December 02

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Self-sustainability symbolizes success

Sorry for the tongue-twisting tantalizing title.  It has been a couple of months since I last blogged about my GSK PULSE assignment with the Millennium Villages Project Tropical Laboratory Initiative in the Bonsaaso cluster of villages in Ghana.  The reason for the delay was due to waiting for the outcome of some important interactions with the Ghana government, as well as a crashed laptop computer. Thankfully, the laboratory has recently overcome all of the governmental hurdles and my wife brought me a new laptop on a visit last weekend, so I am back up and communicating, and the lab has never been in a better position.

usual disclaimer: These views are my own and do not necessarily represent those of GSK or MVP.

So what am I going to tell you about the last several weeks?  The TLI lab in Tontokrom now has a new logo and a sign with our hours on the front of the building. In the next week or two we will even have a new sign out front.  We have lots of new equipment that I either donated myself or have helped procure such as a waterbath, autoclave, pipetters, water filtration unit, precision balance scale, and we have a new sink to wash in.  We fixed the new generator so it is able to provide power for several hours every day during our almost constant outages. Most importantly, we held many, many conversations with the Ghana Health Service authorities, the Ghana Health Insurance authorities and the MVP staff  in order to find a mechanism for converting the laboratory from an NGO sponsored support unit (with funding completely dependent on the MVP in the US), to a quasi-governmental clinical laboratory that is a separate private enterprise (The Tropical Laboratory Inititiative in Tontokrom), which acts as a not-for profit business.  Thanks to our successful application for credentialing and re-accreditation, the TLI will be a self-sustaining laboratory for the future which can be reimbursed for tests by the Ghana Health Insurance Scheme and which can charge a nominal fee from patients who do not have insurance.  This is a very novel concept for an NGO health center to go off on its own and has not been done before in Africa.  We had to define our own way of operating and get buy-in from many governmental officials.  Our last and only remaining hurdle is the re-inspection of the laboratory.  However, since we have added new equipment and in the last few months have instituted all of the suggestions and recommendations from the last inspection two years ago, we believe that is only a formality.  In fact, the TLI lab is now probably as well equipped as all but a few clinical laboratories in all of West Africa, despite our location in the middle of one of the poorest and most remote regions of Ghana, and a client list that includes clinics with only midwives and nurses, and no doctors anywhere close.

Francis and Atta, our medical technologist and lab technician (both shown in the picture above) have undergone additional training and have been great in helping the lab achieve its goals and objectives. The director of the TLI recently visited from NYC and was very pleased with all of the progress (Yanis, also shown in the picture above). Our reputation is now such that we just held further conversations with another clinic in the region which is eager to join the current cadre of seven clinics the TLI services. I have really enjoyed my days at the laboratory running the various tests, and especially providing my expertise on the microscope. I hope I have also provided the staff with some helpful tidbits about how to manage a lab.  At least that is one thing that a pathologist can provide that few other volunteers have experience with.  The other advantage of my background was in speaking with the officials.  They don’t have much exposure to western doctors here, so when I spoke they listened.  I hope it helped with overcoming some of the credentialing bureaucracy.  I do not want to jinx anything by standing on the deck of an aircraft carrier and saying “mission accomplished”, but I am very proud of our work here.

In ending, I would just like to remind everyone of the whole purpose of the TLI lab in Ghana and other parts of Africa and the developing world, and that is to provide diagnostic services to those who would otherwise have to travel long distances for medical advice. The concept is working and saving lives. We have been seeing a HUGE number of cases of Hepatitis B, to the point of it seeming like an epidemic.  This is likely from local infected water sources.  Only a tiny percentage of the houses in the area have a toilet, and people don’t seem to want to bother going to the public village toilets when available.  Of course, we also see huge numbers of malaria cases.  Last week we had a small 3 year old presented to the Tontokrom clinic DOA.  His poor mother did not realize he had died. Postmortem examination of blood confirmed severe malarial infection.  He lived only a few kilometers from the clinic, but the mother waited a little too long to bring him in to the nurses/midwives for treatment.  Before rushing him to the clinic, she probably utilized some of the other Ghana alternatives to medicine, which in this region include faith healing by many or most Ghana pastors/ priests, herbal remedies, liniments, and even the use of so-called fetish priests (witch doctors) who will chase away evil spirits. It is indeed disheartening to know that in 2015, there are still places in the world where western medicine is a last resort instead of a first line therapy. Even when readily available as in Bonsaaso, distrust of the west lingers to the point that “magic” is still the preferred avenue for treatment or cure.  The really sad thing is that most of these alternative faith based approaches are much more expensive in practice than the diagnostic assays and medicine.  For all of the cases that we have not been able to help, like this poor child, there have been many others where the diagnosis and treatment have been beneficial and often life-saving.  I have seen enough hepatitis, HIV, TB, bihlarzia and other parasites including the almost universal malaria, that I can say without prejudice that I am proud that GSK is taking a leading role in treating these diseases, and through the Community Health Worker (CHW) program, are reaching more and more people with GSK vaccines and therapies.  I hope that the CHWs are able to change the current attitudes of the rural African people so that western medicine will be not only accepted but actively sought out as a first line therapy.

Has it been worth it?  Having to put up with very long 4 wheel drive journeys every day;  hours and days without electricity, water or internet; and multiple bouts of dysentery and food poisoning?   The short answer is yes.  The long answer is still yes.  The results speak for themselves. I have made a difference here. Ghana is changed, TLI is changed, and I am changed.  And in my remaining weeks on assignment, if I can save just one more of the children with Malaria by quick and accurate diagnosis of his/her condition, who would instead be going to see the local priest to have the evil spirits exhumed from his body, then I can tell you that the answer will always be yes, despite several more bouts of traveler’s diarrhea and a sore back from the future road journeys. Thank you GSK for the PULSE program and for your commitment to better and more available and affordable heath care in Africa and the developing world.

Until next time…….. Ken