FEATURE
Most public health laboratories across the US share the same challenges , such as lack of sustained funding and worries over staff recruitment and retention . But laboratories in more rural areas and remote locations , or in large states with sparse populations , have their own unique set of challenges . These circumstances often necessitate ingenuity , independence and creativity .
Before Tim Southern , PhD , D ( ABMM ), became director of the South Dakota Public Health Laboratory in 2015 , he worked in the Omaha , Nebraska , state laboratory though a fellowship with the American Society for Microbiology .
“ There are as many people in Omaha as there are in the entire state of South Dakota ,” Southern said . “ And the rural nature of South Dakota really changes the dynamic of service delivery . In South Dakota , we are highly resource limited , and our laboratory is geographically in the center of the state , hours from our major urban centers .”
Resource limitations have made the laboratory staff “ fiercely independent ,” Southern said . “ We cannot order the kinds of supplies that other laboratories might order and get next-day delivery .” In addition , the staff tends to make most of their buffers and media and service their own equipment . “ It ’ s very difficult to get technicians in Pierre ,” he said . “ They either have to drive a long way or they have to fly through our local airport that only has two flights a day .”
“ When you ’ re dealing with a small state with a geographically dispersed rural population , you make do with what you have ,” said Michael W . Edwards , PhD , HCLD ( ABB ), director of the New Mexico Department of Health Scientific Laboratory Division . “ You typically
When you ’ re dealing with a small state with a geographically dispersed rural population , you make do with what you have .”
Michael W . Edwards , PhD , HCLD ( ABB )
have less money than everyone else . You get less money from the [ federal government ], and if you want to be successful , you have to sort of punch above your weight class . You just find creative ways to make things happen .”
Finding a Way to Reach All Citizens
Scott Shone , PhD , HCLD ( ABB ), director of the North Carolina State Laboratory of Public Health , can relate to the need for creativity . While North Carolina might not be as sparse as South Dakota , the state has a diverse geography and some very rural locations . “ Some of the places we serve have a sizable population living in unincorporated areas ,” Shone said .
Shone spent the first 12 years of his career in the New Jersey Public Health and Environmental Laboratories ( including a year as an APHL Emerging Infectious Diseases Research Fellow ). The two laboratories differ in a variety of ways beyond the population and geography .
“ They differ just in the way public health is structured and how different groups rely on state public health for public health services ,” said Shone , who joined the laboratory as director in 2019 . “ North Carolina has a decentralized system , so the local health departments are critical in the decision making and the provision of services for their constituents . The state public health laboratory perspective is we are a service provider to those local health departments who know and address the unique needs of the populations they serve .”
This requires the public health laboratory to embrace flexibility , he said , particularly because the Outer Banks islands , the Triad that includes the capital city of Raleigh , and the Blue Ridge Mountain communities in the west don ’ t have the same needs .
With this in mind , last year the public health laboratory and the state ’ s Department of Administration ( DOA ) created a courier service specifically for the laboratory . Historically , the laboratory was required to use DOA as its mail service courier , but that service wasn ’ t designed to meet requirements by the Clinical Laboratory Improvement Amendments ( CLIA ) or the US Environmental Protection Agency ( EPA ), Shone said . Plus , DOA was concentrated on the center of the state , so the laboratory used UPS to reach the farthest parts of the state . But UPS didn ’ t visit every location every day , and specimens didn ’ t always arrive meeting regulatory testing requirements .
Shone ’ s team approached the DOA in 2021 to see how to improve the system . “ My goal is that no matter where you live in the state of North Carolina , if you rely on your local health department for care that the state laboratory of public health is going to provide the best possible laboratory service we can ,” Shone said .
The laboratory was approved to contract with a private courier for about 18 months , as DOA and the laboratory partnered to build the laboratory its own courier service , which launched in 2023 . “ It has been a great collaboration between different agencies of our state government ,” Shone said .
Now , DOA medical courier service drivers visit 109 locations in 99 North Carolina counties every single workday . The drivers collect the clinical and environmental samples , store them properly during transit , and deliver them to the public health laboratory in Raleigh by 11 PM the same day .
“ That allows us to ensure continuity of that sample quality to comply with CLIA and EPA and any other regulatory entities ,” Shone said . “ It ’ s been great , and having it be part of a state agency is very helpful because there is a shared mission to serve the citizens of North Carolina .”
Working with Underserved Communities
By definition , public health laboratories are a part of the larger public health mission to protect and improve the health of all people . This includes working with and for underserved communities , which in more rural areas of the country often means people with lower socioeconomic status . Rural residents across the US have lower incomes than those in urban areas , and rural areas have higher overall poverty rates , particularly among racial
10 LAB MATTERS Fall 2023
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