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

Global Outreach and the Laboratory

Just like in any profession, laboratory medicine faces challenges that are universal to any almost any lab, anywhere. Those familiar with laboratory medicine will recognize these challenges: inadequate resources in labs and in medical technology schools; communication difficulties between lab staff, clinicians and others; patient education; and personnel shortages.

Those who practice laboratory medicine in the developing world know these challenges and more. Poor or non-existent electricity supplies mean that automated machines are not an option, temperature regulation of samples is unreliable, and working conditions are excessively hot.  Lack of quality roads and transportation options make specimen or patient transport difficult and supplies hard to obtain.  Few educational opportunities mean that lab workers do not receive adequate training or opportunities to practice hands-on skills before working in a lab. Current laboratory employees have few resources with which to improve and refine their skills and learn about the latest research and technology.

The Center for Global Health at ASCP has been working to improve medical laboratories in the developing world since 2004.  By providing continuing education training to professionals, assisting schools with the revision of their curriculum, and purchasing needed laboratory supplies the Center for Global Health has touched thousands of individuals and labs around the world.  You can read more about their work and find additional stories here.

Every month on this blog, I’ll explore the world of laboratory medicine in the developing world.  I’ll also discuss topics such as equipment maintenance (how do different climates affect equipment functionality?), development aid (how do non-profits and other forms of aid impact changes in the lab?), and communication with the clinician (how does this work in a non-digital world?), among others.  I hope to provide a few interviews of those working on the ground in the developing world and am open to your questions to guide our blog ‘conversation’.

-Marie Levy