The Case of the Rogue Suitcase

“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 bsumwalt@pacbell.net. I’ve seen them all!

Cheers, Beverly Sumwalt

Equipment Procurement in Resource Limited Settings

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.

-Marie Levy

Thoughts Without Borders

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 bsumwalt@pacbell.net.

-Beverly Sumwalt

Passions and Pitfalls as an International Consultant, Part II: What Works and What Doesn’t

 

As I reflect on the huge impact 9-11 had on our country, one of the things that speak of who we are as a nation is the concept of Global Health. Even in the strife of conflict, there is never compromise when it comes to humanitarian assistance, and work continues toward peaceful ways to make the world a better place. Once again I am reminded that strengthening and building laboratory capacity around the globe is making a major contribution to the healthcare of nations around the world.

There are passions and pitfalls to consulting in healthcare internationally. Some tactics work well, some don’t—and I have a few short personal examples to share. What typically “doesn’t work” are the smooth and precise operational processes we tend to be familiar with in our lives and laboratories.

“The best laid plans of mice and men do often go astray” and indeed, that happens each and every project I am privileged to participate in. Expecting things to change is the norm, and no matter how carefully planned, the trip never goes as planned!

Each project has it’s “pitfalls”—and they are sometimes concerning, often funny, and always require a huge amount of “go with the flow flexibility.”On one trip we were scheduled to assess seven laboratories scattered throughout a very large geographic area. The hours and hours of driving took so much time, performing thorough assessments was quite a challenge. Providing the very best feedback possible was difficult to accomplish and there were several sleepless nights working over reports and comparing notes. That meant nodding off in a very hot car….and missing the warthogs!! On another trip we were scheduled to assess and offer accreditation feedback to a comprehensive specialty laboratory. It fell to us to spend several days in their new and very modern facility and walk through their processes. As the week progressed we found our assessment team was “in the middle” of a conflict in the stakeholders’ goals and our closing sessions with the laboratory leadership took a fair amount of diplomatic energy to stay focused on the laboratory assessment findings. In this case, experience in cultural differences, being able to read the nuances of unspoken sensitivities, and even the ability to maintain meeting and agenda control were essential skills. If this one had been my “first rodeo” it would have been a disaster!

But what about those things that go as planned? In my experience one thing that always goes well is the receptivity. I have worked on first time visits to new countries and also in the same country multiple times. Without exception I have been welcomed by laboratory and health professionals who are anxious to share information and exchange operational methods and expertise. In all cases they are proud of their laboratories, and eager to show what they do and how they do it. One of the “passions” and something that works very well are the connections with people. We all live, love, want the best for our families, and want meaningful and purposeful work to do in the world. The relationships I have developed over the years are priceless. On one trip my ASCP teammate and I were invited to the rural home of our in-country colleague, and the elder of the family presented us with a parting gift—a chicken! It is traditional to honor guests who are traveling with something to eat along the way so they don’t suffer hunger on their journey….and after a lengthy explanation about why the airlines wouldn’t allow us to take our chicken home, we asked if our host might keep her for us so she could raise many chicks and honor many other guests in the future.That seemed an acceptable compromise, so we named our chicken “Elao” which is the native word for “Lucky”. Poetic irony, but we hope Elao went on to make a bit of history.

Every trip has moments that work well and some not so well, but one constant is “adventures in travel.” Next time I’ll share some stories about my challenges with luggage…and some crazy adventures in strange airports. By the way, if you are ever in Ondangwa, Namibia please order something other than chicken—and if you see Elao the Famous Chicken running around, be sure to contact me at bsumwalt@pacbell.net!!

-Beverly Sumwalt

 

Passions and Pitfalls as an International Consultant, Part 1: What We Do and How We Do It

According to the dictionary and the ever-popular Wikipedia, the definition of a consultant is “a person who provides expert advice professionally.” These same sources define “international health” as “an area for study, research and practice that places a priority on improving health and achieving equity in health for all people worldwide. Global health focuses on determinants and distribution of health in international contexts from several perspectives including: the pathology of diseases and promotes prevention, diagnosis, and treatment…”

Describing my “avatar life” as an international global health laboratory consultant is both a lofty definition and a mouthful. When people ask what we do as consultants, it’s easy to say “we provide expertise, training and mentoring in laboratory operations, to help strengthen them in process improvements so countries can grow in their capacity to provide the quality of laboratory services needed to diagnose, treat and prevent diseases in their countries.”  What exactly does that all mean?

When a country invites a consulting team to work with them, the first steps are to identify what their particular needs are in their laboratory system. Sometimes it’s developing a classroom curriculum that helps prepare students for laboratory and pathology careers. Often it is preanalytical training so specimen integrity, supply chain, and transportation issues do not compromise results. Other times it is analytical process mapping to identify areas for operational improvements and use limited resources in the most effective ways. And in many cases, it’s helping a lab comply with accreditation requirements. This entails assessing, advising, coaching and mentoring in the areas of procedures and quality metrics.

When a country invites a consulting team to work with them, the first steps are to identify what their particular needs are in their laboratory system.

An in-country consulting project usually has multiple phases. Once a country decides their course of action and focus, a series of visits are arranged to meet the goals set by the country’s leaders and the CDC in their region. That coordination of effort helps maintain focus and leadership so the time and resources are used most efficiently. Consulting teams are then set up depending on the expertise needed, previous experience and familiarity with the country, availability, and other considerations unique to the project. When a team is assembled they work together on logistics, content, accumulating materials needed for the project, and coordinating their efforts. When the project finishes, the team continues to collaborate on follow up, reports, lessons learned, next steps, and sustainability issues. It’s all very fun and exciting. It’s also all hard work as my fellow consultants and ASCP staff teammates can attest to! And that same cycle is being done in multiple countries, multiple phases, and multiple times during the year. Shifting gears quickly and maintaining flexibility are key capabilities you must be able to pull out of your bag of resume tricks or you won’t survive to tell the story!

That is a summary of what we do and how we do it, but that’s just the standard operating procedure. The real purpose is the passion and dedication to improving the health and laboratory conditions alongside our international colleagues and partners. And the outcome? Evidence based results are proving each step makes a difference, and we are seeing growth and change each trip, each project, each step of the journey. Come to the ASCP Annual Meeting and see the progress being made and how the Global Outreach teams are working together!

Next time let’s talk about some of the “pros and cons” of what works…and what sometimes doesn’t. And if you are ever in Kazakhstan, be sure to order beshbarmak…which means “five fingers” because you eat it with your hands. The traditional dish is made of wonderful thick boiled noodles in an onion broth and chunks of a variety of boiled meat…goat, mutton, beef and yes, horse. And if you’re there in the spring, wash it down with the traditional drink of fermented mare’s milk.I don’t have a recipe…but I do have a wonderful friend there who will take you out for an authentic Kazakhstani meal! Contact me at bsumwalt@pacbell.net.

-Beverly Sumwalt

A Brief History of Global Health—“Rats, Lice and History” in Action!

Wandering the planet in search of diseases to cure is not a new concept. Global Health certainly is a focus for the 21st Century, whether or not you are a movie star, a superhero, or Bill Gates! Most of us remember anecdotal history stories about “Dr. Livingstone, I presume.” Dr. Livingstone bush-whacked his way through Africa and encountered several tropical diseases as well as what we now know as malaria. With the onset of internet, frequent travel, and advanced international public health issues we find global health to be a connecting factor affecting the well-being and progress of all nations today. Volunteering in this area is a major way to help meet the increasing demands for worldwide health improvement.

So how did we get here? About 25 years ago, Rotary International began what is now a worldwide crusade to eradicate polio from the globe. The World Health Organization outlined the program and partnered with Rotary to provide the volunteer man/woman-power. “Polio Plus” took its place among the most effective international health campaigns of our time. With the help of other foundations and contributions (Gates Foundation matching grants, for example) we are close to ending this devastating disease. This campaign paved the path to the Global Health Initiative of2009, establishing the President’s Emergency Plan for Aids Relief. Commonly known as “PEPFAR”, this funding is dedicated to the global focus on HIV/AIDS treatment and prevention. PEPFAR funding oversight has been the responsibility of several governmental organizations including the CDC, and they partner with non-governmental and professional organizations to implement global health initiatives. This of course is a very high level summary; it should be noted that several other public and private international health funding streams exist in addition to PEPFAR.

Along with several other laboratory professional partnering organizations, ASCP has been working with the CDC for many years on improving and strengthening laboratory capacity in many PEPFAR funded countries around the globe. Projects include phlebotomy training, quality management, operational expertise, curriculum development for university training programs, and just about everything in between. One of the best ways to connect and build rapport with our international colleagues is by comparing and contrasting standard operating procedures, supply chain processes, teaching and training methods, and process improvement projects. I have had the good fortune to participate in all of these laboratory improvement initiatives. I learn something new every time I participate.

Laboratory professionals know that without a quality laboratory, healthcare is compromised. The Mayo School of Health Sciences reports that 60-70% % of healthcare decisions requires laboratory diagnostics (and it’s even higher in pediatrics). What better way to make the world a better place than to improve and strengthen the quality, safety, and operational effectiveness of our laboratories worldwide? On a personal level, it’s a way to give back to the profession that has enriched my life and given me so much over the years.

Global and international health affects all of us, and this century will be one of global initiatives and improvements worldwide. We can all make a difference locally, regionally, internationally. No matter where your focus and heart for laboratory improvement lies, you can make a difference. We’re all a part of the world’s big and interconnected laboratory! I’ll look forward to hearing about YOUR interest and involvement one day. Next time let’s explore some of the passions and pitfalls of being an international volunteer.

If you’re ever in Windhoek, Namibia during the last part of the rainy season, be sure to try the big white and meaty omajova (Oshiwambo for mushrooms…). They are the size of flying saucers, (no exaggeration!) and really, really good fixed just about any way you can imagine! If you’d like to see a picture of them and maybe a recipe from my favorite German chef in Windhoek feel free to email me at bsumwalt@pacbell.net.

Beverly Sumwalt

Intro to Global Health—What it IS and What it ISN’T

As a Global Health Outreach volunteer working to strengthen and build capacity for laboratories around the world, I travel to many strange, new and wonderful regions. When people learn about my travels, they ask such questions as “Where are you going? Where is that exactly? What are you doing there? Isn’t it dangerous? Who’s going with you? Will you get to see any exotic animals/historical sites/seven wonders while you’re on vacation? Don’t you need shots or something to go there? Wait, don’t they eat monkey brains/fried grasshoppers/fermented worms there? Eeewwww!” Their curiosity and awe serve as a reminder that little is known about global healthcare outreach. While many people think working internationally sounds glamorous, they don’t know what this work involves.

To tell you what volunteer work in international health is all about, let me first tell you what it ISN’T.

  1. It’s not a vacation. Volunteer and staff teams are expected to present, teach and train, tour and assess laboratories, mentor improvement projects, teach phlebotomy (sometimes by collecting samples on themselves to demonstrate technique), meet with leaders of that nation’s healthcare system and participate in the country’s goals, agendas and plans for laboratory operational improvement. And, oh by the way, get up early and work late to accomplish all that in very short periods of time, without regard for jet lag or any other travel inconveniences like lost luggage. A leisurely iced tea by the pool, reading a novel, or sightseeing just isn’t going to happen (except perhaps on the 1000 km drive through the desolate, hot, deserted two lane road from point A to B…now and again you spot a warthog!). The food can be challenging, the bathrooms are a chapter all by themselves, and accommodations can be shared with insect species you can’t identify.
  2. It’s not a chance to beef up your resume. Our government, our professional societies, and the nations who invite us are all expecting a very high level expertise.  It’s necessary to have a lot of experience in order to establish credibility, and to have real experiences to share when the tough questions or collegial discussions come up—and believe me, they will come up! Before you consider volunteering, have some years in the trenches in bench laboratory operations and in manager/supervisor/director level positions.
  3. It’s not “lucrative”. Often, quite a bit of time is spent before ever leaving the U.S. preparing presentations, learning about the people and country, challenging yourself with knowing polite language and greetings, and researching. Conference calls, early morning and late evening debriefs, all are very exciting and fun—and unpaid time. It can be challenging squeezing all that around your “real job” and family commitments, etc.

Given all that, who in their right mind would want to do this?  To answer that, I’ll tell you what Global Outreach in laboratory medicine IS.

  1. It’s the chance to be part of something bigger thanyourself. You’ll be reminded that health systems we have in our country are so much more robust than what exists globally, and we should not take our laboratories for granted.
  2. It’s an opportunity to learn how to build a better mousetrap. Many times, international laboratories find solutions to problems that are less complicated or use fewer resources than we would use in the states. These ideas can be brought home and used in our labs. I’ve never yet worked on an international project where I haven’t brought back several ideas for improvements!
  3. It’s humbling. I’ve worked with so many extraordinary people who have strong skills, knowledge, education and training. They have great understanding of concepts but lack resources.  It’s about resource management and using what you have in the safest way possible to provide quality for patients. We can learn a lot from a resource-restricted environment—and we can share a lot on how to incorporate safety and quality metrics in that environment. The knowledge exchange, the relationships with international colleagues, the dedication and commitment of volunteer teammates, the results of seeing and being part of change that improves safety and patient care are rewards beyond amazing.

If you have a passion for making the laboratory world a better place, and think you have the “right stuff”, there are ways to be involved. Consider volunteer work with a local “underserved” clinic in your own community; no muss, no fuss, no immunizations, and no food challenges.  See if the rewards of volunteering ring your bell. Tap into your professional societies (ASCP as #1 of course!) and explore international volunteering, help prepare training materials,and meet others who have done this kind of work. Or, even support another volunteer (work an extra shift while he/she goes…that’s unsung hero-ship at its most altruistic!) The glamour of traveling to a project is part of it, but it takes a whole society of people in lots of roles to create positive outcomes—and together, we ALL can reach out and make a difference!

Next time….let’s talk a little bit about the history of global healthcare outreach. How did we get to where we are today?

And, oh yes, if you’re ever at the Jannat Hotel in Bishkek, Kyrgyzstan, be sure to have the Greek Salad. It’s amazing! If you can’t make it there in person, I have the chef’s recipe hand-written on a cocktail napkin in Kyrgyz, in milliliters and grams. If you’d like a copy, feel free to email me at:  bsumwalt@pacbell.net .

-Beverly Sumwalt