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 .