La Laboratoire...and Leah's other experiences working in Togo

Nothing about working in the lab at the dispensary is anything like the work I was doing at UGA.  The only knowledge I had that was useful in the beginning was my basic bench top skills.  This started out a a big challenge, but I am having a lot of fun learning new things.  Although the guys in the lab all speak at least a bit of English, the language barrier is still there when it comes to technical terminology.  When I first arrived, I was very surprised by the level of technology in this third world village.  The dispensary was started and funded by Italians so most of the lab equipment is Italian.  Just another thing to add to the language barrier.  On the bright side, I'm learning A LOT of French and Italian!
All of our work in the lab is body fluid analysis.  It is mostly blood work, but we do tests on urine and other things as well.  In regards to blood, we do basic counts and levels, but also we do blood typing, tests for HIV/AIDS, typhoid, malaria, and Hep A, B, and C.   I learned how to do blood draws on patients.  Most of the adults are pretty easy.  I have only drawn blood on one child, and he was 10 years old.  Watching the children scream, cry, and flail when we are trying to draw blood breaks my heart and is not confidence inspiring.  I still don't feel comfortable drawing blood on children yet.
We also do bacterial and yeast cultures in the lab.  I haven't done much with that since most of my responsibility is in the blood area.  We do fecal tests looking for worms and other parasites under the microscope.  Pregnancy tests are a daily occurrence.  One of the difficult parts for me is doing a pregnancy test and HIV test at the same time for some of these women.  Some of the girls are young and already have one or more children.  I've had pregnancy and HIV tests come back positive together.  It always puts a damper on the rest of my day.  Positive HIV tests are always a heavy emotional hit for me.  Even though I see it every day, I know it will always be difficult for me to the positive test results, especially for the babies and children.
I am reminded every day how different things are in the medical field here.  Almost NOTHING is sterile and it makes me cringe sometimes.  The only sterility is found in the surgical area.  Needles, syringes, and others things that come in processed packaging are fine but when the medical personnel don't use them properly it becomes a mute point.  Taking a needle out of a patient, placing it on the hospital bed (which is a thick plastic mat, no sheet, and not usually cleaned between patients) and then picking the needle up and using it again is not exactly clean.  Blood typing is also a little sketchy. We have reagents in the lab to do blood group testing, and although I've never seen it done in a first world setting, I can imagine it's a bit different.  The sketchiest part though is when they are about to do a transfusion.  They take a little of the patients blood and mix it in a small plastic tray with a little bit of blood from the transfusion bag.  If it doesn't agglutinate they start the transfusion.  Yikes!
One of the biggest challenges for all three of us working in this type of hospital setting is their lack of urgency.  We have been told many times that this isn't America and we need to learn that these people don't feel the urgency of some situations like we do.  These people don't really understand urgency because everything in life here is so slow.  It is difficult for us to see a patient who needs urgent care and they sit and wait or we just don't have the ability to care for them.  Patients who are beyond our medical capabilities must be told to go to Tokoin, the big hospital in Lome.  But most of them don't have transportation and can't afford the medical care, let alone the moto-taxi fee to get there.  So most of them just go home when we've done all we can do.  The reason these things are so difficult for us is because we always have that sense of urgency in certain situations...it's hard not to.  But we keep hearing from the dispensary staff, you can't come into a world you don't understand and try to change things so they fit your ideas of the way things "should be."  Even after months of being here we are still adjusting to that.
Sometimes I glad that I work in the lab and don't have as much direct contact with patients.  But sometimes when I'm running blood work on a patient in a critical situation, especially children, it's hard to not go look around to put a face to the name.  I have also been helping with the malnutrition program that we offer every Friday morning.  This is a free program, and we work with malnourished children over 6 months of age.  Every Friday we take the child's temperature, weight, and length/height.  We have a calculation system to determine their percentile and depending on their severity we give them a follow up appointment for further evaluation.  We distribute enriched flour and sometimes milk and supplements depending on the status of the child.  The most severely malnourished children must come every Friday, but when they start getting healthier we can have them come every two or three weeks.  Some children don't return, and you assume the worst.  Most of the time the other mothers can give us information about that child.  Sometimes it's only that the mother didn't have the money for transportation to the dispensary that day, but occasionally it's that the child passed away.  That is always heartbreaking.  When a child reaches 100% of weight to height ratio we release them from the program.  This has happened many times, and it is so satisfying to think you played a roll in helping these children become healthy.  We have become very fond of one of the little girls from the program, Marie, and her mother, Christine.  Marie is at 100% and has been released from the program, but Christine still comes by our house to visit and we are so grateful for her friendship.
Back to the lab for a couple of interesting stories.
Blood group testing...
About a month ago I was doing blood group testing and I noticed a strange pattern.  I had 5 patients, and they were all A+.  To run 5 tests and not get an O is a little odd, but also having no B's or AB's made me wonder if our anti-B reagent was working properly.   So I mentioned something to our chief of the lab and he was also concerned.  We tested one of our lab techs who is AB+ and the anti-B reagent worked fine.  Just a crazy coincidence that all 5 of my samples were A+.  But in any case, I received a huge pat on the back from the chief for my observation of a potentially hazardous situation.
Lab equipment hiccup...
Monday our machine that runs blood samples (it calculates basic levels of blood components) started giving VERY inaccurate readings.  This is the only machine we have to do these readings.  It's very important since we use it every day, and doctors need results to make a diagnosis and treat their patients.  Our chief called the technician who usually does maintenance, and he was not available until next week.  Not good enough, so other technicians were called, the director of the dispensary was notified, and more frantic phone calls were made.  In the meantime, doctors were coming in asking for test results we couldn't give them and patients were waiting for doctors to treat them.  While we were waiting for someone to come to our aid, we did everything we could to try to get it working again.  We kept flushing all the internal tubing but the readings were still bad.  Our chief finally decided to open it up and look at the inside for himself.  After 30 minutes of looking at all the components (he doesn't know what most of them are) he found a large red ant stuck in one of the tubes.  That's it...just an ant. This is so funny for us because the joke around here is that you can NEVER escape the ants.  They effect a lot of the way you do things around here.  In the kitchen you must store food in a certain way, and cook in a certain way.  You set a pan down and 3 seconds later there are ants in it.  We don't have a dryer, only a clothes line, and the ants love to crawl on drying clothes.  There are so many different species of ants here, and they are EVERYWHERE!  They range from the almost invisible and harmless to the inch-long, aggressive, attacking, and biting.  The fact that our little ant friend was the big red aggressive one made it that much more thrilling when we found the cause of the machinery hiccup.  All that stress over an ant.  When we first arrived, I said that these ants were big enough to kill someone.  Well, I didn't realize in what way that would actually happen until the incident in the lab today.  In the end, we were able to remove the ant and get the machine running smoothly again.