Internationally Thankful

Settling into November, fall is “in the air” and in the United States we all start to think about most everyone’s favorite holiday, Thanksgiving. I’ve been fortunate to have traveled to many places both for work, for volunteering, and for pleasure—and I always come home “thankful” for the people I’ve met.

Relationships with people are what matter most to a consultant. And over many years I’ve enjoyed reinforcing my belief that people are the same everywhere—our differences are so small compared to our similarities. We all laugh, we cry, we share with friends, we want the best for our families, we celebrate life and mourn death, we strive to do meaningful and challenging work that makes a difference, we seek to understand life and have moments of personal reflection when we look in the mirror. The fact that we do it in a myriad of languages, wearing different clothing, eating different foods and honoring different holidays and beliefs, coping with different weather and available resources are all just part of the platform.

A feast in any country, any language, any culture is a celebration, a way to say “welcome—come and share—you are friend and family”. Celebrating our holiday of Thanksgiving, it is very easy for me to say “thanks for what international work gives” to all of us! I’d be happy to share some “feast favorites” with you, just send me an email at bsumwalt@pacbell.net . But the real treat is the smiles!

Blog 10 Celebrating with the Batwa
Celebrating with the Batwa

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My good friend Matthew in Namibia

Cheers,
Beverly Sumwalt

Never a Dull Moment

As an international laboratory consultant, there is never a dull moment.  One minute you are working with energized people from another country engaged in spirited dialogue, learning and sharing experiences—and the next you are up very late with your team colleagues in a smoke-filled hotel lounge with multiple computers plugged into walls trying to capture information into an assessment template not designed for the technically challenged.  It’s better than Sudoku for mental exercise!

I recall one trip where the biggest challenge was keeping our notes and information straight.  We were scheduled to visit two laboratories on the same day; small but relatively full service labs, so there was much to review, discuss and digest in order to understand their capability and progress.  Some people can type notes into a laptop, but I find that a pencil and paper are the most useful tools. Working with people, making eye contact and facilitating interactive discussion provides a backdrop for what you are able to observe.  After a walk-through and overview, questions and comments, log reviews and notations it is imperative to elaborate on your notes and add comments immediately after an assessment visit.  Believe me, after 6 laboratories in 4 days covering >1000 miles, they can very easily “all run together” if you are not careful and diligent.  Laboratorians  tend to be overly organized and a bit obsessive about documenting things—it’s the nature of the beast, since we live our career lives in data production and information dissemination—and it has to be correct, all the time, for every patient. I smile as I remember many nights on that trip with my ASCP colleague Wendy, plugged into the wall in a deserted hotel lobby and barely able to see the computer screens as we compared and contrasted assessment scores late into the night before getting up before dawn to take off and do it all over again.  Well, it was all in a day’s work!  She and I will both admit to wishing we’d had a little more sleep, and we would also tell you we wouldn’t have missed it!

So if you find yourself up late at night studying, preparing for a presentation, catching up on journals or even waiting for a teenager to get home at the appointed hour, I recommend keeping a hot cup of tea and some local chocolate near at hand.  I can highly recommend chocolate from Kazakhstan, and also from Namibia— contact me at bsumwalt@pacbell.net and I’ll send you the name of my favorite brands.  But even if you can’t read the label, the pictures are all you really need!

Blog 9 Working Late

 

Cheers,
Beverly Sumwalt

Adventures in Travel–A Very Spooky Moment

Coming up to All Hallows Eve reminds me of a very “spooky” moment with my passport; one that illustrates the odd and scary things that can happen when you are overly “travel tired.”

It’s said the longest flight on the planet is flying from the east coast of the United States to Johannesburg, South Africa.  I’d have to agree; no matter how you book it the flight is over 19 hours in the air, non-stop. It’s a bit of a flying marathon, and makes you a little mentally and physically fatigued just getting there.

I was on my way to Namibia with very tight connections (always a little stressful) and on arrival in Jo’burg I had less than an hour to catch the last flight out to Windhoek.  Our schedule for two weeks of laboratory assessments had been carefully arranged and there was no room for error in the schedule—so I HAD to make that flight.  If I missed it, I would be responsible for throwing the entire schedule off and so the pressure was “on.”

As I got off the plane there was a bright young man in an airport vest asking if he could help anyone.  I told him I had a very close connection and didn’t know where I was going, but had to catch the flight to Windhoek.  His eyes got big as he looked at my boarding pass, and said, “Come this way madam, you must hurry, they will be leaving and we have a long run ahead”.  Of course!  He grabbed my suitcase and headed out, I followed with a fuzzy brain and very wobbly legs from sitting so long.  We reached the ticket gate (me gasping for air) and they said “Sorry, we have closed the desk for that flight.”  I was obviously ready to come un-glued, and he said quietly, “Do not worry madam, I have another way to get you there—give me your ticket and passport, and I will run ahead and be sure they don’t leave you—please follow me as quickly as you can!”  In a stupor of exhaustion, I handed him my boarding pass and passport.  He jogged ahead and out a side door marked “Do Not Enter—Tarmac Employees Only” and held it open for me to follow, then ran.

Now you might be saying, “Are you kidding me? You handed a young man built like a Kenyan marathon runner your PASSPORT and BOARDING PASS? And went running across the restricted tarmac??  Which South African jail will we find you in?!”  Well, yes, I did…and when that realization found its way to my conscious brain I kicked it up a notch and ran harder, determined to keep him in sight even if I couldn’t catch him!  We jogged under the belly of two huge planes, around luggage carts, through a garage and a tunnel, and headed straight for a large bus just closing the doors to take a load of passengers to the Windhoek plane.  He waved and shouted and ran in front of the bus…forcing them to stop, waving my passport and boarding pass wildly over his head.  He and the security guard on the bus had a robust and heated discussion while he blocked the closing door and threw my suitcase on the bus. Just as I breathlessly caught up he said, “Madam, they are taking this group to your plane, please hurry to get on…are you OK?”  Completely breathless, I could not answer but shook my head “yes” and could have hugged him.  In some moment of clarity, I reached into my vest pocket and handed him the two twenty dollar bills that I keep there—he refused, saying “No, no madam, this is my job to get you safely to your destination!”  I pressed them into his hand and said, “You have helped me more than you know, thank you for your kindness, do something nice for you and your family, please!”  The bus door closed, the security guard frowned and called me some Swahili name I have yet to translate, and we chugged to the plane.

Suddenly realizing what just happened, I scared myself enough to be very wide awake all the way to Windhoek…

So travel fans, if you are ever on the long journey to Jo’burg, I recommend a very strong cup of coffee on the last leg of the flight.  I personally like coffees grown and harvested in Africa…but any cup will do to help you avoid a fatigue-inspired “spooky passport adventure.”  If you want a few recommendations on wonderful coffees, contact me at bsumwalt@pacbell.net, and let’s have a round of applause please for a young man who works in the Johannesburg airport for his integrity, his smile and his unparalleled customer service!

Cheers,
Beverly Sumwalt

The Importance of Global Outreach

In the wake of the September 21st shootings and hostage takings at the Nairobi Westgate Mall I have found it difficult to write about the minutiae of laboratory medicine and the details of running a laboratory in the developing world. Instead, my mind wanders to my own personal experiences in Kenya and Nairobi and the people I have encountered in my travels.

In all my times on the African continent I have only been to Nairobi twice (not counting transiting through the airport, which would take the number up to at least ten). My first time in Nairobi was for one day as I made my way to a six month volunteer position in Tanzania. I landed at the Nairobi airport, an intimidated 25-year-old, all alone. I was scared and nervous but incredibly excited. My memory of the city that time is hazy but I can still smell the distinct scent of the air upon exiting the airplane, and I can still feel the knot of nervous excitement in my stomach.

By my second trip to Nairobi, years later, I was much more accustomed to East Africa. This time I was there with an ASCP colleague and volunteer to conduct laboratory assessments at level I and II labs throughout the city. We spent a week driving all over Nairobi and the surrounding suburbs visiting multiple labs. We saw a lab being run out of a container, and another that was inaccessible by car, it was so tucked away in one of the poorer areas of the city that the road was too narrow for anything but foot traffic. We saw labs in desperate need of basic supplies and electricity. We met lab techs who were working hard to do their best with the few available resources.

As we drove around the city we not only had the opportunity to visit these labs and conduct our assessments but, while mired in the worst traffic jams I have ever experienced, we had time to observe the city. We watched women and men working, shopping, socializing; children playing, and running to and from school. We saw an energetic city with millions of people going about their daily lives. People who I imagine are touched by this tragedy. People I have been thinking about these past couple of weeks.

While my heart breaks for those who suffered and lost loved ones, a tragedy like this reminds me why the work of global outreach is so important. With injuries (both catastrophic and not) the lab is an important part of overall health care. A situation like this reminds us of the importance of having well-run, safe, accurate blood banks to treat the wounded and sick.

-Marie Levy

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