Lab Matters Fall 2016 | Page 11

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Although Diallo says government leaders see the need for coordinated disease surveillance, this lower middle income nation of 12.6 million— 42 % under age 15— faces many challenges.“ During the last two years, everyone was geared just to Ebola,” said Diallo.“ They forgot there are other diseases,” such as TB, malaria, dengue fever, schistosomiasis and diarrheal diseases.

The country’ s Laboratoire National de Santé Publique, part of the Ministry of Health( MOH), needs assistance. Said Diallo,“ If you look at a picture of that laboratory, you would weep.... It went for 50 years without any infusion of money of any kind.”

Yet, important work has already taken place. This past March, APHL organized a four-day workshop addressing biobanking, biosafety and biosecurity— real concerns in a country with“ too many Ebola specimens” left behind by international responders. In the spring, workers from eight regional hospital laboratories, four national hospital laboratories and the Laboratoire National de Santé Publique attended an APHL-organized workshop on quality management systems. In September, Guinea’ s first laboratory quality manual was presented to the MOH. And an effort to train African engineers to certify laboratory biosafety cabinets is ongoing.

Work in Kenya— a lower middle income nation of about 46 million— has progressed beyond the basics. The National Public Health Laboratory in Nairobi boasts five reference-level, sub-laboratories that test specimens coming from hospital labs in Kenya’ s 47 counties. APHL’ s latest project here, still ramping up, will focus on training and technology for identifying microbial markers of antibiotic resistance.

This level of sophistication is important in a region known for emerging pathogens. A 2004 chikungunya outbreak here spread to the Indian Ocean Islands and from there to parts of Europe, before crossing the Atlantic Ocean and precipitating a massive outbreak in the Caribbean in 2013-2014. Since then, local chikungunya transmission has been documented in Texas and Florida.

We don’ t want information islands. From the patient’ s point of view, it should be one system.

Dr. Alpha Diallo, APHL Guinea country lead; Lucy Maryogo-Robinson, Director APHL Global Health Program; Scott Becker, Executive director, APHL; with Guinea Department of Defense representatives

Dr. Alpha Diallo discusses guidelines for Guinea’ s public health laboratory

In addition, the MOH has established a separate Directorate of Laboratory Services and a national agency for health security. Although routine disease surveillance is only just beginning, there is a weekly meeting for national epidemiologists, laboratory leaders and other public health partners to review communicable disease data supplied by Guinea’ s regional hospitals( run by the MOH).

The next items on Diallo’ s to-do list are reviewing the needs of the Laboratoire National de Santé Publique to increase diagnostic capacity; to“ participate in the revival of laboratory services” in one of the national hospital laboratories in Conakry, the Guinean capital; assessing the training curriculum proposed for Guinea’ s first continuing education school to“ make laboratory technicians into laboratory technologists”; and identifying a resident molecular microbiologist to work at the national Hôpital Ignace Deen and Laboratoire National de Santé Publique, both in Conakry.

Above all, said Diallo,“ We have to be able to support epidemiological surveillance.”

Kenya—“ We don’ t want information islands”

Three thousand miles east of Guinea, below the Horn of Africa, Edwin Ochieng, MBA, is also considering the needs of a modern public health system.“ We don’ t want information islands,” said Ochieng, APHL’ s in-country lead consultant for Kenya.“ From the patient’ s point of view, it should be one system.”

Altogether, the association has been involved in projects in Kenya for about ten years, initially supporting the development of a national laboratory strategic plan and helping to implement electronic laboratory information management systems( LIMS) in select facilities, beginning with the HIV, TB and microbiology reference labs within the National Public Health Laboratory and progressing to large hospital labs in Mombasa, the Rift Valley and Coast Province. In all, the association has provided technical support for LIMS implementation in 14 major laboratories.

Said APHL consultant Rufus Nyaga, BBIT,“ We’ ve been able to integrate LIMS with laboratory equipment, so test reports are automated and there is improved turnaround time.”

Moreover, he said,“ We’ ve also been able to integrate LIMS with external systems. Remember, the LIMS is in the laboratory. But now it is linked to the doctor’ s office. By the time he is walking to the laboratory, we already know the patient is coming. When the test is done, the result goes to the doctor’ s health information system.”

The turnaround time for virologic tests— from sample receipt to results reporting— was once as high as 90 days. Today it is three.