Tuesday....Lab Day!

Yes, Tuesday was the day that I finally got to meet with the AMPATH lab manager, Wilfred, and visit his laboratories.  It was definitely another eye-opening experience.  The laboratories are primarily diagnostic labs that provide testing for the patients who visit the various clinics (HIV, Diabetes, Oncology, Cardiovascular, and Mental Health) and they also test samples that are submitted as part of clinical trial protocols or other research studies.  The lab manager was very open and patient with us and allowed us to ask him many questions. He discussed the laboratory operations with us and shared his areas of focus and concern and then took us on a tour of all of the labs which included:  an up and coming microbiology lab to do blood cultures for bacterial and fungal infections; a serology lab that tests for things such as HIV, Herpes, Hepatitis, and pregnancy; a flow cytommetry lab for measuring CD4 blood levels in HIV patients, a PCR lab to determine HIV viral load; a TB lab where they view hundreds of smears under a microscope each day; and a general chemistries lab to determine analytes in blood.  Many of the labs were highly automated and had very high sample throughput (hundreds of samples per day).  It was clear that there were similarities with test method validations and laboratory certifications that we deal with in our pharmaceutical QC Labs and there were also some significant differences. The discussions and tour were very insightful and we came away with lots of ideas for how we might be able to help them achieve their vision.  On Wednesday I'll have a chance to visit with their Quality Management team and learn even more...after my brain has a chance to recuperate from all it tried to soak up thus far!

The majority of the remainder of the day on Tuesday was spent with a very impressive individual who is actually on faculty at Purdue and has been at AMPATH for a few years.  He is in charge of several special projects ranging from updating the software for their pharmacy to advancing the effectiveness of their satellite diabetes clinics.  He is highly energetic and driven by a passion to improve the health of individuals in this region.   He and his team which include former Kenyan diabetes patients, Pharmacy students, and other researchers and clinicians from the States and from Kenya shared their latest vision which is to expand the scope of the satellite clinics to include Primary Health Care and Chronic Diseases (beyond the HIV and Diabetes scope of today) and utilize a concept they've coined as a Revolving Fund Pharmacy.  It was exciting and exhausting all at the same time!

While we were touring the various pharmacies today we met some very interesting people.  One of them was a petite but feisty little lady named Jane, who from best I can tell is responsible for getting Lilly to donate the insulin that we provide to them today.  As she told the story it was obvious that her literal plea for help from Lilly initially fell on deaf ears (would have liked to crawled under a table at that part of her story...).  Thanks to her perseverance and the help from an IU physician she finally made the connections she needed to and received an initial very small shipment.  She told us how those first 20 vials of insulin went to the street children, and when the next little larger shipment arrived, it went to the orphans and vulnerable/at risk children, and as the supply chain grew, they are now able to provide much needed insulin to hundreds if not thousands of patients.  We were riveted while she told her story and in the end she told us that she prays for Lilly every day in hopes that they will continue to help them save lives….all this from a true Angel of Mercy herself, who driven by her compassion for her people found a way to make it through all the Lilly red-tape and get the insulin they so badly needed.

As Jane was telling us the history she mentioned that now people come from hours away, some even from Uganda to get treated for diabetes and receive insulin if its needed.  She mentioned that she knows how far some of them have to travel so that helps her decide how much insulin to send with them.  I asked her if/how the patients keep their insulin cold – it is meant to be stored in a refrigerator and I can tell you that refrigerators here are few and far between.  She then told me about an ingenious vessel that is used by the native tribes to keep things cool.  It is a clay pot that is filled with charcoal-like substance with a small glass in the center.  The insulin vials are kept in the small glass and water is added to the charcoal in the pot which is where the cooling effect comes from.  I’ve attached a photo so you can see for yourselves….not exactly a validated shipping container but its available to just about everyone if they need it... and it works!

During one of our short breaks in the early part of the day, one of my colleagues made a new friend with a young Kenyan boy.  They had fun trying to talk as Bill speaks no Swahili and the boy did not speak much English.  At some point they were playing with Bill’s video camera and the young boy saw his picture “zoom” into view and gave it a resounding “good”!  Bill wanted to share something else with him so he gave the youngster a pack of Trident (sugarless!) gum.  After that wherever we went throughout the center the remainder of the day, Bill’s little buddy wasn’t far behind….I think they are probably friends for life now!

One interesting thing we have noticed in our tours through the facilities is the plethora of anti-corruption posters posted in many of the hallways.   I’m not sure we know exactly what to make of it but I’ve attached a photo of one so you can see for yourselves.

We had a new item to try at lunch called getheri (or something close to that) which is a mixture of beans, corn, and a few carrots.  It is a staple out on the streets and I’m sure its one of the few sources of protein for many people.  The corn they eat here is nothing like the sweet corn that we eat.  As a matter of fact, it is much closer in consistency and flavor to our field corn that is used to grind into animal feeds and produce cereals.  It had obviously been cooking for a long time and had a nice flavor to it but probably not something I will try to make at home…

At the end of the day today, the guys on our team were invited to play a whiffle ball game with some of the folks who have been hosting us who live in the IU housing complex.  It was played out in the open parking/street area and was quite entertaining…actually, we were all invited to participate but only the guys took them up on the offer!  We had heard about a young Kenyan man who is one of the guards at the compound and he is quite a sports talent.  It seems that until earlier this year he had never thrown or played anything like baseball.  After watching the guys show him how its done, he is now an expert pitcher….trust me, I doubt any of you have ever seen a whiffle ball travel as fast as this young man can throw it….I imagine with a fully weighted baseball he would be even more impressive.  They call him “Ellie” because of it sounds like his Kenyan name but he definitely doesn’t throw like a girl!  The game was good fun to watch and from best I can tell, the guys had a good time playing.  It was a nice way to unwind at the end of another intense day and we all enjoyed a good Kenyan-Chinese dinner afterwards.

Wednesday looks to be another good day….I’ll let you know how it goes…

Thanks to all of you who have shared your comments and encouragement on the blog postings….I guess I'll keep posting them as long as someone is reading them....