Archive for the 'Global Health' category

APHL Global Health: My Touchstone

Apr 01 2014 :: Published in Global Health

by David Mills, PhD, Director, Scientific Laboratory Division, NM Department of Health

It all began with a late afternoon phone call from my boss, asking if I had any interest in volunteering my time on an APHL project to help public health laboratories in Central America recover from the devastation of Hurricane Mitch. “Sure,” I casually replied, not realizing that my answer was launching me on a journey that, over the next 14 years, would take me to 17 countries on four continents and provide me with some of the most meaningful and rewarding experiences of my professional life.

Looking back, I have to say that I have thoroughly enjoyed the ride. Much of the satisfaction and enjoyment my experiences with the APHL Global Health Program have provided are what I might have anticipated when I first got involved. Philosophically, I had always been a proponent of international assistance and a fan of engineer and inventor, R. Buckminster Fuller, who described the planet as a boat and pointed out the fallacy of the notion that people living in the starboard side of the boat could allow the port-side to sink “without getting their own feet wet, let alone being drowned.” So, international work appealed to me on that level.

APHL Global Health: My Touchstone |

In addition, I have always enjoyed travelling and experiencing different cultures, and my work with the APHL Global Health Program has certainly provided that. And then there was the opportunity for adventures; finding time, after the official work of APHL was finished, to squeeze a day or two for personal activities before returning home, e.g. a safari in Tanzania or a visit to the Forbidden City in China. Other “excitements” were smaller, serendipitous and, perhaps because of that, even more memorable. I will always remember stepping off a small plane near Mt. Kilimanjaro at sunset, catching my first intoxicating whiff of dry grass and faint smoke and being told, “You will never forget that; it is the smell of Africa,” or eating breakfast at sunrise on the edge of a Namibian water hole and spying a troupe of baboons, with babies on their backs, moving through the brush on the far side. Nor will I forget an initially staid and formal evening dinner in a Ukrainian garden that (d)evolved into a boisterous evening of singing, toasting (vodka…) and laughing with new friends after the electricity failed and the gathering continued long into the night by candlelight.

Teaching has also always brought me a great deal of satisfaction—I was a university professor before switching to a public health career—so developing courses and providing training to laboratory professionals for APHL has been extremely enjoyable. I have had the good fortune to be able to share the lessons of my professional experiences (successes and failures) with colleagues in other countries and also to learn from theirs.

But what I never could have anticipated so many years ago and what, more than anything, has kept me coming back again and again to volunteer are the inspiration and humility that that I experience on every single project for Global Health. My day job is terrific—as director of a state public health laboratory, I go to work every day in a new multi-million dollar facility equipped with millions of dollars of analytical instrumentation (and a staff engineer to maintain it) and sophisticated engineering safety systems. Our laboratory is supported by a central team that responds immediately to IT issues, and a courier system that delivers specimens overnight. We have access to federal laboratories for specialty testing and technical support and a national organization, APHL, which provides training and professional support. And yet, with all of these resources, I find that much of my time is spent focusing what is perceived as lacking—budget, staff, competitive salaries, flexible work schedules, new instrumentation, software and so on. These challenges, difficult and ubiquitous, are the reality of management in public health. Over time, however, immersion in these details day after day can make the excitement over the greater purpose of the mission and the people we serve fade and seem very far away, and it is this that keeps me coming back to volunteer.

To periodically leave my day job and travel to a place where smart and talented professionals pursue the mission of the public health laboratory, performing testing similar to that in our own laboratories, but under very difficult conditions, is inspiring. What do I mean by difficult? Difficult is a laboratory performing serology testing when it has electricity irregularly for only 2-4 hours per day. Difficult is washing and reusing latex gloves because of their scarcity. Difficult is performing microscopy in a room with high water stains on the walls a meter off the floor and all of the refrigerators on blocks to keep them above the periodic floodwaters. Difficult is not having a single repair technician in the country to service analytical instruments. Despite these incredible challenges, the people I have worked with in country are enthused, dedicated and optimistic about the work they perform and its importance. Seeing how much they accomplish under these circumstances, I often have thought to myself, “If these people had even half of the resources and support that I have in my laboratory, they would leave me in their dust!”

Quite simply, the international projects are my touchstone. They remind me how fortunate we are, and they re-energize me and rekindle my enthusiasm for my career as a scientist in public service… and after each experience, I return to my laboratory able to do my job better than before I left. Without a doubt, I gave my boss the right answer.

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Sochi? So What? Public and Environmental Health at the Winter Olympics

By Michael Heintz, MS, JD, senior specialist, environmental laboratories, APHL

Sochi? So What? Public and Environmental Health at the Winter Olympics |

Hi. I’m Michael and I admit it: I’m a Winter Olympics fanatic. From learning new geography at the Opening Ceremonies, to hoping for that US-Canada hockey game, and seeing the short-track speed skaters hurl themselves in roller-derby-on-ice, I can’t get enough. I’ll even watch a couple hours of curling. I’m all-in for two weeks (well, except ice dancing, but that’s another post).

However, in the midst of the competition and spectacle, the public and environmental health aspects can get lost. With the international locations, huge crowds and new buildings, the footprint of the Olympics can be significant. So where do the Olympics intersect with public and environmental health?

The Centers for Disease Control and Prevention provides basic information if you’re heading to the Games (and more generally for international travel). In addition to routine vaccinations, like chicken pox and your flu shot (which you should already have!), the CDC recommends specific ones for Russia, such as hepatitis-A and others if you are particularly at-risk or heading to remote areas. Visitors should also prepare a travel health kit, including the medications they might need during travel. The CDC even provides a list of Russian phrases to use if you are sick or injured.

Next, one particular aspect of public health at the Games is interaction with the other spectators or athletes. Always remember to wash your hands, wear your seatbelt and generally stay aware of your surroundings. And yes, sexually transmitted infections are a concern at the Olympics. Organizers help the athletes by distributing condoms (150,000 were distributed to athletes at the London Games), but you might be on your own, so be prepared.

Finally, we cannot ignore the environmental impact of the Games. Sochi has an average population of 350,000 people. The 2010 Winter Games in Vancouver attracted an estimated 500,000 visitors plus another 10,000 journalists and 2,700 athletes (not counting security or volunteers). In all, Sochi’s size may double (or more) for the Games. The huge number of people coming to this Black Sea resort town, plus the construction of the new venues and other capacity improvements, will stress Sochi’s environment.

In 1996, the International Olympic Committee added environmental protection as the third pillar of the Olympics. As part of this commitment, Sochi organizers are making efforts to build and conduct the Games in an environmentally responsible manner, including a Green Building recognition program. But with a $50 billion price tag to build and run the events, the environmental impacts include increased construction waste, water shortages, habitat disruption and increased logging. All of these activities increase the amount of pollution in air, soil and water resources. Add the increased demand for drinking and wastewater services, transportation, and curiously, saving last year’s snow, and the overall environmental impact of the Games may be significant. However, we won’t know the full effects until after the Games are over. Looking ahead, the Rio Summer Games have already launched their sustainability program for 2016. Expect future Olympics host-cities to continue concentrating on environmental concerns when preparing for the Games.

While the public and environmental health concerns don’t decrease my appreciation for the spectacle that is the Olympics, including the athlete’s amazing abilities and the two weeks of global good will, it does add context to what goes into making such an event happen. Just another reminder that public and environmental health is part of everything.

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APHL Belongs in South Sudan — It’s About Saving Lives

Dec 01 2013 :: Published in Global Health

By Lucy Maryogo-Robinson, MPH, Director of Global Health, APHL

Sometimes people ask, “Why does APHL do global health work?” Granted I hear this less often than I did five or ten years ago – public health emergencies in the context of globalization have answered this question time and time again – but I do still hear it. When I get this question now, I immediately think of South Sudan.

Global Health Program staff member, Sherrie Staley, and I got off the plane in Juba, South Sudan with trepidation this past September expecting to spend an hour or more being grilled by the known-to-be-difficult immigration officers. We gingerly maneuvered through the one-room immigration, customs and control check points, and explained as best we could why we had dozens of digital thermometers in our suitcases. The term “public health laboratory” was completely foreign to the officers, but upon hearing the words “CDC project” and “HIV laboratory testing” we were whisked through.

APHL Belongs in South Sudan -- It's About Saving Lives |

Eager to learn more about this new country, we quickly ventured out to the hospitals to visit their laboratories. In most developing countries the clinical system has to take on public health functions as there is no clear distinction of roles between these two. Sherrie and I consider ourselves well-travelled having been to many of the 22 countries the Global Health Program supports. We have seen poverty, we have seen infrastructure failure, and we have witnessed various disease outbreaks firsthand. Yet neither of us were prepared for Al-Sabah Children’s Hospital.

Al-Sabah Children’s Hospital is the only children’s hospital in South Sudan. Walking through the hospital we saw women sitting along the corridor walls, waiting for care and treatment for their sick children.  We met with the hospital director, a frail elderly woman, in her unlit office. I remember noticing her sad, tired eyes.  She shared her heavy burdens. “One of our biggest challenges is we can’t run a blood blank at this hospital,” she explained. “Culturally we struggle with the notion of donating blood; patients have to come in with a relative who will donate blood to them.” How do we overcome this cultural barrier to ensure a sustainable blood supply for these babies, I wondered?  She went on, “Even if we could get donations, we couldn’t store the blood because we only have electricity for two hours a day.” My mind started racing – solar powered refrigerators. “And even if we could get power,” she continued, “we have no cross matching capabilities. We do one HIV rapid test on the blood, and if it is negative we transfuse the blood.” In this setting, rapid test kits are not always rigorously reviewed to take into account their performance in the field. As such, the patient does not benefit from scientific rigor and the delivery of a quality test result may be compromised. The transfusion patient – in this case a child – is potentially being exposed to infected blood. The transfusion of incompatible blood may make the transfusion useless, and quite likely activates an immune and clotting system response that could result in death.

It took a second for me to digest the information, and I looked outside as I collected my thoughts. Babies and toddlers were laying under the tree keeping cool in the shade, oblivious to the public health challenges facing the hospital staff inside. How could we help?  I considered the procurement of solar panels or generators; the facilitation of laboratory testing training specifically for HIV and cross matching; the provision of technical assistance around quality systems – the list of possibilities for helping this facility are endless. So little could go so far here in saving the lives of these infants. APHL belongs here, I thought. International public health is not about recognition, and glamour – it is difficult and messy and complicated. It is about saving lives.

The South Sudanese are a proud people. You can tell by their elegant gait, by their handshake, and by their story. But the South Sudanese people have suffered unspeakable pain. Sherrie and I were commenting to each other that this was the only country we had visited where we could not get the children to smile back at us or engage in playful banter. These truly were the “lost boys of Sudan.” Despite their stories, the South Sudanese people remain positive and eager to work hard to improve the quality of life in their nascent nation.

The laboratory staff we support soak in all they can from APHL trainings and, amidst the struggles of their tough lives, they look to APHL as a beacon of hope.

On this World AIDS Day, we celebrate all that has been achieved under the President’s Emergency Plan for AIDS Relief (PEPFAR) and we look to the future for all the good that still can be done. On this World AIDS Day we think of South Sudan and we are reminded why we do global public health work.


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My Global Experience as a Public Health Microbiologist

Apr 25 2013 :: Published in Global Health

By Sally Liska, DrPH

Being a public health microbiologist can mean more than just working at the lab bench helping diagnose communicable diseases or being involved in public health outbreak investigations.  There are many opportunities available.  One activity I particularly enjoy is teaching and mentoring clinical laboratorians in developing countries.  And now retired, I have more time to do this rewarding work.  Sharing my knowledge – something we in the field call “technology transfer” – with a willing group of lab personnel can be very uplifting.  To feel their enthusiasm, see their progress and receive their sincere thanks is truly heart-warming.

Sally Liska -- Global Health Consultant

For the past five years I’ve participated in about 12 laboratory management workshops in several African countries including Kenya, Nigeria and Ethiopia.  You never know what to expect during the training session; each class of laboratorians is different.   Are they going to be shy and reserved, as we lab folks tend to be, or are they going to be an enthusiastic bunch wanting to share their knowledge with their colleagues?   Will we have to draw them out to participate, or rein in their many comments and questions?  Of course they are always courteous and receptive during the presentations but blossom during the small group exercises where they take center stage.   Through group exercises, role-playing and presentation they get the opportunity to interact with their colleagues about the real-life situations they face.  For many participants, there is that special moment when they see themselves as important and integral parts of the health care system of their country; and to be there to witness that is truly special!  Throughout the week they network with their colleagues, forming bonds that last long past the end of the workshop.

Although we may differ in culture, age or mother tongue, we share many of the same issues of constantly striving to improve the quality of our work, gain recognition for our profession and do what’s best for our clients.

Being a public health laboratorian means not just doing what you know, but sharing it as well; I’ve been fortunate to experience that.   And teaching is a wonderful opportunity to do this on a close-encounters basis.

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Getting to Zero: Lab Scientists Fight HIV/AIDS in Africa

Dec 01 2012 :: Published in Global Health

By APHL Global Health Program

Over three decades have passed since the words “HIV” and “AIDS” became part of our everyday lexicon. Though we have yet to reach the United Nations’ goal of zero new HIV infections, we have come far since the onset of the pandemic thanks, in part, to the drive and dedication of public health professionals.

Among them is a cadre of professionals whose contributions often go unnoticed: public health laboratory scientists. From Addis Ababa to Johannesburg, these laboratory experts work with APHL’s Global Health Program to realize the association’s vision of a healthier world through quality laboratory practice. They build laboratory diagnostics and reporting capability, hone the skills of laboratory technicians, foster the growth of effective laboratory managers, and chart the direction of national laboratory systems in collaboration with ministry of health officials, to name a few of their many functions.  Below are introductions to a few of these public health laboratory champions.

Emmaculate Agolla, APHL’s “field champion” in Kenya, works to ensure that laboratory information systems (LIS) function effectively to deliver lab data and test results. Her laboratory colleagues respect her ability to troubleshoot systems and interconnect LIS components, skills that are in short supply in her country.

APHL is fortunate to have two Bob’s supporting its LIS initiatives in Africa. Bob Bostrom is an LIS veteran who has traveled the continent to implement LIS. Bob shifts between LIS vendors and African cultures with ease, assisting with review of RFPs, selection of vendors and system implementation. He assumes responsibility for activities ranging from laboratory assessments to support and review of LIS implementation processes.

Bob Sokolow is APHL’s paper-based LIS expert.  He has helped numerous countries to evaluate their paper-based reporting systems, and develop more effective, standardized forms for sample entry.  The result is improved consistency and accuracy of laboratory data.

Brett Staib, the association’s database guru, has assisted several countries to design databases for more efficient management and reporting of lab data. His efforts have led to improved access to health information by health care providers and ministries of health.

Solon Kidane, APHL’s field consultant in Mozambique, collaborates with the country’s ministry of health and other agencies to strengthen laboratory capacity. Always, one to go above and beyond, he serves as a master trainer for CDC’s step-wise laboratory accreditation program, Strengthening Medical Laboratories towards Accreditation (SLMTA), and provides training in laboratory leadership and management.

Isatta Wurie has done it all — strategic planning, training, renovating and commissioning labs, networking with ministries of health, and mentoring of laboratory staff. She tackles this work in the two countries under her charge and elsewhere in sub-Saharan Africa.  She is a force to be reckoned with among those building quality laboratory systems to combat HIV/AIDS.

“Queen of Laboratory Quality” Kim Lewis has worked throughout sub-Saharan Africa as a master trainer and technical advisor to ministry of health laboratories.  Recently, she coordinated LIS implementation in Lesotho, a small country located within the borders of South Africa that has been devastated by AIDS. Ever-patient, Kim ensures that project deliverables are on time and of the highest quality.

Ralph Timperi, APHL senior advisor for Laboratory Practice and Management, shares his expertise in in laboratory science and practice, both global and domestic, with APHL staff and consultants.  A former state laboratory director, university instructor and chair of APHL’s Global Health Committee, Ralph is highly respected for his expertise by partner countries. His achievements include renovation of two laboratories in Mozambique, design of laboratory training curricula, and crafting of strategic plans and guidance documents in collaboration with ministries of health and CDC in-country offices.

The contributions of these laboratory scientists remind us that it is possible to effect positive change in the world even when the ultimate goal is as difficult to attain as an HIV incidence of zero.

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Japanese and US Public Health Labs: Not So Far Apart

May 30 2012 :: Published in Annual Meeting, Global Health

By Jody DeVoll, Director of Strategic Communications, APHL

The distance between the US mainland and Japan is over 6,800 miles (close to 11,000 kilometers), so you might assume that their public health laboratory systems would differ markedly. In fact, the similarities are striking, as I learned from members of the Association of Public Health Institutes of Local Governments in Japan who attended APHL’s annual meeting in Seattle, May 20-23. They included:

  • Kunihisa Kozawa, MD, PhD, president, Association of Public Health Institutes of Local Governments in Japan and director, Gunma Institute of Public Health and Environmental Sciences
  • Komei Shirabe, MD, PhD, director, Yamaguchi Prefectural Institute of Public Health and the Environment
  • Yoshimasa Yamamoto, PhD, director general, Osaka Prefectural Institute of Public Health
  • and Toshio Kishimoto, MD, PhD, general manager, Okayama Prefectural Institute for Environmental Science and Public Health.

The Association of Public Health Institutes of Local Governments in Japan has 79 members, including 47 prefectural institutes and 17 ordinance-designated city laboratories. The prefectural institutes, which correspond roughly to our state public health laboratories, serve as the central public health reference laboratories within their respective jurisdictions. Two-thirds of them conduct both public health and environmental testing either as a single institution or as two, co-located laboratories.

Map of Local Public Health Labs in JapanOver a glass of beer in the hotel lounge, we exchanged reports on the status of governmental health laboratories. Below are several notable points, including several comments that could have been overheard in a US public health laboratory:

One Lab = One Lab: Laboratorians in the US often joke, “If you’ve seen one public health laboratory, you’ve seen one public health laboratory.” In Japan, there is wide variation in size and capability among institutes, making it difficult to coordinate among them.

What is a Public Health Lab?: Governors of prefectures and local government officials generally do not understand the value and function of the laboratories serving their jurisdiction. Federal officials tend to be better informed about the laboratories’ role in protecting public health.

Limited Resources: The global recession has led to cuts in funding for Japan’s governmental laboratories, which are challenged to maintain staffing, programs and technical proficiency.  Association members assert that centralization and/or sharing of laboratory services would trim costs and ensure the overall viability of the laboratory system. Yet government officials aim to preserve broad testing capability within their respective jurisdictions. In Osaka, there are proposals pending to consolidate the two city institutes with the institute serving the prefecture. If this consolidation is approved, it would be the first of its kind.

Training & Money: Many institutes lack the expertise to train young technical staff and have no budget to send them to outside courses. In response, the association has organized a central training program in bacteriology. Government leaders, members say, do not understand how difficult it is to acquire the technical skills required for complex testing.

Lab Leadership: Japan’s baby boomers are rapidly exiting laboratories at the mandatory retirement age of 60, and there are no mid-level scientists ready to succeed them. Young professionals do not have the experience to assume senior leadership roles.

Food Testing: Japan’s institutes are responsible for daily testing of seafood and other staples in compliance with the country’s stringent food safety standards. Any contamination is immediately reported to public health authorities who remove the product from the market. Some US leaders have proposed that public health laboratories expand their limited role in food testing as part of broader efforts to strengthen the food safety system in this country. Perhaps US labs will one day look to their Japanese counterparts as models in this area of laboratory practice.

As we got up to leave, I discovered that Dr. Kishimoto is an accomplished musician who plays and composes for the shakuhachi, the traditional Japanese bamboo flute. According to his colleagues, he is only moonlighting as the general manager of a prefectural institute. You can listen to this multi-talented laboratorian perform and be as impressed as I was.

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One World. One Health… and the Vector at Our Back Door

You don’t have to explain to public health laboratorians that the health of humans, animals and the environment are inextricably linked. HIV/AIDS, SARS, 2009 H1N1, West Nile Virus: laboratorians know the inner workings of these enterprising pathogens that travel (from jungle, field or suburban neighborhood, etc.) to animal hosts (chimpanzees, bats, birds, field mice, etc.) and on to us.

One World One HealthAnd they know that more of these smart bugs are coming our way. Population growth, climate change, deforestation, diminishing species diversity and changes in land use are all interfering with established patterns of interaction among people, animals and the environment. Vectors that were once in a distant forest are now at our back door. Already the majority of emerging infectious diseases affecting humans (approximately 75%) are of animal origin.

This dynamic has broad implications for public health as well as human medicine, veterinary medicine and environmental science. In a world where the interface between animals, humans and the environmental is in flux, it’s perilous for health and science professionals of any stripe to operate in professional silos. To protect the health of all species, those of us in public health must join with our colleagues in veterinary science, human medicine and environmental science to adopt a holistic approach to disease surveillance, detection and control. To put it simply, we must be about one health, not several.

At the 2012 APHL Annual Meeting, “one health” will be center stage. Participants will have the opportunity to meet leaders in the One Health movement – including James Hughes, MD; Lisa Conti, DVM, MPH; and Terry McElwain, DVM, PhD – and discuss actions required to operationalize One Health objectives. Here are a few questions to get you started with these discussions. How can we:

  • Expand and improve national and global surveillance networks, particularly those that capture the animal-human interface?
  • Enhance sentinel event coordination to detect and reduce environmental health threats?
  • Build efficient global reporting and sample submission systems to support surveillance systems?
  • Communicate the benefits of investment in surveillance? (Too often disease surveillance is viewed as an old-school public health function, one that’s not sexy enough to warrant sustained investment.)
  • More effectively employ animals as sentinels for human health—and humans as sentinels for animal disease risk?

For an introduction to the “one health” concept, see the websites of the One Health Initiative and CDC’s One Health Office.

And a parting thought: When was the last time you took your state veterinarian or your colleague in environmental science to lunch? It’s a small step, but remember: One Health is collaborative; you can split the check.

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Using Technology to Combat HIV/AIDS in Swaziland

Apr 25 2012 :: Published in Global Health

This week is National Medical Laboratory Professionals Week and National Environmental Laboratory Professionals Week.  APHL is honoring the many individuals working public health and environmental laboratories around the world.  Stay tuned for blog posts this week featuring the work of many of those unsung heroes working to protect the public’s health.

Computerized information systems make work easier in many fields, including laboratory practice. But can a laboratory information system (LIS) help make a dent in one of the world’s worst HIV epidemics?

Laboratory and health experts in the Kingdom of Swaziland are betting the answer is yes.

Swaziland, a geographically small, landlocked nation bordering South Africa and Mozambique, has been home to human inhabitants since at least the early Stone Age 200,000 years ago. Today, however, the country’s population of 1.2 million is seriously threatened by the highest HIV prevalence rate on the African continent. An estimated one of every four adults is infected with HIV, and many of those are co-infected with TB or multi-drug resistant TB, both of which are also highly prevalent.


Health experts know that HIV prevention, education, testing, counseling and treatment programs are essential to reverse such a daunting public health crisis. Swaziland has responded with a campaign to reduce HIV transmission by circumcising HIV-negative men aged 15-49, and with greatly increased access to testing at voluntary counseling and testing centers and other Ministry of Health (MOH) laboratories. Yet these efforts have been complicated and slowed by reliance on paper-based systems.

Marie-Claire Rowlinson, PhD, a former senior APHL global health specialist, said an electronic LIS “is important for quality of testing and therefore for the quality of patient services.” She continued, “It enables laboratory technicians to test samples more efficiently and with fewer errors in the testing process. For example, because the LIS is integrated with testing instruments, there are fewer manual transcription errors, and quality control procedures can be monitored more easily.”

All of this has a positive impact on testing quality, speed and volume. Technicians are able to spend more time generating potentially life-saving test results, rather than entering data by hand. And the test data can be retrieved in seconds.

Rowlinson added, “A common issue for the labs in Swaziland is that patients will get the same test two days in a row when they only need one, which wastes much needed resources. With a paper-based system, it is much harder to track what tests a patient is getting, but with an electronic LIS this can be monitored.”

Fortunately, the advantages of electronic information management will be coming to Swaziland Ministry of Health (MOH) laboratories soon. APHL completed a laboratory assessment in Swaziland last year and is assisting the MOH with development of an LIS strategic plan for the country. Previously APHL helped MOH stakeholders in the selection of an LIS software vendor.

In 2012, the new electronic LIS system will be installed in the national reference laboratory, the Mbabane Government Hospital National Reference Laboratory, and five other MOH laboratories. It is hoped that the new LIS system will eventually be installed in all 18 MOH laboratories, and the current stand-alone systems made interoperable to enable real-time data exchange.

“In addition to improving quality and expanding test volume, the LIS can be used to centralize data and support MOH decision making,” said Ralph Timperi, MPH, a senior advisor for laboratory practice and management at APHL. He explained, “You can put personnel data on a central database so you can see where your technicians are, their ages and education. You can determine whether you need to provide training for people in one location or if key people are nearing retirement.” He added, “You can store supply information and equipment information, so you know: Where is the equipment? How old is it? An LIS gives you the ability to accurately keep track of things in real time. That’s a very helpful thing.”

In the end, said Timperi, it all comes down to one critical trade-off that can indeed make a difference in a HIV epidemic:  “Putting out quality test results versus moving paper.”


Other Lab Week blog posts: 

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Social Media As a Tool for Real Time Tracking of Diseases?

Oct 13 2011 :: Published in Global Health, Infectious Diseases

By Sikha Singh, MHS, Senior Specialist, Laboratory Response Network

Recently featured an article titled Using social media for disease surveillance, providing examples of real life breakouts that demonstrate how the internet has fundamentally changed global health surveillance.  Epidemic intelligence, says the author John Brownstein, flows not only through government hierarchies but also through informal channels, ranging from press reports to blogs to chat rooms to analyses of Web searches.  Social media outlets promote real-time reporting, accessible almost anywhere to users with internet-capable devices.  Twitter users, for example, tweet first hand information that has the potential to provide a wealth of information to groups that monitor trends in social media activity.  The downside of self-reporting, however, is that false information may generate widespread misperceptions.

Researchers at the Johns Hopkins University have adapted a model that can rapidly comb millions of public twitter messages to identify up-to-the-minute trends.  Initial studies have revealed patterns in self-medication for illnesses that don’t typically require a visit to the doctor.  For example, Twitter users reported using Tylenol or Advil for pain relief and Claritin or Zyrtec for allergies.

Google Flu Trends, a website that maps flu activity around the world based on data from Google searches, is another demonstration of how information expressed in web searches enables extraction of social and health trends.  Additionally, the web resource called HealthMap offers real-time, contextualized information on health events both local and distant.

It is undeniable that social media is an emerging tool that plays an increasing role in alerting the public to what is happening in the world.  Consider the vast reach of social media: if Facebook were a country, it would be the world’s fourth largest, behind only China, India and the United States.   What are the public health surveillance and disease tracking implications of self-reporting through social media?  Will health agencies increase their reliance on ubiquitous social media outlets for disseminating vital health information?

I wonder how Facebook feels about the potential for capturing, synthesizing and analyzing the information generated from the chatter of its over 800 million active users.  Can social media services capitalize on their wide reach to promote public health campaigns?  Will self-reporting in the form of tweets and status updates ever truly benefit epidemiological investigations by offering accurate and reliable data?   Maybe the masterminds (ahem, Mr. Zuckerberg) behind some of the most popular social media services will answer these questions.  Calls for comment to Facebook headquarters were not returned. (Or made).

To learn more about APHL and its social media activities please connect with us on our Blog, like us on Facebook, follow us on Twitter, join us on LinkedIn and watch us on YouTube.


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APHL Assists Haiti to Rebuild Devastated Lab System

Jul 22 2010 :: Published in Global Health, Partners

On January 12, 2010 tragedy struck in Haiti. A massive earthquake rocked the tiny national, particularly Port-au-Prince, causing damage and destruction that will take years to repair.

One of the buildings severely damaged in the earthquake was the public health laboratory. Deemed unsafe for use, laboratory operations moved to a tent erected outside of L’Hôpital de l’Université d’État d’Haïti (HUEH). Since the earthquake, the number of patients being treated at HUEH has tripled from 14,000 per month to almost 42,000 thus increasing demands for laboratory testing. Due to extremely high temperatures and no air conditioning in the tent, automated testing requiring cooler temperatures, such as hematology and blood chemistry, are being run manually. The result is that the current testing capacity is only 25% of the daily demand.

Following the earthquake, the Centers for Disease Control and Prevention requested and authorized APHL Senior Technical Consultant and Team Leader for the APHL Haiti Field Laboratory Support Team, Dave Doherty, to assist all of the public health network laboratories in Haiti in getting testing services back up and running to support the enormous demands for medical care and treatment

Upon learning of the dire needs in the tent laboratory, Doherty sought out to find an air conditioner that would help keep the tent at the appropriate temperature. Before he knew it, a casual conversation with a Doctors Without Borders volunteer led him to International Relief Solutions (IRS), a Georgia based company that creates modular buildings in areas of need. The APHL Haiti Field Laboratory Support Team led by Doherty provided technical assistance to IRS in planning and design of a new modular laboratory facility to will replace the temporary tent facility.

The 24’ by 36’ modular laboratory will stand next to HUEH. The facility is designed with infrastructure for work benches, heating, ventilation, plumbing and electrical services. With direct hookup to electrical and water supplies, the laboratory building will have the air conditioning necessary to meet the requirements of the many intricate and delicate tests that the laboratory technicians on scene perform routinely. The lab will arrive with the electrical system and plumbing pre-installed allowing for a quick start-to-finish set up of approximately four days.

Better lab facilities will improve testing services and will enable laboratory technologists to get back to work. According to Doherty, “Many well-trained technologists in Haiti are unable to work and provide testing services because of the loss of laboratory facilities to earthquake damage.”

It could be years before the permanent structures are rebuilt; the new modular lab serves as a long term solution. This initiative was a success due to the collaboration of willing and committed partners, each of whom brought essential resources and expertise to assure an effective solution for meeting a critical need in Haiti. Lives will be saved and illnesses treated effectively because of the efforts of APHL, IRS and CDC. Doherty modestly explains, “We were able to come through. APHL has always come through in Haiti.”

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