On the HIV/AIDS Frontline
Posted on: Thursday, 1 May 2008, 03:00 CDT
By Anonymous
Many clients refer to the Makerere University-Johns Hopkins University (MU-JHU) Core Laboratory as "family" because they have known some techs who have been there since its inception in 1988. The lab is located at Mulago Hospital complex in Kampala, capital city of Uganda - a country once ruled by Idi Amin, with 25 to 30 million citizens from at least 18 distinct ethnic groups, a similar number of languages, and several religions. Five teams made up of 45 professionals comprise the total workforce: technical teams for two shifts, as well as processing, data-entry/lab-support, QA/QC, and administrative teams. The lab operates at least 14 hours daily during the work week, as well as on weekends and all holidays. With prior notice, a clinic or study needing services outside working hours can have technical lab staff available. The lab's two main bench teams relay activities one to another via hand-over forms, while two runners transport items among clients within walking distance of the lab, equipped with two-way walkie-talkies for constant communication with the lab and clinical areas it serves. The MU-JHU Core Lab has a reputation for uncompromising standards of quality and excellent service in a developing country where sustained provision of basic infrastructure such as electric power and transportation is not always dependable. In the event of lab- operation interruptions, the lab collaborates in the areas of equipment maintenance, reagents supplies, operational policies, and back-up services with a number of organizations, laboratories, vendors, and stakeholders in the Ugandan Health Service.
"We are one of the busiest medical labs in Uganda, processing an average of 16,000 tests monthly. Although perhaps not a high number in comparison to U.S. labs, given the local environment and lack of fully computerized systems, our testing volume is fairly high for local laboratory standards," says Elbireer.
The Core Lab imaginatively handles often-meager resources to confront challenges such as finding suitable lab space, increasing costs for lab tests and supplies as well as fuel, and meeting staff- development needs. Without space for file cabinets, the data department bought and stacked locally made metallic cases for archiving records chronologically for easy retrieval. To help meet professional-development goals - given the limited funds for attendance at external programs - a scheme for monthly presentations allows staff members to share professional training, technical challenges, and academic reviews.
In 1999, without financial resources to purchase a comprehensive laboratory information system, the MH-JHU lab staff procured a "homemade" system to which the team keeps adding enhancements to improve productivity. Although LIS interface for automated instruments is a standard American lab practice, the Core Lab (now working with an LIS software company, along with their LIS manufacturer) will create an interface link with its automated instruments to ensure accurate, timely results with reduced turnaround times in order to eliminate data-entry errors. The lab now uses four different quality-assurance data-review levels before releasing results to clients. The lab created LIS downtime procedures because of the fluctuating electricity supply, and to get a technical rep for preventive maintenance or repair on lab equipment can take up to four weeks. Having two of each analyzer or instrument is part of the lab's back-up contingency plans in case of any failures.
Nonetheless, the Core Lab has been accredited by the College of American Pathologists (CAP) since April 2003 and ended its June 2007 CAP inspection with a perfect score (i.e., zero deficiencies). The MU-JHU Core Lab is one of only three labs on the African continent accredited by the CAP. Presently, no laboratory licensing or accreditation is available or required in Uganda, but MU-JHU lab leadership decided to attain the highest world-class laboratory quality standards available.
It is hard to talk about health in Uganda, or Africa, without mentioning the HIV/AIDS plague. After the Ugandan government recognized the HIV/AIDS pandemic threat and spearheaded efforts towards prevention, prevalence rates have gone down from more than 20% to 7%. Uganda is a rare success in Africa in the face of a severe AIDS crisis. The Core Lab's most important contribution to patient care has been its landmark clinical trial, which resulted in a more than 50% reduction in mother-to-child HIV transmission using single-dose Nevirpine. Nationally, the Core Lab validated the current HIV rapid-testing algorithm used by all Ugandan government lab facilities. It also serves as a center-of-excellence training site for clinical and lab personnel needing to monitor patients on HIV treatment. Because a CD4 count is an essential part test at HIV diagnosis, and should be repeated about two to eight weeks after starting or changing anti-HIV therapy and every three to six months if treatment is maintained, the lab undertook an effort to find a reliable, cheaper CD4-testing method for limited-resource settings. It hosted a research study, testing CD4 count utilizing three different methods to establish the level of accuracy, reliability, and value. Today, HIV/AIDS patients all over the world are benefiting from outcomes of laborious yet quality work of the dedicated MU-JHU Core Lab staff.
In addition to performing many tests in chemistry, hematology, serology, urinalysis, flow cytometry, parasitology, pharmacology, and molecular pathology, the lab offers clinical and research lab services to over 72 different research studies, hospitals, and clinics.
"Laboratory performance -tests, consultations, support - has remained a wonderful island of consistency in a sea of medical change. Thanks to the folks that make it happen."-Barbara Harty- Golder, MD, JD, Pathology-Attorney Consultant, Chattanooga, TN.
"Being the very best that they can be ... providing exceptional service while delivering personalized care to patients and staff... just two ways of describing so many clinical laboratory professionals! Are we really this good? YOU BET! Confirmation of this is provided by three teams of superheroes whose steadfast commitment to quality, provision of exceptional service and evidence of remarkable resourcefulness in times of limited budgets and manpower merit their recognition as MLO's Outstanding Laboratories of 2008. Congratulations and praise and blessings to you all!"- Sharon M. Miller, PhC, MT(ASCP), CLS(NCA), Professor Emeritus, Clinical Laboratory Sciences, College of Heatlh & Human Sciences, Northern Illinois University, DeKalb, IL.
When he heard his lab won as 2nd Runner-Up this year, Nominator Ali Elbireer, MT(ASCP), MBA, immediately took photos of the staff with bright smiles and thumbs up.
"As clinical laboratory personnel you must be proud of the fact that you create the vast amount of information in each individual's medical record and equally awed by the responsibility that rests upon your shoulders."-Leland Baskin, MD, FCAP, Division Head, General Laboratory, Calgary Laboratory Services, Calgary, AB, Canada
"Continue to keep the quality high. That next sample comes from somebody's loved one. Congratulations on the great and dedicated work that you do every day."-Christopher S. Frings, PhD, CSP, President, Chris Frings & Associates, Birmingham, AL.
Our esteemed MLO Editorial Advisory Board Members who served as judges for the Medical Laboratory
of the Year 2008 Award are:
Daniel M. Baer, MD
Professor Emeritus of Laboratory Medicine
Oregon Heatlh and Science University
Portland, OR
Christopher S. Frings, PhD, CSR
President
Chris Frings and Associates
Birmingham, AL
Sharon M. Miller, PhC, MT(ASCP), CLS(NCA)
Professor Emeritus
Clinical Laboratory Sciences
College of Health and Human Sciences
Norther Illinois University
DeKaIb, IL
Copyright Nelson Publishing Apr 2008
(c) 2008 Medical Laboratory Observer; MLO. Provided by ProQuest Information and Learning. All rights Reserved.
Source: Medical Laboratory Observer; MLO
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