The 3 sub-city health care labs we visited in Adama were so basic in comparison. None of them had more than 2-3 microscopes and 2-3 centrifuges. Most had no generator backup if the power went out. We didn't see gloves in all instances (hopefully they just weren't out in the open) and some openly admitted they didn't have the supplies they needed. They were often single room affairs, maybe 2 at most. Blood was drawn in the same room (some had tubes from our company) and often the lab technician (2 year diploma) or technologist (4 year degree) was also acting as the phlebotomist - and maybe more. These techs counsel patients on testing, results and treatment - there is no doctor on site, maybe a nurse or two are available. In Adama, the busiest clinic probably saw >100 patients a day.
Here in Awassa, we visited 3 more yesterday and 3 today. Our first stop was the Regional lab - they are still in their old building but apparently the new CDC-funded lab is in process and they kind of bragged that it would be 'better' than the one in Adama. Mr. Goshu Belay was very generous with his time and even had introductory letters written up for us to present to the 6 labs he suggested we visit. The furthest from the city center were about 45 km away and the roads deteriorated quickly once we were out of town. The potholes were sometimes big enough to swallow us alive! Yesterday the most impressive lab was in Chuko HC. The health officer was very involved, had tons of charts depicting all kinds of metrics about everything from demographics to main diseases over the past 2 years to maternal health stats. They are open 24/7 (on call on weekends). They said that recently, malaria cases have spiked in their region - they said they are 'famous' for it - and in one week alone they diagnosed 259 positive cases. They are working at the grassroots level (their own words!) within the community to try and talk about prevention. They have seen results, too - in the past 3 days, the number of cases have gone down. The lab was very organized, the techs were engaged. They screen upwards of 100 malaria samples a day! The other 2 labs were small and less organized. At one of the labs they had posted pricing for pharmaceuticals - I think pretty much all were under 50 cents US. We should be able to make a huge difference at that rate if funds can be directed properly. We had thought we'd make it to all 6 labs in one day, but after a bit of a late start and terrible roads, we only got half way through. (Darn - I just missed the sunset over Lake Awassa because I was writing this blog!).
Today we went in the other direction and visited 3 more HC labs, the first one by mistake - must have been some miscommunication with the locals... In any case, they were more of the same - a couple of microscopes and centrifuges, sending ART and CD4 samples to a referral hospital or the Regional lab, no (or no functional) generator, lots of patients every day. The last lab was in quite good shape, though, and had 3 rooms with some additional equipment in the back room. I don't think it was functional, but they said they did clinical chemistry in the past since they had the means, but now send it off to the Regional lab with the CD4 samples. The health officer was happy to tell us that their lab is well known throughout Ethiopia and is used as a model for others within the region. The downfall was that they don't get to attend much training because the Regional lab knows very well how they are working and are satisfied. We all thought that was not a good excuse to miss out on trainings.
Pretty much all these sub-city HCs are cookie-cutter in shape - a few are a bit bigger than the others - but the layouts are almost identical for each. The basic level of each is almost the same, as well. Turn around time for samples that are reffered to other sites for testing because the local site doesn't have the ability to perform the test seems to range from same day to about 3 days, depending on geography and what kind of test it is. The other stunning thing that came up during SRS training last week was that none of these health care workers, no matter sub-city tiny lab or brand new regional lab, get any kind of preventative vaccinations provided to them. There's another area of opportunity for sure!
It makes me grateful to have so many options available and to have clean, well equipped facilities near by when I go home.
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| Our mis-spelled names in Amharic |
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| Typical equipment in the lab |
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