Monday, 07 August 2017 14:45

Have Microscope … Will Travel

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Every summer I get questions from laboratorians—clinical microbiologists and others—about volunteer opportunities for laboratory capacity-building in underserved areas. Summer seems to be the time that many of us can afford some time away from our work. Some people wish to travel overseas. Others wish to remain within the United States. Either way, there are many exciting opportunities to get involved with clinical laboratory improvement around the world.

Traveling microscopeClinical Laboratory Work in Indonesia. Photo courtesy Audrey Schuetz.

I didn’t think in the past that there would be opportunities for opportunities to apply Pathology or Laboratory Medicine in underserved areas. As a student with an eye on overseas work, I wanted to choose a career that would be easily adaptable to underserved areas. While rotating through Pathology and the various laboratory benches as a medical student, I sometimes found it hard to envision how relevant my training in Laboratory Medicine could be to work in resource-limited areas. I was learning advanced molecular techniques, such as real-time PCR, on intricate instruments and wondered how suitable these instruments would be in resource-constrained areas. The basic clinical training of an Infectious Diseases doctor seemed more fitting to this particular career goal. Therefore, Infectious Diseases/Internal Medicine was my initial choice as a career path. However, in the end, I decided that the Clinical Microbiology laboratory was really where my heart was.

I’ve since discovered that there are many opportunities for laboratory capacity-building in resource-limited settings, especially for microbiologists. For instance, by improving the accuracy of cryptococcal antigen testing through laboratory training, I’ve seen higher confidence given to these laboratory results by the treating clinicians. Higher quality laboratory testing leads to an increased laboratory presence in the hospital system and ultimately higher quality patient care. Also, more molecular sample-to-answer testing platforms are becoming available and are relatively easy for laboratories in resource-limited areas to adopt. Opportunities exist in all areas of laboratory medicine—from microbiology to chemistry to transfusion medicine.

What are some “positives” about volunteering?

  • You can definitely make a difference. Depending where and in what manner you volunteer, you may be training people with very limited experience in the laboratory. During one of my first overseas laboratory experiences, I was training the custodian/caretaker of the hospital who also served as the laboratory worker and had no formal laboratory training. Some of the basic tenets of laboratory medicine are just as important as covering more complex concepts.

  • Ample opportunity exists for creativity (… and flexibility). Limited economic resources in many countries may require getting back to laboratory basics. As an example, when working abroad, I’ve often had to figure out how to prepare recipes for microbiologic stains with very limited laboratory equipment consisting of a few beakers, one graduated cylinder and the cook’s stove.

  • Opportunities vary by level of expertise and training. Although some programs target fully-trained microbiologists, others welcome microbiologists-in-training or students in undergraduate school, graduate school, or medical school. A student may be assigned to aid in training of a particular procedure, while a fully-trained microbiologist may be assigned to performing a full laboratory inspection.

  • You meet and learn from others. We learn the most through training and teaching others. It’s helpful to see your own approach to the laboratory through someone else’s eyes, and it’s often useful to bring back practices and questions to your own laboratory and to reexamine your own approaches. Plus, it’s always fun to meet new people, try new foods, and see new sights!

What are some of the opportunities available?

  • Introduction of diagnostic tests to healthcare clinics or laboratories. This is perhaps one of the easiest areas for us, since many of us bring new tests into our own labs and are familiar with this process. However, it is also one of the most challenging, since we aim to provide sustainable testing processes that can be used in the laboratories long after we leave. Therefore, working with the laboratory and institution to find the most appropriate test to introduce is one of the most important steps. For instance, a laboratory may ask for implementation of mycobacterial susceptibility testing because of a perceived increase in rates of clinical treatment failures, but you may find out that the advance most needed is to set up quality control for their acid-fast bacilli staining procedures.

  • Training laboratory technicians, technologists or other healthcare workers in general laboratory techniques or specific assays. In order for the laboratory updates and changes to remain sustainable for that particular laboratory, proper training is crucial. Donations of complicated equipment to overseas labs are often welcomed by the recipients. However, in order for that equipment to remain sustainable over the long term, training in use of the assays and in maintenance of the equipment is paramount.

  • Laboratory assessments to prepare for accreditation or prioritization of “quality gaps.” Some laboratories are pursuing accreditation and appreciate the feedback on process improvements, while others are looking for prioritization of quality gaps that can be addressed over time.

Whom should I consider contacting? For a start, some organizations are listed below.

  • American Society for Microbiology (ASM). ASM has a program aimed at laboratory capacity-building overseas, called LabCap. This program provides technical assistance in clinical microbiology in resource-constrained countries. Microbiologists serve as consultants for various LabCap projects, which include strengthening quality management systems and assuring quality testing. ASM is working with the Centers for Disease Control and Prevention (CDC) Global AIDS Program to build global HIV and clinical microbiology laboratories worldwide in support of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) initiatives. Benefits and responsibilities of volunteers and consultants for ASM International can be found here.

  • American Society for Clinical Pathology (ASCP). ASCP has opportunities for volunteering globally through ASCP’s Center for Global Health. ASCP also has a cooperative agreement to support laboratory training and quality improvement in the laboratory through the PEPFAR initiative and works with local ministries of health, education institutions, and national reference laboratories to determine each country’s needs and tailor the aid to target those needs. Frequently asked questions and detailed instructions on applying for consideration as a volunteer or consultant can be found here.

  • Diagnostic Microbiology Development Program (DMDP). DMDP also has opportunities for clinical microbiology volunteers from the United States who wish to work with and train laboratory staff in resource-poor countries. DMDP was established in 2008 and currently supports microbiology laboratories in Cambodia. The website and contacts can be accessed here.

The above represents the opinions of Dr. Audrey Schuetz, and is not necessarily representative of ASM.

 

Last modified on Friday, 25 August 2017 16:27
Audrey Schuetz

Audrey Schuetz is Associate Professor of Laboratory Medicine and Pathology at Mayo Clinic College of Medicine and Science in Rochester, Minnesota. She is a pathologist and microbiologist. She enjoys studying antimicrobial resistance, anaerobes, and Infectious Diseases pathology. You can follow her on Twitter at @schuetz_audrey.

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