Planning Lab Testing for Medical Missions

I am frequently asked questions about establishing clinical lab testing in the field, or how to approach bringing lab tests on medical missions. There are three key questions that I always start with when planning diagnostic lab testing for any situation, and they are 1) what is the mission? 2) what are the needs of the population? and 3) what is the environment like?

The first question – what is the mission? – sets up the framework for the project. Is the goal to provide sustainable testing or to support a short term medical mission? An examples of sustainable testing would be establishing a new assay for permanent use in a clinic or hospital, and would require a plan for identifying and training operators, ensuring reagent availability and maintenance plans in-country, and a budget. Supporting a short term mission often requires only point of care testing. For this post, I’ll focus on supporting a short term mission.

The second question –what are the needs of the population? – helps determine a test menu. As with any diagnostic lab testing, it helps to ask the question “what are you going to do with the result?” when deciding which tests to offer. It is important to know what the medical care team is equipped to treat, what treatments are available in the community, and the cost of the treatment. It is important understand the prevalent health care issues that will be encountered by the care team on the mission. For example, if the goal of the medical mission is to provide routine healthcare to a remote environment, then you would want to know of any endemic diseases that the team would be prepared to treat. However, if the mission is surgical in nature, lab testing might need to address blood typing and viral testing, or perhaps coagulation testing.

The third question – what is the environment like? – guides the selection of testing platforms. If there will be electricity and running water, you will be able to use powered devices like a Piccolo chemistry analyzer, or platforms that require refrigerated reagents. Temperature extremes, especially heat, must be kept in mind. Many instruments can’t function over a certain temperature. A battery powered point of care instrument that is very useful in the field in moderate climates might be useless in high heat. For example, the Renal Disaster Relief Task Force of the International Society of Nephrology used the Abbott iSTAT in their response to the 2010 earthquake in Haiti. They found that this device often failed due to the extreme heat (>100 degrees F) of the field hospital environment (1). Improvisation can sometimes get around these limitations; I have used ice packs in coolers or even suitcases before to keep instruments cool enough to operate while in the field. Many times, especially for remote locations, lateral flow, whole blood based, point of care testing is the best option. There are many options available that do not require any special handling like refrigeration, and the ability to use capillary blood is a huge benefit in situations where venipuncture might be difficult.

In any situation you must know the sensitivity, specificity, cross reactivity, and limit of detection of the assays selected for the mission. You should be able to communicate any limitations to any of the care providers who might use the result. If the laboratory professional is not able to go on the medical mission, then another person should be identified as responsible for oversight of the laboratory testing. Most importantly, it is important to carefully plan for lab testing on medical missions. With thoughtful planning, adequate laboratory testing can be provided to support medical missions.

Reference

  1. Vanholder R, Gibney N, Luyckx VA, Sever MS. Renal Disaster Relief Task Force in Haiti earthquake. Lancet 2010;375:1162-3.

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Sarah Riley, 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.  

 

 

Metrics, Goals, and Lab Leadership

In an April 2015 publication in Lab Manager, then ASCP President Dr. William Finn discussed the Lab Management University (LMU) program “designed to help pathologists and lab professionals take their laboratory management skills to the next level.” He also cited “gaps” in professional training and experience that revealed a lack of management skills in “pathologists, laboratory professionals, and pathology residents.” Utilizing advanced coursework available to them from LMU, laboratorians of various specialties would stand to benefit from this knowledge and effectively influence more positive outcomes for patients.

Within the last year, I’ve been writing about utilizing data from epidemiology, laboratory studies, and community partnerships in an integrated public health initiative combating mosquito-borne illness on the island of Sint Maarten. It is an ongoing multidisciplinary project I started which reaches various fields of study from immunological seroprevalence, to community health work, to social determinants of health, and team leadership and coordination. What started as a group of six students in the fall of 2016, has flourished into a team of now more than fifteen with partners in local government, local NGOs including the Red Cross, social and broadcast media, and our individualized message of local self-motivated disease prevention has reached well into the thousands.

Citing this experience as a process of a simple medical literacy proposal to an expansive public health initiative, I believe there are some significant advantages that being a laboratory professional can give you. Experiences during my time in clinical laboratories gave me many parallels to study as I became a leader of a dynamic and diverse program. Here is what I consider is a highly-oversimplified model for successful problem-solving, leadership, and ultimately measured success. As a common laboratory metric of efficiency/success—and something I have had experience with before—consider turn-around-time (TAT) as a problem many labs face. Compared to the problem of addressing risk reduction and source control for mosquito-borne illnesses like Zika, I found myself in the same model I had recognized many times before.

Example 1: Outside the Lab

Addressing Zika as a Public Health Concern

Example2: Inside the Lab

Addressing TAT as an Efficiency Metric

 

START: Clearly and Specifically Define the Problem or Need to be Addressed
With the advent of a local outbreak and information from local government regarding the increase of epidemiologic cases, behavioral change for risk reduction was highlighted as a major obstacle in improving public health outcomes. Creating self-sufficiency in the community would not only improve health but create sustainability. As a laboratory potentially signs on new clinics or accounts because of local changes in hospital structures, efficiency is being examined as workflow is slated to increase. Staffing, instrumentation, LIS/LAS, and other tools are being considered to reduce TAT and improve overall patient outcomes and strengthen quality control and quality assurance metrics.
Locate Potential Helpful Partners, Staff, or Tools that Can Assist Your Cause
To gain access to resources otherwise unavailable, it is imperative to collaborate with partners in the Ministry of Health as well as NGOs like the Red Cross. To reach communities most affected by the problem at hand, it is necessary to implement cultural liaisons to act as intercessors preserving the autonomy of individuals while creating a safe environment to communicate an effective public health message. As part of initial assessments to discover a clear problem, vendors may offer instrumentation or technology that would improve the conditions affecting the TAT. It would be highly prudent to reach out to the new accounts or clinical sites to determine if TAT is affected by workflow, personnel, communication, or procedural faults. Assessing the staffs’ skills and competency are also crucial for implementing corrective action.
Implement Initial Intervention, Paying Attention to Results Before/After
In the case of Zika virus education and prevention, initial interventions include utilizing community partners as liaisons to introduce us to targeted audiences/communities. Results should focus on the pre-and-post-survey data collected, referenced in earlier articles regarding engagement, knowledge, and behavior. In the case of TAT efficiency/improvement, initial interventions should include collecting data points regarding how specimen-to-result turnover is affected at every checkpoint while implementing changes as necessary. Data should indicate success in particular measures which improve TAT incrementally.
Take Measures to Make Further Interventions More Successful Along the Way
Educating communities about the risks associated with standing water and the spread of arboviral infections with clear demonstrations/examples of how to enact improvements. Distribution of educational or advertising materials throughout targeted areas will bolster an effective message. When staff or other changes effectively improve the streamlining process, they should be recognized and praised. Moreover, clients should be consulted in both inpatient and outpatient settings to inform procedural change and deter further external compromise of TAT.
Implement Follow-Up Intervention, Paying Attention to Results Before/After
Like before, interventions with Zika virus education include community partner meetings to hold engaging discussions about health promoting behavior. Similar surveys collect data before and after the presentation and are correlated with the previous meeting, however, with the addition of data regarding the effectiveness of secondary measures (i.e. advertising and educational materials). With the implantation of various measures to improve turnaround, assessments of protocol, instrument utility, effective transport, and other previously mentioned aspects would indicate successful outcomes. Combined with the supplemental consultation to steps both inside and outside of the laboratory, an comprehensive conclusion can be established to indicate a permanent solution via these metrics.
Conduct More Comprehensive/Translational Analysis of Intervention Effectiveness
Correlating the primary intervention with follow-up measures can indicate possible opportunities for further improvement. It can also highlight areas of significant success where interventions had the greatest impact. If significant enough, these results should promote the process and further the original cause set forth early on. Continuous metrics which analyze the TAT as a marker for productivity and efficiency before, during, and after interventions can offer insight into effective changes. Extrapolating this data can improve processes across departments and models made from this process can improve TAT and other metrics in a laboratory.
Share Significant Successes and Challenges with Partners/Staff and Share the Success
Based on standards in current literature, community partners benefit significantly from both repeat-visits as well as becoming involved and informed participants for positive change. As laboratories face staff shortages and personnel challenges, sharing the success and making sure the rewards are collectively appreciated can improve workplace dynamics.
Create a New Protocol, SOP, or Publication to Influence a New Standard
As with any successful public health interventions, shared information can lead to future improvements elsewhere. Publications often cite the process of creating a platform and approach to tackling social health concerns and highlights emphasize these positive outcomes. Many productivity projects in clinical settings are difficult, successes should be shared between departments and outside the laboratory. Ultimately, publication might present an ample opportunity for improving standings for overall hospital metrics and larger outcomes.
FINAL: Implement the Same Model Outlined Here for Potential Future Challenges

Obviously, this is a crude and generalized model for how to approach leadership both inside and outside the laboratory, but some of the key aspects of clear goals, interdisciplinary teamwork, resource management, and creativity are paramount. Having my laboratory experience was critical for finding success with my team here with our public health work. Laboratory professionals have strong skills and unique insights for a variety of important fields. Having that experience has truly enabled me to contribute in a meaningful way as I pursue my medical career. As you can clearly see, there are so many useful tools that apply across disciplines. Furthermore, the most important part of managing a project aimed at a positive outcome is answering the simple question: how do I utilize and interpret the data I collect along the way?

And here’s another question: who does data analysis better than us laboratory folks?

Thanks for reading, until next time…

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Constantine E. Kanakis MSc, MLS (ASCP)CM graduated from Loyola University Chicago with a BS in Molecular Biology and Bioethics and then Rush University with an MS in Medical Laboratory Science. He is currently a medical student at the American University of the Caribbean and actively involved with local public health.

Diagnostics for Displaced Populations

A few months ago, Sarah Riley discussed diagnosing disease in displaced populations. She says, “… being aware of the problem of limited access to diagnostic laboratory testing in refugee populations is a good start. We need to get a better understanding of the scope of the problem. We should be ready and able to provide specific recommendations for meeting diagnostic needs in these populations including most appropriate diagnostics…”

Dr. Riley’s post has stuck with me, and I wanted to know how I could help. While several organizations work with refugees worldwide, it’s unclear if any dedicate money to laboratories or diagnostics. Thankfully, there’s the ASCP Foundation‘s Global Health Fund. The GHF is dedicated to providing diagnostics, establishing laboratories, and training local personnel in countries where access to pathologists or medical laboratories is inadequate. If this sounds like something you’d like to support, you can do so here.

 

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-Kelly Swails, MT(ASCP), is a laboratory professional, recovering microbiologist, and web editor for Lab Medicine.

 

 

 

 

 

The Voice of Sint Maarten

It’s often difficult for a medical student to take time out of their schedule and work on projects in their community. Our free time is often encumbered with the “fire hose” of information that we all need to process and master before we sit for board exams. To be fair, there isn’t any free time per se. It is apparent (in medical school more than any other time I’ve known) that every minute of the time we schedule is, by choice, purposeful or not. With that noted, something exceptional happened this month in a span of three days that I am truly proud of. My “Z-Pack” Zika virus prevention initiative team all came together and tackled three extraordinary events around our Sint Maarten community.

If you’re just joining the Zika-related action, check out the background behind my work as well as some of the major accomplishments, achievements, and noteworthy lessons along the way this past year. My team’s work bridges a gap that exists between public health and the data we laboratorians acquire through diligent research.

The whirlwind of public health outreach events the Z-Pack was able to do were highly productive to the cause:

  • We have bolstered our public health and source reduction message on local radio, television, and print.
  • We have engaged and partnered with innumerable entities within this community and were an integral part of a mainstay annual health fair.
  • We engaged with local community members, not as students, but as public health liaisons fielding in-depth questions and addressing real concerns of the local population.
  • During these episodes, we were able to procure true data which we continue to collect, analyze, and use to formulate new approaches to positive health outcomes.

The first exciting development I listed was the debut into our media campaign. Being invited to the local radio to advertise our work and promote upcoming events was both exciting and reaffirming. In a short interview, I addressed Zika and other virus threats to the island community and discussed epidemiologic data and what it means in the scope of public health. Talking about our work alongside two of my team members and the project manager of the Ministry of Health’s vector control program was a thrill. A fellow team member and I were also fortunate enough to be flagged down by a local cable access television program to promote our work on a short video spot during our presence at the Lion’s Club Annual Health Fair I’ll discuss shortly. These media outlets reminded me of moments back in the laboratory when I had to present data clearly and field questions “on the fly.” Whether it was a staff meeting, educational resource assessment, or CAP inspection response, I couldn’t have been more prepared to handle the translational bridge from data to public view.

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Image 1: “Z-Pack” on the radio!

(Listen to the 16 minute radio spot here from PJD2 102.7FM/1300 AM The Voice of Sint Maarten)

I mentioned the Health Fair the local Lion’s Club sponsors each year, with booths that address a plethora of health education outlets from diet/nutrition, to diabetes, to (of course) mosquito reduction.  Partnering with our colleagues in the Ministry of Health we set up several tables in a tented booth and made available all kinds of educational resources for the public. There was a station designated to secondary interventions for combating mosquito risk reduction such as fogging guns and larvicides for standing water areas. I designed some clear-message flyers to distribute to patrons and others passing by our booth and was able to spark some interesting conversations with local community members and business owners who wanted more information—they wanted to distribute and display the same information in their offices and homes. Gaining popularity with the local community, we decided to record those interested parties and give them the title of “official community partners.” Not only will they feel more involved in the process of empowering and advocating for health for their community, but they will be motivated from within! I will say that my absolute favorite part of this health fair was the station our Ministry partners set up which included all their laboratory equipment they use to speciate, quantify, and analyze the local mosquito threat. This, alongside with our friends in local laboratory medicine who were collecting specimens to screen for Zika serologically, made this a very friendly environment for a laboratory professional like myself. You can bet I was happy to talk to visitors about epidemiology and risk reduction over a few microscopes!

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Figure 1: Clear-message informational flyers for public patrons to our booths at the health fair.
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Image 2: Health fair snapshots, a fogger gun, and some team building with microscopes.
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Figure 2: Preliminary data processing reveals an improvement in perceptions, attitudes, and behaviors toward Zika virus and overall arbovirus risk reduction.

On a more serious note, I want to speak briefly on the amazing opportunity that our community meeting offered for my team and I to learn some real truths about public health here on the island. With the success of partnering with laboratory services, research work in the field, and participating in a growing media campaign, the Z-Pack arranged a community meeting at a local religious center. Our “community meetings” as proposed in part from our earlier work focus on presenting audience and culturally specific information about reducing arbovirus risks and addressing health within the community. A community liaison connected us to a local Islamic center, where we conducted one of these meetings. Our presentation was received well, and a vigorous discussion followed. Having a partner from the Ministry of Health with us that day provided some clout to our discussions. I drew heavily on my interpersonal skills as a laboratorian when I fielded some really challenging questions from the adult crowd. Concerns in this particular community included specific objections to the effectiveness of the Ministry’s work on reducing mosquito populations, frustration over tourist-heavy areas receiving unfair attention, and true worry over improving health outcomes in a constructive and collaborative way. Taking the time to share their personal experiences was greatly appreciated by my team. Really engaging with the community on an individual level really makes it feel as though we are creating positive change. As a part of our work, data was collected on the effectiveness of our message. Still in its early stages, the data (Figure 4) shows qualitative improvements toward answers in post-presentation surveys which reflect new facts learned, potential for social/behavioral change, and establishment of health risk as a community priority.

 

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Constantine E. Kanakis MSc, MLS (ASCP)CM graduated from Loyola University Chicago with a BS in Molecular Biology and Bioethics and then Rush University with an MS in Medical Laboratory Science. He is currently a medical student at the American University of the Caribbean and actively involved with local public health.

Social Accountability Inside and Outside the Laboratory

Being a medical laboratory scientist is more profession than occupation. Those of us who are affiliated with ASCP through our certification or work know the value of being part of an organization that values education, certification, and advocacy for patients. Finding a place in this network has given me a strong foundation through years of understanding a “best practices” paradigm. If you’ve been following my posts these last few months, you’ll have heard all about my work with Zika virus prevention and detection initiatives on the island country of Sint Maarten. Being here at the right time and right place have provided ample opportunity to flourish as a medical student with a history of laboratory experience. Recently, my school honored me with the Social Accountability Award and Scholarship for outstanding service during my time as a student with respect for my colleagues and the surrounding community of Sint Maarten. Having authored proposals and leading initiatives coalesced into an ongoing functional public health initiative, partnered with local government and NGOs. My experience as a certified scientist allowed me to build on three major ASCP foundations:

  1. Leadership. Receiving the award from the school validated my confidence in the work that I and my team have been doing this last year. Letters of recommendation came from my service-learning course director and Dean of Community Affairs, and the consultant advisor to the public health prevention office of the local Ministry of Health. The Dean of Medical Sciences even spoke about me with kind words and an inspired tone that really meant a lot to me, personally. This overall validation was not just for me—it was for the work, my team, and our efforts in local public health. The exercise in textbook-to-field informatics, education, and interventions could not have come to fruition without experiences I drew from in my lab years. Responding to CAP inspections, spearheading changes to SOPs or operations, and being a voice at the conference table taught me how to collaborate as well as lead.

 

  1. Education. If there’s anything I would say has been paramount in my time (both here in medical school and back in the lab) it’s the value of education. I could not do the work or pursue the projects I do today without backgrounds in molecular science, lab informatics, or general pathology and disease. Through numerous degrees and opportunities to work in the field of laboratory medicine, there are countless venues for someone to continue to patient care. My journey included a foundation of molecular biology, a graduate degree in lab science, an ASCP certificate with continuing maintenance as an MLS—now in post graduate work; I continue to work and learn in a dynamic environment. I have created SOPs from scratch, researched literature on seroprevalence and epidemiological statistics, managed and interpreted specimen collection and ELISA testing, and contributed to public health awareness and education. If you want diverse and exciting, this field has it! Education doesn’t stop with the degrees and certificates on the wall behind my desk, however. A very important, and arguably mandatory part, of being a scientist/clinician is being able to engage in an educational conversation with a wide variety of audiences. Talking about Zika virus prevention, seroprevalence, and risk mitigation is a different conversation with children, or local adults, or medical colleagues.
  1. Advocacy. Finally, I should say: if there’s one major thing professional organizations like the ASCP do for its members and our communities, it’s advocacy. Giving a concrete voice and substantial representation to the causes we care about as professionals yields positive returns for our overall shared goal of improved patient outcomes. My work here is first as a medical student, and second as a public health partner. Sharing and collaborating on how this community can best utilize its resources to address a local epidemic is at the forefront of my team’s work. When I started this project, I was inspired by the aims and goals of the Partners for Cancer Diagnosis and Treatment in Africa Initiative from the ASCP Foundation. I first heard about this at the annual meeting in Long Beach, and, as I prepared for my own stint overseas, I tried to keep that close to heart. Improving global health outcomes and increasing laboratory visibility were two of the major tenets of this project. Proudly, I would say I’ve been involved in both aims. Clear success has been documented (and continues to be seen!) in my Zika initiatives, and more and more people engage in conversations with me about translational medicine. With all my documents signed “C. Kanakis, MS, MLS (ASCP),” people have been surprised by all the things someone with “just a lab” background can really do! Breaking stereotypes and inspiring others to reach out for improving patient outcomes is all part of the same conversation I have with my community partners.

In short, my work with Zika virus prevention is an ongoing project, with new events and achievements tallied weekly. But before I get back to recounting the most successful events each month, I wanted to take a step back and say that I could not have been a Social Accountability Award recipient in this community without first learning the way to be a leader, educator, and advocate in our community.

Thanks for reading! Until next time…

 

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Constantine E. Kanakis MSc, MLS (ASCP)CM graduated from Loyola University Chicago with a BS in Molecular Biology and Bioethics and then Rush University with an MS in Medical Laboratory Science. He is currently a medical student at the American University of the Caribbean and actively involved with local public health.

Diagnosing Displaced Populations

If you are at all aware of current politics, you are aware of the refugee crisis. The United Nations High Commissioner for Refugees Global Trends report estimates that 65.3 million people were displaced from their homes as refugees or internally displaced persons in 2015. Refugees are a population at risk for many diseases and health complications, and also lack access to adequate diagnostic testing. The average length of conflict-induced displacement is 17 years, resulting in significant healthcare ramifications. The health of refugees is important for obvious general humanitarian reasons, because the risk of spread to the host population when refugees find asylum, and for the burden untreated chronic diseases place on the healthcare systems of host countries.

The most common diseases in refugee camps are communicable, and include diarrheal disease, acute respiratory disease, measles, malaria, meningitis, TB, and HIV. Poor sanitary conditions and close accommodations are driving factors for these diseases. Loss of infrastructure in the country of origin increases the likelihood that a refugee will enter camp with a communicable disease. For example, disruption of vector control programs or efforts in a volatile country increase the risk of vector-borne diseases such as malaria. Breakdown of vaccine programs increases risk of vaccine-preventable diseases; the low vaccine rates in areas producing most of the world’s refugees contributes to the mortality of measles in refugee camps.

While there’s no denying that communicable diseases are a huge threat to refugee populations, non-communicable diseases (NCDs) are also a significant burden. In 2008, the WHO estimated 63% of deaths occurring globally were attributable to NCDs. The number is projected to increase to 55 million by 2030, with the most rapid rise expected to occur in developing countries – which are also the main source of displaced persons. Displaced persons are also more vulnerable to NCDs because of risks associated with population movements, including psychosocial disorders, reproductive health problems, higher newborn mortality, drug abuse, nutritional disorders, alcoholism and exposure to violence. Unfortunately, there is not much published on the incidence of NCDs in refugee populations, but at least two studies describe diabetes, hypertension, and seizure disorders are frequent diagnoses in refugee camps. A study of Congolese refugees found 9.5 cases of diabetes/100,000, 5.9 cases of seizure disorders/100,000, and 2.6 cases of diabetes/100,000. A Belgian study found a high number of refugees with chronic diseases and interrupted maintenance treatments in addition to those with diabetes, hypertension, and seizure disorders. Not diagnosing and managing non-communicable diseases in refugee populations increases the risk of morbidity and mortality in these populations, and means that the refugee will present a larger burden to the health system of the country in which the refugee finds asylum. Any loss of function due to an unmanaged NCD – loss of limbs from diabetic neuropathy, for example – will impact the future livelihood of a displaced person.

Increasing rates of antimicrobial resistance, of malaria and TB for example, make it even more important the that correct diagnosis – including pathogen strain where appropriate – is made before treatment is started. However, most health-related efforts in refugee populations focus on disease prevention and control, and less with building diagnostic capacity. The CDC Division of Global Migration and Quarantine (DGMQ) recommends testing refugees for infectious disease, especially those with long latency. Some of the diseases the DGMQ recommends testing for include malaria, TB, and intestinal parasites. There’s less guidance regarding testing for non-communicable diseases. The WHO recommends “ensuring the essential diagnostic equipment, core laboratory tests and medication for routine management of NCDs are available in the primary health care system”, with no further detail.

There’s very little in the peer-reviewed or even lay literature about the availability of laboratory diagnostics, but from what is available and anecdotally, diagnostics are often not at the forefront of medical efforts in refugee camps. The Belgian medical team consisted of 400+ volunteer medical staff, and yet was severely under-supported in terms of diagnostics.

Challenges to bringing laboratory diagnostics include infrastructure needs and cost. Unfortunately, lab diagnostics are not cheap! The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) spent $6.9 million USD to operate comprehensive labs in 124 of it’s 139 health facilities. Infrastructure needs – electricity and clean water –  and the need for trained personnel are common limitations to operating diagnostic laboratories in resource-poor settings such as refugee camps. Political instability also contributes to the challenge. In 2013, the DGMQ reported that the Dadaab refugee camp, home to over 300,000 refugees, had a fully functioning comprehensive laboratory. In May 2016, this camp was closed due to safety risks, eliminating the laboratory resource.

So what do we do? I have to be honest that – even though I thought I knew about this problem – writing this blog post has been eye-opening for me and I’m not sure I can answer the question. I’m definitely going to be thinking about this for some time. In the meantime, I think being aware of the problem of limited access to diagnostic laboratory testing in refugee populations is a good start. We need to get a better understanding of the scope of the problem. We should be ready and able to provide specific recommendations for meeting diagnostic needs in these populations including most appropriate diagnostics given clinical needs, infrastructure, and available treatment options. The road toward a solution will include global collaboration, research, and advocacy.

 

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Sarah Riley, PhD, DABCC, is passionate about bringing the lab out of the basement and into the forefront of global health.  

IRBs and Public Health Pathology

Hello again! Welcome back to my latest check-in following my progress with Zika risk reduction and public health outreach. Partnering with the Sint Maarten Ministry of Health through my medical school has provided amazing resources to take a look at social determinants of risk under the purview of public health, integrating both medical sciences and community service.

Early on in this project, I discussed the early stages in conceiving and planning these public health works in my first post “An Arbovirus Abroad.” This of course seemed like the perfect name for the proposal my team and I authored at the end of our first semester together. Done under an elective service credit, our full Internal Review Board (IRB) proposal for research within the community was called “An Arbovirus Abroad: a Service Learning Project Exploring Public Health Outreach, Social Determinants of Health, and Partnerships with Local Government to Address Zika Virus Knowledge and Community Outcomes.” The goals were to strengthen our partnership with local government offices as we aligned our efforts with reducing infectious risk and addressing community knowledge and attitudes regarding Zika.

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Figure 1. Title Page of original IRB/Research Project Proposal under G. Jackson, Ph.D., Assistant Dean, Community Affairs and Service Learning at AUC School of Medicine

After we secured IRB approval, we began work quickly. Holding meetings with the Ministry’s representative consultant for their office of Collective Prevention Services (i.e. vector control) and scheduling the remaining work for the semester. With five new members of the “Z-Pack” we established a loose timeline with our advisor. Our new goal: integrate what we learned last semester and bring it to a conclusive change within the community.

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Figure 2. Title card from initial briefing meeting with members of the Z-Pack, including coordinating partner from the Ministry of Health (CPS office) Mr. G. Davelaar.

This integration of knowledge from literature review/research, evidence-based best practices, and forward moving progress are all things those of us in the medical laboratory profession are quite familiar with. Getting IRB approval for a lab-centric project is quite involved and requires meticulous proof and substantial support to posit any claim to the benefit/risk ratio involved with human or animal subjects. I remember from my own graduate and undergraduate research that without heaps of evidence, you will be hard pressed to continue in any direction. While public health is a different science, the basis on evidence-based research is still present. During our initial assessments, literature reviews, and brainstorming, the “Z-Pack” went through hundreds of scientific articles covering everything from infection control precedents, to social behavioral change, and even the use of media and fear to illicit change.

Laboratory scientists know the impact of their work, though it may not always be the most evident to the general public. The near 70% of diagnostic information that comes from our work, and the virtual entirety of neoplastic diagnoses rely heavily on our training, skill, and certified competency in evidence-based practices. ASCP has a long-standing mission of advocacy for patients in the way its members and affiliates represent the profession at large. I believe that having those years of experience under my belt and those letters behind my name give me a head start when executing translational research. Going from raw data, analyzing it, and bringing it to life is something we all inherently train to do—and do well!

So, up to date, my team has secured two measures to contribute to our research. First, we gave an educational presentation to a community after-school program in one of Sint Maarten’s endemic regions. We had tailored a wonderful presentation I discussed in a previous post which caught the eye of the Ministry of Health and has spread to numerous places around the island under their sponsorship. With the same success, we managed to reach school-aged children in an engaging way about Zika, their health, and source reduction. Our second event is slated for this weekend where we have partnered with the Muslim student-interest group (MSA) on campus to go with them on their routine visit to a local mosque on a school-sponsored student service day we call “Community Action Day.” While the MSA students engage with their local community, the “Z-Pack” will conduct a two-part effort: to conduct a grounds-inspection for source/vector control around the mosque, and deliver a presentation for both children and adults regarding Zika prevention behavior.

How do those two events connect with my theme of evidence-based lab scientists? Well, one of my engagements when at Northwestern Medicine was to teach a course discussing transfusion protocols and laboratory information to clinical nursing staff. Presenting information, or teaching people, new ways to think about their environment at work or home is a part of being interdisciplinary. I was able to speak with medical jargon to the clinical staff, but with the children I have to use my ability in translating medical knowledge to understandable facts while also keeping the audience interested. My team proved in our last school-aged project, that when children are engaged and enthusiastic about something they have learned, they will take those messages home with them and hopefully contribute to a positive outcome. As for the second example, what could be more directly appropriate for lab folks to understand here: a surprise inspection! Sure, no one’s losing any accreditation points here, but the fact remains that we all have experience from one side or another making sure that things are up to code on pre-determined conditions and protocols. We have an SOP from the Ministry regarding the items of inspections as they relate to source control, so translating them to a new site should prove interesting.

I’ll close this post off with an interesting piece recently posted by Ms. Susan M. Lehman, MA, MT (ASCP)SM where she discussed learner (i.e. student) experiences. She talked briefly about how online curriculums and other lab-skills courses may rely on more independent learning, changing the expectations of students. One of her students summarized it positively saying, “you get what you put into it.” That’s what I think about the service elective my work is associated with. It could be simple directed readings with great discussions, but what my “Z-Pack” team has and the skills we each bring to it have made the project and its partnerships exciting.

Thanks for reading!

 

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Constantine E. Kanakis MSc, MLS (ASCP)CM graduated from Loyola University Chicago with a BS in Molecular Biology and Bioethics and then Rush University with an MS in Medical Laboratory Science. He is currently a medical student at the American University of the Caribbean and actively involved with local public health.