global outreach – Page 9

Greetings from Tajikistan

Assalomu Alaikum!

As I write this to you, I am working in Dushanbe, Tajikistan with my ASCP Volunteer colleague, Dave Gingrich. We are teaching and training in preanalytical processes. Our Tajik colleagues come from the far and remote reaches of their country, where they provide blood drawing and patient services to the people of their respective regions. They’re calling me Bunafsha…Beverly doesn’t translate, so they’ve given me the name of a flower. By description, it sounds like a yellow water lily…strange for a country with so little water, but perhaps it’s because I come from over water they’ve never seen. In my travels I can’t help but compare and contrast different cultures and their reaction/interaction to us as “foreign experts.” We were told Tajiks could be shy, yet nothing is further from the truth! What lovely, respectful, personable people.

Our last few days of teaching/training in laboratory processes have been eye-opening. We heard that due to lack of supplies in some remote and rural clinics, safe practices are very difficult to adopt because they aren’t able to get basic resources like syringes. I was certain this had been translated incorrectly, so asked again several times…only to hear I’d heard right the first time. It was also described for us that tubes of blood were centrifuged, the serum transferred to glass tubes (hand-washed, not sterilized) and the patient requisition is twisted into a cork-like cap for the tube so it can be transported 3-4 hours to a regional lab for HIV/AIDS testing…and no one had ever heard of Parafilm. My heart breaks for conditions of such limited and much needed resources that could so easily be remedied. And yet, despite such circumstances, they are so eager for knowledge of better techniques, safer ways of doing things, and so positive about their situation without bitterness for what they don’t have—that I am in the confused state of being humbled and enthusiastic all at the same time. How can what we are doing make a difference? And yet, how can it not?

In just a few short days, we have shared ideas, techniques, and the passion for our professions—and I’ve shared several of your “best practices” with them that I’ve been writing about over this past year—and the circle of our collective desire to improve laboratory services is truly global. Dave and I both feel we now have many new laboratory friends in Tajikistan!

Cheers!

–Beverly Sumwalt, MA, DLM, CLS, MT(ASCP) is an ASCP Global Outreach Volunteer Consultant.

Fresh Ideas

It’s always interesting to me how you can “look” at something for so long you no longer “see” something right in front of you! Take advertising for instance…we can all recognize the fast food chains advertising signs, but if asked whether or not one is hanging in your patient waiting room, you might be surprised that you’d walked by it so many times you just don’t see it!

I had the privilege to do a walk-through in a small, but efficient and organized, critical access hospital laboratory in the past few days. As we looked in their storeroom, we were ushered past a row of neat, clean, personally labeled lab coats—obviously one for each staff member. And, on a shelf just near them were a couple of neat, clean, and organized rows of tennis shoes…what?? Lab shoes!

I’ve seen this in other countries where laboratorians have “street shoes” and “lab shoes”—often because they wear sandals in tropical climates or boots in frosty climates—and they work in labs where the instance of public health contaminates tend to be very high. Hence the safety of not taking home any lab detritus on your shoes.

I’ve not seen this safety practice in this country, or at least not often—which makes me wonder if I have just “walked by” this best practice in laboratory safety so many times that I just don’t see it as often as perhaps it is being implemented. My “kudos” to the laboratory staff who pointed theirs out for me, they are certainly showcasing a best practice—and I’m reminded that perhaps it never hurts to look more closely at things we take for granted in our laboratories! If your lab has a best practice in laboratory lab coat/shoe/personal wear safety, I’d love to hear about it; please email me at beverlysumwalt@gmail.com and I’ll be happy to share it with your colleagues in my travels both at home, and globally.

Cheers!

–Beverly Sumwalt, MA, DLM, CLS, MT(ASCP) is an ASCP Global Outreach Volunteer Consultant.

Laboratory Response to the Ebola Outbreak

You may have heard in the news over the past few months that there has been an outbreak of Ebola in West Africa. The first registered case was in Guinea in February of 2014. Reports have since noted the spread of the virus to other areas in Guinea, as well as Liberia and Sierra Leone. As of June 24, the CDC noted on their website that ministries of health in the three countries have reported 390 cases in Guinea (this includes 270 fatalities and 260 laboratory confirmed cases); Sierra Leone had 147 laboratory confirmed cases with 34 fatalities; and Liberia reported 34 laboratory confirmed cases and 34 fatal cases.

Genetic analyses of the confirmed cases show that this strain of the virus is closely related (97 percent) to variants of the virus that have been previously identified in Gabon and the Democratic Republic of the Congo.

Response to the outbreak is difficult for many reasons, including the lack of medical and laboratory resources in the regions where it has been discovered. The WHO and other partners have deployed laboratory experts to staff mobile field laboratories in order to provide accurate testing to confirm cases. Other specialized medical personnel have been deployed to treat affected patients and provide education to local communities. There are reports, however, of local medical personnel in Liberia not showing up at work due to fear of contracting the virus because they say they lack the appropriate personal protective equipment (PPE) in order to adequately protect themselves.

Spread of the virus has been attributed to the ease of contagion in densely populated cities (such as Conakry, Guinea), local traditions and beliefs that have resulted in lack of quarantine and/or removing patients from medical care, and the porous borders and ease of border crossings in the West African region. However, some countries have taken various measures to close borders or restrict movement across borders. The CDC, WHO and MSF (known as Doctors Without Borders in the US) are working with partners on the ground to lead the response to the outbreak.

-Marie Levy spent over five years working at American Society for Clinical Pathology in the Global Outreach department.

Never a Dull Moment

Every now and then it’s good to be reminded that laboratories are all very dynamic and play an active role in the delivery of healthcare worldwide. We are often so focused on our day-to-day operations, the tests we’re performing, the myriad of measures we use to assure safety and quality that we tend to fit rather nicely inside the “black box” just by doing what we do every day. So once in a while it’s good to have interesting conversations and experiences that remind us that labs add value in so many areas.

Just this past month I have had the privilege to be part of multiple unique conversations that involved laboratory services and career paths. These included: sitting in on a panel discussion around the Medical Laboratory Technician (MLT) training programs; exchanging thoughts and challenges faced by couriers who serve very remote Native American communities in our country; shared and compared notes on world primary care clinics and the need for laboratory services in both western Africa and eastern China; brain-storming ideas and initial plans for merging several lab operations into an efficient and effective new model; and of course, the next exciting adventure for me with ASCP Global Outreach coming up later this summer in Central Asia! These conversations with various experts and leaders in our field covered staffing, recruiting and training, operations, remote challenges, international services, and the vision for the future of laboratory medicine nationally and globally—just about everything from the ground up and every facet from the top down in laboratory medicine was in there somewhere!

As I reflect on the past month or two, I’m reminded that there has never been a dull moment in my laboratory career. In retrospect, what an excellent choice I made all those years ago. Encountering a B positive bleeder in surgery while on the night shift or working solo on Christmas Day with only Shigella group D cultures to keep me company were a few of those times I wasn’t so sure I had made a good decision. Now, looking back, experiences like that have gifted me with knowledge and the experience to share in dialogue with colleagues and perhaps inspire new students in our field both at home and internationally. And lo and behold, even after all these years, there’s still never a dull moment.

Cheers!

–Beverly Sumwalt, MA, DLM, CLS, MT(ASCP) is an ASCP Global Outreach Volunteer Consultant.

Professional Societies Abroad

In my last post I wrote about how Lab Week was being celebrated around the world. In that post I mentioned two medical laboratory associations that are up and coming in their respective countries and working hard to provide a voice for laboratory professionals. These organizations are the Association Ivoirienne de Biologie Technique (l’AIBT) in Cote d’Ivoire and the Medical Laboratory Scientists Association of Tanzania (MeLSAT). These two organizations are among a growing group in Africa recognizing the importance of professional associations to provide a voice, educational resources, and other tools for medical laboratory professionals.

Over the past few years the Centers for Disease Control has been a leader in helping facilitate the development of the African Society for Laboratory Medicine (ASLM). According to the ASLM website, the organization “is a pan-African professional body working to advocate for the critical role and needs of laboratory medicine and networks throughout Africa.” ASLM provides membership opportunities, continuing education, publishes a journal, and implements the WHO AFRO framework for improving medical laboratories in Africa called SLIPTA (Stepwise Laboratory Quality Improvement Process Towards Accreditation).

While ASLM focuses on providing services and member benefits across the African continent, L’AIBT and MeLSAT serve the local communities in their respective countries. You can find more information about l’AIBT on their facebook page, which features photos and posts on l’AIBT activities in Cote d’Ivoire and their website. For more information on MeLSAT, you can visit their website, which also has a job postings page for lab professionals looking for opportunities in Tanzania. Both organizations have benefited from mentorship support from ASCP and have begun a dialogue with each other to exchange information and best practices. As they continue to develop and grow they will be important resources for local laboratory professionals and can provide an important network of professionals throughout the continent.

-Marie Levy spent over five years working at American Society for Clinical Pathology in the Global Outreach department.

Laboratory Professionals Week Celebrations Around the World

Happy Laboratory Professionals Week! Lab week is celebrated not only in the United States but around the world as well. As in the United States, labs get in on the fun on an individual level as they recognize their employees and the importance of the lab, and larger organizations organize celebrations and community outreach events.

In Cote d’Ivoire, located in West Africa, there is a week’s worth of activities and celebrations planned. The activities include ceremonies recognizing laboratory professionals throughout the country, demonstration sessions, and community outreach to the general public via radio broadcasts, information pamphlets, and text messages, among other activities. The official lab week ceremony will take place on April 22^nd in the largest city of Cote d’Ivoire, Abidjan, at INFAS (the Institut National de Formation des Agents de Sante or the National Institute for Training of Health Workers). Speeches will be given by high ranking government officials, including the Minister of Health, as well as representatives of CDC-PEPFAR, and the Association Ivoirienne de Biologie Technique (l’AIBT), the national lab association.

In Tanzania, located in East Africa, the Tanzanian laboratory professionals association, Medical Laboratory Scientists Association of Tanzania (MeLSAT) has organized awareness raising activities and celebrations as well. Throughout the week they will provide community outreach by offering testing and educational information on HIV, diabetes, and high blood pressure. They will also be collecting blood donations for the national blood bank. The lab week closing celebration will be a parade in the town of Sumbawanga to celebrate laboratory professionals and their achievements and to raise awareness among the community.

What are you doing to celebrate in your neck of the woods?

-Marie Levy spent over five years working at American Society for Clinical Pathology in the Global Outreach department.

Think Globally, Act Locally

National Laboratory Professionals Week is April 20-25, 2014—and this year during the same week is Earth Day, on April 22, 2014. That is an interesting combination of things we should take time to contemplate—what does Earth Day have to do with laboratory medicine? Or vice versa?

Well, a number of things come to mind:

As laboratory professionals, we are committed and dedicated to being part of the healthcare team that discovers and cures peoples’ health and promotes well-being.
Laboratory professionals are also committed to using supplies efficiently and effectively, saving costs, and using/disposing of hazardous materials safely which parallels a strong commitment to our environment.
The health and well-being of the planet is directly proportional to the health and well-being of the inhabitants of the planet.

It seems to me there is a directly proportional relationship here; and a link to our present and future state, as we pursue health for both the people of the world and the planet we all occupy.

Laboratory professionals the world over act locally to take care of the patients who are our neighbors and friends and family in our communities…and we think globally to support the needs and resources and collegial relationships that take care of the patients and neighbors and friends on our planet. What better combination to celebrate, support and call world-wide attention to than National Laboratory Professionals Week and Earth Day? If your laboratory is doing something special that illustrates “thinking globally, acting locally,” please send me a note about your Lab Week Celebration Activities at bsumwalt@pacbell.net . I would love to consolidate and share those ideas!

Wishing everyone in the field and industry of Laboratory Medicine a great Lab Week—both locally, and globally!

–Beverly Sumwalt, MA, DLM, CLS, MT(ASCP) is an ASCP Global Outreach Volunteer Consultant.

Loading Viruses

Occasionally some of our terminology in healthcare has its own set of nuances. We combine words or word-parts to give them more precise and clear meaning, and often they create a unique definition. Take for example, words like symptomology; chemotherapy; biotechnology; or the now-ever-popular term genetic engineering. Then take for example some well-used medical terms that have become mainstream—like the term for a gazillion little strands of RNA, all of which we lump together and call “viral.” Viral loads in laboratory terms indicate diagnostic criteria for the remission or advancement of disease, such as the case in Hepatitis or HIV/AIDS. But it also now means a serious problem with your computer, or the latest cat-video gone rampant on the internet. In my case, it just recently indicated a personalized upper respiratory infection from Central Asia!

Travel has its ups and downs, and at the end of two weeks of wonderful training and interaction with our colleagues in Kyrgyzstan, I succumbed to a “load of virus”—and faced the drudgery of coping with it while cramped into the aisle seat of airplanes, passing time wandering during layovers in foreign terminals, hopping into passport lines and customs checks. With nearly 36 hours of travel ahead of me, I plowed through it all in the fog of decongestants and analgesics and tried desperately not to sneeze or cough—which only made it worse. I’m certainly not the first, nor the last person on the planet to catch a cold, but I was certainly among the most miserable!

Now that the worst is behind me and my diagnosis is just a “horse” and not a “zebra,” I’d be interested in your opinion…is catching a cold considered “a viral load” or just merely “loading a virus?” Just maybe we have a new and even more descriptive term for uploading seasonal cold and flu! Let me know what you think at bsumwalt@pacbell.net and who knows, maybe our new twisted term will actually “go viral.”

–Beverly Sumwalt, MA, DLM, CLS, MT(ASCP) is an ASCP Global Outreach Volunteer Consultant.

Mobile Technology and Health Care

I just stumbled upon this BBC article about a TED talk from about a year ago that discusses an app called Ucheck that can be used to test urine samples for a variety of elements, including glucose, proteins and nitrites. Instead of having to go to a lab to get these urine tests, an individual can use this app—the purchase of which includes the dipsticks and supplies needed to utilize the app—to run initial urinalysis screening tests.

I imagine the Ucheck folks have thought about and researched the pros and cons and possible issues with a system like this. Process issues, user error, contamination (although supposedly one of the elements in the test helps to gauge contamination), among others come to my mind immediately. My biggest question, however, is what does the Ucheck app-user do next after they receive their results? How does the patient proceed if they do need additional medical attention?

The internet can make mini doctors of all of us—there is enough information to make many self-diagnoses, but not necessarily accurate ones. My doctor recently told me they have stopped giving patients full reports from various tests because they found the patients would go home and Google everything on the report and come back to them scared and with inaccurate information. She said this Google-ing gives everyone access to enough information to be dangerous. Would this app give people just enough information to be dangerous?

The TED talk mentions that the app is being put to the test in a laboratory in India—if effective that certainly could be very useful in terms of providing mobile health care, particularly in remote regions of the world. Use of the app in a controlled medical setting where there are trained laboratory and medical personnel available to interpret results is a different story than an individual using it at home.

The TED talk and related articles I found were from 2013 so I did some sleuthing to see if I could find more recent information. I found an article noting that the FDA sent the Ucheck developers a note that the app needs to meet FDA guidelines in order to be in use. I didn’t find follow-up information on what happened after the FDA note, but I haven’t been able to find the app through my iPhone’s app store. Perhaps it’s been put on hold?

Regardless of whether this particular app moves forward, however, medical advances using mobile technology such as these are certainly on the horizon. Which makes for an interesting conversation. Mobile technology could be revolutionary in some parts of the developing world where access to medical resources is scarce. But do they provide what is needed? Are they being used in a setting where if a diagnosis is made there are resources to treat that diagnosis?

What do you think? Are these positive developments? Could they be helpful and harmful? How will regulation work?

-Marie Levy spent over five years working at American Society for Clinical Pathology in the Global Outreach department.

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.

–Beverly Sumwalt, MA, DLM, CLS, MT(ASCP) is an ASCP Global Outreach Volunteer Consultant.