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MT duty in famine wracked Ethiopia.

MT duty in famine-wracked Ethiopia

Ethiopia. The name conveys grim images of starving children and stirs a sense of futility in most of us. Other than send money, there doesn't seem to be much we can do to help the tens of thousands suffering there.

It's unlikely, for example, that many medical technologists could go to a place in such awful need. And even if a few did manage to get there, would they really make a difference?

Absolutely. I spent two months in Ethiopia last winter. I helped start four laboratories from scratch, worked to fight epidemics, and even lent a hand at the feeding centers. It wasn't enough, for I saw people die--but I also saw a lot of the good that came from worldwide fund-raising efforts, and I left Ethiopia knowing that my brief time there had made a real difference.

How did a bench tech from Vancouver, Wash., find herself clear on the other side of the world in the middle of what had merely been pictures on the evening news? It all happened very quickly.

Last December, Northwest Medical Teams, a nonprofit group based in Salem, Ore., made an appeal for health care volunteers. Someone showed me the newspaper article at a Christmas party; to my surprise, the group was looking for medical technologists, among others, to work in Ethiopia for two to three months. I called Salem the next day, was named to a medical team two weeks later, and was packed and on my way to Addis Ababa by the end of January.

The team consisted of two doctors, 10 nurses, and three technologists --Michael Glassey of Salem, Barbara Oakes of Cathlamet, Wash., and myself. (Another technologist was chosen to travel with a second medical team.) We would work with World Vision International, a nonprofit Christian aid organization that, like the Peace Corps, strives to make local populations self-sufficient. In addition to supporting the World Vision medical staff at established nutrition/ health centers, the team was supposed to help organize new medical facilities in the field. Our task as technologists was to start up laboratory services and then turn them over to Ethiopian technicians employed by World Vision.

Northwest Medical Teams had received hundreds of applications from medical professionals. The primary MT requirements were strong organizational skills and the ability to return to a very basic level of medical technology. We also needed understanding employers --mine granted me a 2 1/2-month leave of absence. My strong background in parasitology was an asset as well.

Finally, a strong sense of altruism was a must. Volunteers received absolutely no salary. Northwest Medical Teams paid out air fare and expenses. World Vision provided food and lodging, and handled travel arrangements within Ethiopia.

The medical team left the United States on Jan. 29 after several weeks of collecting medical equipment and supplies, mostly through donations. The technologists had drafted a list of necessary items, and the laboratory community in the Pacific Northwest responded generously to public appeals, emptying cupboards of long-discarded equipment that would prove to be invaluable in Ethiopia. Two of the larger commercial houses donated stains and supplies, but our biggest coup was collecting four light microscopes--two monocular and two binocular models--which we hand-carried on the journey.

We landed in the capital city of Addis Ababa in early February. The first order of business was a one-day orientation session, much of it devoted to tourist information. We learned that temperatures in this equatorial country ranged from a daytime high of 70 to 90 F to a nighttime low in the 30s to 60s, depending on whether the camp was at an elevation of 9,000 feet (colder) or 5,000 feet above sea level. Darkness fell at 6 p.m., and night lasted a full 12 hours.

The orientation also covered what not to do as visitors in a country with a Marxist government. For example, snapshots of anything involving the police, military, or the revolution were strictly taboo. Women were asked to be decorous and not wear slacks in Addis.

Sundresses and halter tops were considered unacceptable at the camps.

The laboratory volunteers were in for a surprise. We had envisioned working together at the different feeding centers. Instead, World Vision had us crisscross Ethiopia, traveling to and from Addis and the four camps shown on the map opposite. The doctors and nurses were similarly scattered, to spread the new influx of expertise around the country.

Michael, acting as an epidemiologist, left immediately for Ansokia, a village in the midst of a cholera outbreak. He spent his first week overseas tracking where the water supply was contaminated and starting IVs on severely dehydrated cholera victims. Meanwhile, Barbara and I transported the laboratory supplies to Alamata, a center feeding 10,000 people a day.

We were eager to launch our first laboratory, but the allocated space was filled with stored grain. What's more, this lab-to-be had once been a stable--the floor still smelled of manure. It took 10 days to clean out the room for its new role. In the meantime, Barbara and I helped out in one of the intensive feeding rooms where severely malnourished children and their families were fed five meals per day. Once our work space was ready, we unpacked the supplies and got the laboratory operating in less than a day.

Each World Vision nutrition/ health center had either a head nurse or physician at a medical facility that included a small clinic, a dispensary type of pharmacy, a treatment room for injections and wound care, and eventually a lab. These presiding staff members conducted daily rounds at the center. They chose the most acutely ill children, among those already admitted for oral rehydration and feeding, to undergo further medical treatment.

The clinic contended with diseases that often presented with similar symptoms: malaria and relapsing fever, for example, and typhus, hepatitis, and typhoid. Without laboratory support, treatment had often been a shot in the dark. There were also outbreaks of such infectious diseases as cholera, which a field lab might not be able to diagnose definitively. We could, however, at least provide a presumptive diagnosis.

None of the feeding centers had electricity, so all the tests were manual, and at times we performed them by flashlight. It was clear from the beginning that the test menu would be quite small, but we were able to offer what was truly needed.

Stool examination for ova and parasites was both the most frequently requested and the most important test we offered. Using a direct mount only, we found more than 50 per cent of the specimens positive for O & P; most of the rest presented a picture of bacillary dysentery. Next in testing frequency came the films for blood parasites. Plasmodium vivax and Plasmodium falciparum were the more common malarias, and Borrelia recurrentis was found in relapsing fever. We did Gram stains, hemoglobins (using a light hemoglobinometer), and urinalysis (we eventually acquired hand-cranked centrifuges). If asked, we were also able to do WBCs and CSF for cell counts, Gram stain, and protein.

With the Alamata lab up and running, I was ready to move on. Michael stopped by, picked up half of the remaining supplies, and left to set up the Lalibela laboratory. Barbara was assigned to stay on at Alamata awhile and work with Zewditu, her Ethiopian replacement.

The Ethiopian laboratory technicians are trained under the country's national health system. After approximately seven years of alternating between training and field experience, they rank somewhere between an MLT and MT. However, the level of technology lags far behind what we're used to in the United States. They don't get into a lot of areas, because the methodology simply is not available. In fact, the most progressive laboratory I visited was probably 30 years behind ours in most of its sections.

Barbara and Zewditu immediately began the laboratory work on the most critically ill children and started screening the center's food handlers for ova and parasites. Within the first few days of operation, they had diagnosed relapsing fever in children who were not responding to treatment for malaria and had discovered that 80 per cent of asymptomatic food handlers actually had parasitic infestation.

A priority system was established for test orders. The laboratory's prime function was to serve as a support facility in maintaining recovery of the malnourished. Children who failed to gain weight and those who did not respond to treatment for a specific disease merited special attention. Food handlers and medical and administrative staff members were considered secondarily.

Severely malnourished children were generally placed on a superintensive feeding regimen (five meals a day), weighed daily, and evaluated after 10 days. One notch down was the intensive program --children here were weighed after two weeks.

Food and water were the medicine most of the patients needed to recover. Those who failed to respond to this basic treatment were referred for laboratory evaluation.

Michael, meanwhile, had similar experiences in Lalibela, although his stay there was halted by a rebel uprising. He spent one long night on the floor as government and rebel troops exchanged fire for several hours. Things calmed down the next morning, and all foreigners were evacuated to defuse a potential hostage situation. Michael turned the laboratory reins over to his Ethiopian counterpart, traveled to Addis Ababa, and ended his six-week tour a few days early.

By this time, I also was in Addis, collecting equipment and supplies for two more field laboratories --at Ansokia and Ibnat. Had we known that we would be starting up four labs instead of just one, we would have brought more equipment from home.

Anyone accustomed to ordering by phone for next-day delivery will be taken aback by Ethiopian government procurement procedures. Goods could only be purchased by an "authorized buyer,' so World Vision's head pharmacist became my constant shopping companion.

Even such commonly used items as stains and solutions had to be purchased through Central Laboratory Supply, a once-private business nationalized in 1974.

If the government agency did not have an item on hand, we were out of luck--the staff would not make up a batch or back-order the product. Having to submit the paperwork a second time was bad enough, but the ordering process took up to one week with another week lost while the order was filled and billed.

Many things that we take for granted in the U.S. were either very expensive or simply unavailable. Small disposable plastic dropper bottles cost $5 apiece; a single pharmacy in Addis Ababa had the concession on distilled water (40 cents per liter); and disposable pasteur pipets could not be had at any price.

Credit was an alien concept. Ethiopian trade was strictly cash and carry. One good thing: The supplies we brought in were exempt from government control since our arrival was categorized as a mercy flight.

After 2 1/2 weeks in Addis, I finally had collected enough supplies to return to the field. My first stop was Ansokia, the scene of the early cholera epidemic. Assured that only routine testing was required, I started uncrating the laboratory. We were in business by the end of the day. Unfortunately, another cholera outbreak hit the camp two days later. Although our Gram stains were by no means definitive, the doctor was grateful to at least have the diagnosis confirmed.

With Ansokia under control, I answered a desperate plea to set up a laboratory at Ibnat, my final assignment. This time the space was already cleaned out, and I beat my own record for lab setup, starting to process specimens in just two hours.

The basic physical requirements for a field lab were minimal: a room or tent that covered just 9 square meters; a good source of natural light; two tables (one large and one small), two chairs, and a stool; a set of shelves, which could be fashioned makeshift from cardboard boxes or by taping biscuit tins together; buckets for stain and waste disposal; a source of boiled water; and a secure method for specimen disposal (preferably burning).

Two resource books headed the list of necessary field supplies: The World Health Organization's "A Manual of Basic Techniques for a Health Laboratory' and "Medical Laboratories for Developing Countries' by Maurice King. Together, they gave us everything from the practical differentiating characteristics of malarias to blueprints for homemade staining racks. A light microscope was the next most essential tool, followed by supplies for O & Ps and staining.

Our field labs proved that it is possible to get by with very little and still function. What we carried in our heads was our biggest asset. We relied heavily on such fundamentals as formulating and following a set procedure, organizing the workload, and standardizing reporting procedures.

At the bench, we generally found the parasites we had been told were endemic to Ethiopia. However, severely malnourished children often had more than one parasite and sometimes four or five. In some cases, organisms not considered pathogenic, particularly Trichomonas hominis, occurred in such great numbers in severe diarrhea that the children were treated anyway. On direct mounts with saline and iodine, we were able to identify Ascaris, Trichuris, Taenias, Hymenolepsis nana, Schistosoma mansoni, Entamoeba coli, Giardia lamblia, and Entamoeba histolytica. While Schistosoma hematobium was considered endemic, we saw very few cases and weren't able to find any organisms.

The stains were mostly Gram stains, Wright's stain, and a cold carbol fuchsin stain for AFB. Giemsa and the AFB stains were available through Ethiopia's Central Laboratory Supply office.

The lack of electricity dictated a daytime schedule (8 a.m. to 5 p.m.). After dark, we remained on call for emergencies. Staff members lived in a separate compound, and the entire area was heavily guarded. We ate local dishes, usually some variation of engira and wat. Engira looks like a rolled up towel and tastes like sourdough bread; wat, which means hot and spicy, was a stew made of whatever was available. World Vision brought in our food supplies, separately from the famine relief shipments.

The Ethiopian staff members spoke English and were extremely curious about America. Contact with individual camp residents was brief and sporadic, and we had only a limited grasp of Amharic, the one official language out of the 13 spoken in Ethiopia.

I came back to the United States right after Easter and returned to my regular job the following week. Ethiopia was an incredible experience, but one that wouldn't have been possible without a solidly supportive family. My husband and four children-- ages 8 to 16--realized that this happened to be a unique opportunity for Mom.

We kept in touch primarily by phone, whenever I was in Addis. Mail delivery was very slow. A parcel sent soon after I arrived in Ethiopia still hadn't turned up when it was time for me to leave.

Since coming back home, I have spoken to a number of audiences. I want everyone to know what's happening in Ethiopia. This country, which is slightly smaller than the western third of the continental United States, has the lowest per capita income in the world. The evening news has not exaggerated the desperate plight of these people.

Last January, World Vision was reporting a mortality rate of 2,000 to 7,000 people per day. When we arrived, the daily estimates were much closer to 7,000. Volunteers were not shielded from the source of these grim statistics. I saw individuals die in line while they were waiting to enter the clinic.

The death rate dropped dramatically as food and medical care became available. At Alamata, for example, the toll plummeted from 100 to just two or three deaths per day out of a camp population of 10,000. At Ibnat, the camp population doubled from 25,000 to 50,000 during a two-week period and then increased again to 100,000. World Vision and a group called Concern abandoned their usual dietary programs, opened up a soup kitchen, and somehow managed to feed them all.

We opened four laboratories, and other World Vision workers have since set up at least three more. As medical technologists, we were able to help people usually seen only in pictures and know that, because of our expertise, they would recover both from their malnourishment and from many of the diseases that plague their country.

Photo: There's a glow on the faces of children who have begun to benefit from medical team efforts in Ethiopia. Taking a break from her lab work, the author (left) helps out at the Alamata feeding center. The Ethiopian worker beside her holds a tray of porridge. Below, Zewditu, an Ethiopian lab technician, tries out her "new' microscope.

Photo: Technologist volunteers Michael Glassey of Salem, Ore., and Barbara Oakes of Cathlamet, Wash., set up a makeshift staining rack. To keep rods--and slides--in place, they filed notches in the rim of the can.
COPYRIGHT 1985 Nelson Publishing
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Copyright 1985 Gale, Cengage Learning. All rights reserved.

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Title Annotation:medical technologists
Author:Fitzgibbons, Dawn
Publication:Medical Laboratory Observer
Date:Dec 1, 1985
Words:2823
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