September 09

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Small Changes Save Lives

I am gratified and proud to announce that the new Generator is here at the TLI lab in the Bonsaaso cluster of Ghana, and that I was able to facilitate the expedited funding, delivery and installation of the unit, which is critical to lab performance since there are power outages every day.  Thanks so much to Yanis and Sonia at the Earth Institute, and Sam, Frances and Boahen here in the Ashanti for all of their work in providing the lab with such an important piece of equipment. We used it on the very first day! You might wonder how or why a generator would save lives or why is a diagnostic lab that important? Without power the lab cannot run the microscopes, and without lab support the clinics cannot provide adequate medical care to the underserved communities.  I have 3 examples from the past 2 weeks:

1)  A woman came to the lab from the Tontokrom clinic across the street with complaints of lethargy and she was pale and several months pregnant.  The lab results we ran showed her to be quite anemic, but also that she had extremely high bilirubin and ketones in her urine, indicating she was in pregnancy toxemia/ketosis.  Although she was negative for hepatitis, her Hemoglobin had dropped in half in only a few weeks suggesting that the icteric serum and urine may have been caused from hemolysis as well as liver complications. Atta from the Lab staff escorted her back to the clinic and discussed the alarming results with the midwife, and instead of being sent home under symptomatic care (which would have been the routine), she was instantly sent on to the district hospital for care. Both the severe Ketosis and rapid decrease in Hgb are a medical emergency for the mother and fetus, so whatever the final etiologic diagnosis, the lab probably saved their lives.

Example 2) A near term pregnant woman with very low Hgb and positive sickle cell disease was diagnosed at our lab, and she also needed to be referred to the district hospital 25 miles away, but due to no/low blood suppy at St. Martin’s hospital, they  requested that she bring a blood donor with her. She found a friend and we quickly screened him in real time (less than a half hour) for HIV, syphilis, hepatitis and of course blood group (fortunately they were both O positive and he was negative for all!). They jumped on the Trotro bus and headed off to Agroyesum to await delivery of the child. That is 1 patient out of 4000 in a year (most all of whom are positive for malaria to one degree or another). This generator will save lives and will be my lasting legacy in Ghana.

Example 3)  A young woman visiting one of the clinics complained of abdominal pain and vague symptoms including dark urine.  While most of her labwork was normal, her urinalysis showed heavy red blood cells and leukocytes, including neutrophils.  Careful microscopic examination of the urine sediment revealed a single schistosoma hematobium ova.  Bihlarzia shistosomiasis is a condition that occurs frequently in rural Ghana, and is from a parasite than enters the skin from standing water.  Men and women in the rural areas work in gold mines, frequently standing to their knees or thighs in filthy pools which contain the parasite and provides a means for entry into the body.  The disease can be devastating to liver and kidneys if untreated, but can be difficult to diagnose due to often vague or silent or overlapping symptoms with other endemic diseases.  The midwife abruptly started anthelminthic therapy and we hope the patient is on her way to recovery.

These are but 3 of the many patients the lab services in a typical week.  I continue to be astonished at the number of positive malaria cases.  Virtually 100% of the blood samples we receive from the 7 clinics have some microscopic evidence of malaria endoparasitism, although most are subclinical. In the very young, it may still be deadly, and we see severe cases in many infants as well as some adults in a typical week which require artusenate therapy from the clinics.  A more benign therapy is usually offered to the pregnant women.  Back in the ancient days when I was taking medical parasitology, the books said that people with sickle cell disease were resistant to malaria, and therefore it was somehow a seleted trait in Africa providing natural selection advantage.  I don’t know who started that stupid rumor, but it is entirely false.  We have both diseases endemically in rural Ghana, and can confirm that the two diseases occur together and usually are of worse severity, not less.  I read recently where a geneticist had shown the timing and location of the mutation also did not match up with the distribution of malarial disease so it doesn’t even make sense evolutionarily.  I have many learnings on Malaria diagnosis and treatment in the field, and I hope to take many of them back to GSK with the timely registration of our vaccine.  I can tell anyone who will listen that the marketing and release of the GSK malaria vaccine is probably the single most important medical event to occur in West Africa in the last 20 years.  Be proud of that fact, if no other, for our company will make a difference here.

til next time, Ken