APHL Assists Haiti to Rebuild Devastated Lab System

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.”

Rebuilding Haiti’s Labs: Governance, Policies and Systems Before Bricks and Mortar

At a March 31 United Nations special session on rebuilding Haiti, countries responded with pledges of significant funding for the decimated nation; however, funding alone will not rebuild Haiti, and certainly not its battered laboratories.

First, Haitian leaders must find the courage and commitment to confront corruption and inefficiency within their government. Without a fundamental shift from opportunism to public service, donors will not be willing to sustain the long—and costly—process of recovery.

Photo: A typical lab in Port-au-Prince, Haiti

Second, the international donor community must adopt new operational models that are less dependent on the services of ex-patriots. Good models are available. Paul Farmer at Partners in Health and Jean William Pape at GHESKIO/ Weill Cornell Medical College, for example, have shown that impoverished communities with few resources can combat diseases and improve health care. Their approach—like that of APHL's project in Haiti—is to build long-term partnerships with local groups and to help train their doctors and healthcare professionals.

Third, Haiti’s laboratories need to be reconceived and rebuilt as part of an integrated national laboratory network operated under a strong quality management system. A precursor to this is development and implementation of a revised national laboratory policy and strategic plan to guide the orchestration of the necessary resources, including a trained and competent workforce.

Yet the reality at the moment is that there isn’t a comprehensive and forceful Haitian laboratory policy, strategic plan or network, only the commitment of the country’s national laboratory to forge a true laboratory system and support from some non-governmental organizations. How can APHL best support development of a nationwide laboratory system that will serve all of Haiti’s people? We look forward to your comments.

APHL Working to Ensure Power for Laboratory Services in Haiti

When the electrical grid comes back on-line in Haiti, the country’s laboratory system will be able to ramp up services quickly thanks to measures put in place before the magnitude 7.0 temblor January 12.

Even before the devastating earthquake, electrical power in Haiti was unreliable, with routine outages and serious voltage and frequency variations that compromised laboratory testing. Outages can lead to the loss of valuable testing reagents that must be stored at controlled temperatures, while “dirty power” is damaging to a wide range of laboratory equipment, including instruments used for diagnostic testing to support antiretroviral treatment for HIV-infected patients.

With funding from CDC’s Global AIDS Program and funding and technical assistance from the US Agency for International Development, APHL invested in site-specific technologies to improve the quality of the power received from the electric grid and provide continuous power during grid power outages. The core technologies include uninterruptible power supplies, generator back-up power with automatic transfer switches and no-contact inverter battery systems.

In addition, APHL has provided on-site maintenance and supervisory support visits with two-person teams comprised of one laboratory technologist and one service technician that travel to 16 supported sites throughout the country. Thankfully, Haiti’s national public health laboratory, the Laboratoire National de Santé Publique in Port-au-Prince, remains standing in the aftermath of the earthquake.

Although the massive relief effort has consumed all the country’s resources—with surviving laboratory staff understandably focusing on their homes and families—APHL is hopeful that conditions will improve enough to enable public health testing to resume in the not too distant future. At that point, the electrical support infrastructure will be a valuable help.

First Day Back in Haiti: Notes from January 22, 2010

By David Doherty, APHL Consultant

Just had an aftershock as I was beginning to type this message. Here is a very brief synopsis of the site visits from today:

1) Bernard Mevs
- no damage to hospital or lab
- no electricity but a 100kW generator is supposed to arrive from Jamaica tomorrow AM
- they have Sysmex but no automated chemistry; Drs. Bitar (Jerry and
Marlon) are desperate to get up and running to do haemograms and blood typing; they are doing as many as 20 surgeries an hour
- all lab techs survived but are homeless; spoke with two of them this afternoon; one is in Miragoane and is willing to return to work on Monday; another is sleeping outside in P-ville and will be returning to Hinche to accompany the older members of her family out of the city

2) HUP
- some damage to lab and hospital; mostly horizontal cracks on non-load bearing walls; all beams seem to be intact
- no electricity in lab
- Sysmex but no automated chemistry
- spoke with lab supervisor and Drs. Fontilus and Sant Fleur; all technicians are ready to report to work once they open the lab; she has requested one of the APHL techs if we get them a Vitros

3) Hopital Carrefour
- no damage to infrastructure; MSF has taken over the hospital temporarily; they will be moving to a new site on Monday and Carrefour will resume independent operation
- inverter and generators are intact; only concern will be availability of fuel
- no automated hematology except Hb and white cells using Point Care instrument; no automated chemistry
- spoke with the medical director, Dr. Dauphin; Ms. Barolette, the lab supervisor, had just left; all his technicians survived and are available as soon as he gives the word

4) Fame Pereo
- major structural damage to second floor; lab is intact but unsafe due to the unstable mass of concrete above
- inverters are damaged but functional Sysmex and Reflotron operational
- all technicians are available for work except one who returned to Gros Morne; spoke with her this evening and she is ready to return once she has a place to work
- spoke with the medical director, Dr. Pean; she is looking for another building to house the clinic temporarily; she will require some funds to get the lab set up if space is located

5) Maternite Isaie Jeanty
- no major structural damage to hospital or lab; hospital opening half days for emergency cases only
- lab was operating with power during the visit
- no automated hematology except Hb and white cells using Point Care instrument; no automated chemistry

Did not attempt to visit HUEH because it has been taken over by the US Military and PIH.

We need to help CMMB unload a plane tomorrow morning. I will visit NPFS if there is time while we are in the neighborhood. Hoping to get to Leogane tomorrow afternoon to see Sanatorium Sigueneau and St. Croix. (Ran into a team of US doctors on the plane to Miami; they were being posted to the latter site.)

Taking a team of orthopedic surgeons and anesthesiologists to Jacmel on Saturday morning. I will check out St. Michel and Marigot. Don't think I will have time (or a road) to get to Bainet and Lavalee.

We will resume visits to the remaining sites in the West on Monday (Grace, St. Fracis de Sales, IMIS, etc.). We will not schedule a visit to the GHESKIO main campus as they are overwhelmed.
Lastly, went to the Petionville Club to speak with Coty Reinbold. (He is managing the relief camp there, currently 53,000 people.) The situation for Vitros DT60 is as follows:
a) he has two instruments for GHESKIO that have not been installed
b) he has two instruments for PIH that have not been installed
c) AIDS Relief has 5 or 6 instruments at the warehouse in Delmas that have not been installed; I will be meeting with Olivia tomorrow to confirm that those could be made available for the relief effort if needed; their office and storage depot were not damaged.

Public/Global/Environmental Health Leaders Among "Best Thinkers"

Foreign Policy Journal just published a special issue centered on the idea of the "Top 100 Global Thinkers."

As I was reading through my copy, I noticed that a significant number were chosen/noteworthy for public health, global health, climate change, or other environmental issues. While there is overlap (and a likelihood of "classification bias" by me) my review finds the following:

1.) 10 persons noteworthy for public health thought and initiatives...
2.) 5 persons for global health...
3.) 6 persons for climate change...
4.) 2 persons for other environmental issues.

Perhaps this might be of use/interest...or at least a diversion from H1N1. Additionally, several persons are further profiled on what they are reading, who they think are the "best thinkers," what their best/worst ideas were, etc.

Pat Luedtke, MD, MPH
Laboratory Director
Utah Division of Epidemiology and Laboratory Services