, and had to purchase a small duffle to get things home. Oddly enough, that little suitcase made it all the way back to San Diego without incident through intricate travel on the home stretch—I fully expected it to end up in Brazil, but it must have been tired of the game by then!
Lessons learned? 1) Never trust your luggage to make it to your destination—even if it’s your carry-on; 2) Always have one change of clothing with you at all times, even if you have to wear it; and 3) You can actually live and work for three weeks out of a backpack, on two continents and extremes in weather with both professional and casual attire—but you’ll have to trust me on that one!
Next time I’ll share a little about “Adventures in Travel” that involve passports … stay tuned. And, if you are ever in Frankfurt celebrating your birthday, I highly recommend the Marriott Hotel restaurant. They treated me like royalty and were very attentive since I was celebrating all by my self—and served me a very fine birthday dinner with a complimentary glass of champagne! I had a lovely day actually, and if you would like to know how to spend your birthday in Frankfurt, contact me at email@example.com. I’ve got some ideas for you!
Cheers, Beverly Sumwalt
“Adventures in Travel” is one constant you can count on as an international consultant. Some things always work well and some not so well, and I seem to attract all the fun. As promised, in my next few blogs I’d like to share some stories that may help you avoid your own personal “travel adventure”. Or, at least, it will make you smile!
It was January, (translation: Dr. Zhivago weather in Siberia…) and I was challenged with a very complicated schedule for visits to two different countries on two continents for 3 weeks. Just packing for that adventure was not for the faint of heart. My first two weeks were to be on the Siberian border, (yep, in January) followed by a week in sub-Saharan Africa which was summer time for them. I have a history of losing luggage, so wise travel gurus might suggest carry-on. Now, how does one pack carry on for 3 weeks for a business trip in two climates, you might ask? Well I did it, and proudly boarded the plane with a carry-on and briefcase, with a pair of boots and all the sweaters, coats, sandals and light blouses one could possibly cram into them. It was a fait’ accompli to be sure. Smiling at the stewardess, I boarded the plane in San Diego headed for Atlanta where I would catch the international flight. At the cockpit she said, “We’re very full with overhead carry-on for this flight, I will need to take your suitcase here, and you can pick it up on the ramp in Atlanta.I didn’t have a choice, but that was my first mistake.
In Atlanta, I was told my suitcase had been taken to the ticket desk because the plane to Kazakhstan had been cancelled. After much wrangling with the airlines, they told me to “run like the wind”, to another terminal, they would reroute me but I would get there. I told them my suitcase drama and they made a quick phone call and said “we’ll get it on the London flight for you, no worries”. I “ran like the wind” and seriously out of breath, boarded the plane to London just as they closed the gate. My suitcase of course, headed for Amsterdam.
In London, no suitcase, and a 12 hour layover convinced me I should buy a bit of makeup and maybe a sweater. Now you may not know, but Heathrow airport has some of the most expensive shops on the planet next to Paris or Las Vegas, so I opted for makeup and chocolate and headed for the lost luggage counter. The nice man with an oh-so-British accent ASSURED me that my suitcase was logged and tracked in the computer, and would be loaded on my next flights to Kazakhstan—no worries, it would be there with me. I decided at that point there was little I could do to affect the outcome, so I ate the chocolate.
Later…after way too much time in the airport, I boarded the plane and chased the chocolate with red wine, and settled in for a flight nap. Of course, a “flight nap” is different than a regular nap, and requires at least one glass of red wine, half an Ambien, and is only complete if you have a sharp pain in your neck and shoulders and cramps in your legs when you wake up. The pilot announced we were landing and the temperature outside was -30 degrees. That was minus 30. Passengers began to shift and stir and I noticed everyone getting out down coats, scarves and hats, pulling boots out of their carryon, and getting ready to disembark the plane. My coat was stuffed in my rogue bag in the outside pocket, ready for grabbing as needed…so all I had was what I had on—a fleece vest, cargo travel pants, socks (thankfully!) and luckily, a pair of boots that happened to be packed in my over-stuffed computer bag, so I put them on and pretended to be warm.
The plane landed in a field of snow and we climbed down a ramp and walked 200 feet through snow and ice into the terminal. It was 3AM, and the scene was surreal, and my ungloved hands froze to the handle on my computer case. This was a plane change layover—and the terminal wasn’t heated! I opted for coffee this time, burnt my mouth and spilled it all over my shirt while shivering, and stood in a corner out of the icy breeze shifting from one foot to the other in a sort of dance to stay warm. No one was in the lost luggage office at that frozen hour so I watched people, and had an acute attack of coat envy….there were beautiful long down coats, furred collars and hoods, sweeping full length furs with mittens and muffs and hats, and I coveted them all shivering in my corner with hands cupped around a rapidly cooling cup of very bad coffee. When they called to board the final flight to our destination city in northern Kazakhstan, I had expended all my energy shivering and was all too ready for a shower and a shopping trip to buy a coat, hat and gloves!
Next time I’ll finish the story…my rogue suitcase had a mind of its own, and this was just the first 36 hours! In the meantime, if you happen to be in the Almaty, Kazakhstan Airport Terminal, I recommend NOT trying the coffee, go for the hot chocolate instead. And hopefully it won’t be 3AM and minus 30!
And if you want a great coat recommendation, send me a note at firstname.lastname@example.org. I’ve seen them all!
Cheers, Beverly Sumwalt
In the developing world, equipment procurement can be a huge challenge. Funding is usually the initial major road block. In countries where many people live on $2.00 per day, Ministries of Health and local hospitals do not have large budgets to buy necessary laboratory equipment. In such situations, well-meaning donors from developed countries may be inspired to donate their gently used equipment to labs in developing countries.
While this donation is certainly well intentioned, it does not solve the problem. Equipment donations often do not come with assisted installation, a maintenance package or end-user training. While it may be possible to receive technical support from various international companies in some of the larger cities throughout Africa, outside of a major city technical support is difficult to obtain. Therefore, without a clear maintenance package as part of an equipment purchase or donation, the machine may languish uninstalled. The analyzer could also be used for a period of time before an inevitable breakdown renders it inoperative.
Equipment donations often do not come with assisted installation, a maintenance package or end-user training.
The issue of voltage differences between the U.S. and many African countries creates another challenge when it comes to equipment procurement. Equipment that is manufactured for use in the U.S. will not have the correct voltage for use in many African countries. This is certainly a problem when it comes to donations from U.S. labs. When acquiring new items it is crucial that those involved in the procurement process know the voltage needs at the laboratory site.
Once the equipment challenges have been met, the next hurdle is reagent procurement. With both donor-provided machines and those purchased by the local government, MOH, or hospital, funding must remain available for reagents in order for the lab to continue using the machine. I have seen labs with beautiful, well-maintained machines sitting unused because there was no money to purchase new reagents. Without long-term funding for reagents and other supplies, the analyzer itself is ineffectual. No matter if it is the local government, hospital or lab staff, or a donor involved in the procurement of equipment, it is vital that equipment maintenance and reagent supplies be accounted for at all times. A brand new machine can do no good if there is not money to ensure that it keeps working.
Overcoming these challenges is certainly possible, but all players involved in equipment procurement must be conscious of every aspect of the process.
I recently attended the ASCP Annual Meeting in Chicago and was once again energized professionally. As an ASCP Global Outreach Volunteer it was exciting for me to find so much focus on the international work being done. It was a common thread in all the general sessions, including keynote speaker Hillary Clinton, who highlighted the work of the Clinton Foundation and its partnerships in global health. There were presentations on “Pathologists Without Borders,” “Laboratorians Without Borders,” even “Diseases Without Borders.” Well, the diseases were always without borders—but now they have unprecedented transport advantages! The meeting also hosted guests from far-away places such as Lesoto and Viet Nam, who have been working hand in hand with ASCP consultants to build their educational programs and strengthen their lab workforce for a sustainable future.
During the conference my thoughts collided with themselvesas I remember trips to African and East Asian nations, and the experiences of working with colleagues around the globe—truly a bit of “Thoughts Without Borders” for me. The relationships we build are the backbone and platform for global health improvements around the world, and so much can be accomplished with on-site work. Our technology to both perform laboratory analyses and to communicate and store data is so advanced it’s mind-boggling. Yet even with our achievements in this age of “digital everything,” there is still no substitute for a handshake, eye contact, working together face to face, enjoying cultures and language lessons over coffee, and breaking bread while sharing recipes and family stories. THAT is what makes volunteering as a consultant in international health so engaging. I, for one, hope that global health and international outreach will always include professional exchange opportunities for working together in both host countries and in ours!
Next time I’ll get back on track with some travel adventures, as promised. In the meantime, if you happen to be wandering through Chicago, go by the ASCP office and say “Howdy” to the Global Outreach Team whose work and dedication make it possible for me to do what I love and give back to this crazy profession we have chosen. And be sure to get yourself some Chicago style pizza and enjoy a bit of blues while you’re there—two things that are definitely part of our American Culture! If you need a recommendation, send me a note at email@example.com.