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.”

Celebrating National Lab Day

Today marks the very first National Lab Day, an event conceived in 2009 by a grassroots coalition of educators and scientists eager to reinvigorate science, technology, engineering and mathematics (STEM) education for America’s K-12 students. The event earned a stamp of approval from President Obama and was added to his “Educate to Innovate” campaign to combat the nation’s flagging performance in science and math. National Lab Day looks to create a community of students, teachers, professionals and organizations focusing on collaboration to “improve educational outcomes, inspire students to pursue science, technology and engineering careers, improve hands-on laboratory environments in the STEM subjects, and raise student, parent and public awareness of the importance of science and technology to our nation’s future.” Check out the National Lab Day website for more information.

Just as any computer company, alternative energy think tank or NASA department depends on new ideas and innovation from younger generations, public health laboratories also require skilled, innovative thinkers to confront the ever-evolving challenge of keeping American citizens healthy. Public health laboratorians are the behind-the-scenes “disease detectives,” providing the science to confirm food-borne illness outbreaks, emerging infectious diseases, potential chronic illnesses in newborns, and even biological terrorism threats. Despite the importance of the labs, the United States is in the midst of a severe shortage of public health lab workers, and badly needs a steady stream of new laboratorians to enter and innovate in the field.

APHL is committed to assisting the youngest generation to become leaders in the STEM fields, and more specifically, in public health laboratory science. APHL’s Workforce Development department creates continuing education opportunities and leads a fellowship program for the best and brightest studying emerging infectious diseases and environmental health. The National Center for Public Health Laboratory Leadership (NCPHLL) strives to prepare current and future laboratory leaders with the skills critical to public health lab success in the rapidly-evolving field. APHL also participates in the Labs Are Vital education and awareness program, working to promote laboratory science to students and the general public.

National Lab Day is a perfect opportunity for APHL and public health laboratory workers to promote the importance of public health laboratories in their communities and to lead students towards the exciting and vital world of public health. The National Lab Day website has many opportunities for scientists and other professionals to volunteer at schools. There is nothing like hands-on learning and real-life experience from actual laboratorians to excite and inspire kids towards a future in lab science. Who knows, a future laboratory leader may be dissecting his or her first frog today.

National Lab Day Website 

National Lab Day Video

National Public Health Week -- APHL Honors Public Health Laboratories

By Mary Shaffran, Senior Director, Public Health Programs, APHL

Along with our partners, the public health laboratories are working to keep communities healthy. Laboratorians work behind the scenes. Public health laboratories serve as the nation’s early warning system for diseases and other health hazards. When health risks emerge or re-emerge, public health laboratories analyze the threat, provide the answers needed to mount an effective response and act to protect the public in collaboration with other decision makers. They protect our health by monitoring continuously for diseases and other health hazards.

Just a few of the things that laboratories are doing every day to make sure that you and your neighbors are healthy: 

- Public health laboratories in every state are the backbone of our nation’s infectious disease surveillance networks. They are analyzing infectious diseases such as influenza to determine if they are changing and reporting this information to public health officials so they can determine effective prevention measures. [More on the Infectious Disease Program]

- More than 11,000 babies are screened daily for potentially life-threatening genetic and congenital disorders.

• Matt and Noelle Bamonte discovered that their seemingly healthy baby boy had PKU, a serious disorder that can cause brain damage if not treated from a very early age. Noelle is certain that without laboratory screening, her little boy would have been vastly different. Now, aside from a strict diet, he lives a normal life! [More of their story]

- Public health laboratorians confirm whether people are infected with sexually transmitted diseases, and confidentially report back the results so that people can be treated and others are not exposed. [More on the Sexually Transmitted Disease Program]

- In order to detect foodborne outbreaks and ultimately keep Americans safe from foodborne disease, public health laboratorians test human specimens and food samples for bacteria such as Salmonella and E. Coli.

• In 2006, the New Mexico public health laboratory pinpointed the exact source of the E. Coli that made its way into spinach and made hundreds of people sick. [More on the E.Coli outbreak]

- Public health laboratorians test environmental, clinical and food samples to determine whether they contain hazardous agents in order to protect Americans from terrorist attacks, and they are able to do this 24/7.

• California scientists are collecting specimens from 2,000 people to test for the presence toxins used in used in industry, agriculture and the home. They’ll use this information to explore such things as the connection between exposure and diseases, and to examine changes in exposure over time and the connection to changing health policies and industry regulations working to reduce exposure. [More on the work in California]

- Public health laboratorians test water samples in flood-ravaged areas to ensure that the water is safe to drink.

• In 2008, severe flooding in Mason City, Iowa caused the closure of the water treatment facility. Residents were advised to boil their water until the system was restored and the water was tested to ensure it was safe to drink. The Hygienic Lab rose to the task and tested the water quickly bringing the treatment operation back online. [More on the floods in Iowa]

We would like to thank our unsung heroes in lab coats for protecting the public’s health – every day.

 

Join APHL and our many partners in celebrating National Public Health Week. For more information, visit http://www.nphw.org/.

 

 

 

 

 

 

 

 

 

Newborn Screening: Part 1

Newborn screening is the process of testing a newborn baby for genetic and congenital disorders that can cause illness, disability and death. Virtually every state now screens for a core panel of 29 rare genetic and congenital disorders, which include sickle cell anemia, PKU (phenylketonuria) and MCAD (medium chain acyl CoA dehydrogenase deficiency). The test is a small heel-prick to draw blood that is then sent to a laboratory (97% of which are state public health laboratories) for testing. This test allows thousands of babies to be diagnosed with devastating diseases in the earliest stages of their lives, and allows doctors to begin managing these diseases while they still can.

State public health labs are part of a newborn screening system that includes public health staff, birthing center staff, primary care physicians, metabolic specialists, educators and families. Careful coordination among all parties ensures that the infant receives prompt and appropriate treatment, follow-up care and continued evaluation.

There are countless stories from parents who are grateful that their children are alive and healthy thanks to newborn screening.

Parenting Magazine recently published an article telling the story of one family whose baby’s life was saved by early intervention newborn screening.

And in Wisconsin, a family had a scare when a test came back positive for a fatty acid oxidation disorder, a potentially deadly condition.

APHL will be doing a series of posts to LabLog on newborn screening. Please feel free to leave comments and questions.

“Perfect Storm” Prompts FL DOH to Open Workforce Office

By Nancy Maddox, MPH

Recent news from the Florida Department of Health (DOH) offers hope that upper echelon government leaders are waking up to a looming public health workforce crisis.

A Florida DOH brief notes that the agency is approaching a “’perfect storm’ in maintaining a competent workforce,” given a wave of retirements, noncompetitive wages, an ill-prepared pool of applicants and job-related stresses that compound hiring difficulties.

The brief wisely notes, “In times of funding constraints and reductions, there is an even greater need for a better educated workforce that is always learning the most efficient and effective methods of running state government.”

They do seem to understand the situation.

In response to these concerns, the agency has created a special workforce development office to assess and improve workforce competencies. In fact, the office’s task list includes some of the activities carried out by APHL’s own training programs and National Center for Public Health Laboratory Leadership (albeit for a broader state public health workforce), so we know it is on the right track:

• Establishing succession plans, mentoring programs and an in-house leadership program.
• Maintaining a catalogue of state trainers and training resources.
• Sharing best practices across divisions.
• Developing self-paced training modules.
• Coordinating development of a first-in-the-nation clinical management practice institute and training program and a first-in-the-nation financial administration certification program.

We hope the state’s efforts will translate into real improvements for the Florida Bureau of Laboratories.

Those interested in more information can contact Shannon Hughes, workforce development director, at 850.245.4444, ext. 3409 or Shannon_Hughes@doh.state.fl.us.

Laboratory Workforce News: The Good, The Bad, The Ugly

By Nancy Maddox, MPH

The Good
U.S. News & World Report recently named “lab technician” one of America’s best careers for 2010.

Lab technician was one of 11 healthcare careers recommended for “traumatized job seekers and anxious students.” The magazine notes that “job growth is expected to be faster than average, with the number of clinical lab workers rising about 16 percent” and additional openings available to replace retiring workers.

The Bad
ASCP reports in its January 1 ePolicy News update that the University of Nevada, Las Vegas, is mulling the closure of its 20-year-old clinical science program—despite the program’s status as the only of its kind in the state, and despite graduates 100% success rate securing positions within three months. ASCP indicated that it planned to approach program administrators to “shed light on the laboratory workforce shortage.”

The Ugly
Unfortunately, the U.S. News & World Report article mentions lab technician opportunities in private diagnostic laboratories and physicians’ offices and fails to mention opportunities in public health.

Ditto for the entry on clinical laboratory technologists and technicians in the current edition of the Occupational Outlook Handbook put out by the U.S. Bureau of Labor Statistics.

Clinical Learning in a Virtual World

by Dorelle Engel, product line specialist, On-Demand Products

Take it with you! APHL’s Department of Continuing Education and Training has released an outstanding new online course in CD format entitled Red Blood Cell Morphology. The course can be used as a review for hematology technicians, clinical lab scientists, technologists and pathologists. To those new to the field, this course is an invaluable training tool in identification of normal and abnormal red blood cell morphology. In addition to course content, scenarios were developed to provide real-life simulations in a hematology lab setting. These 10 different scenarios include both case studies and bench work situations. Patient history and lab results are presented and the viewer can examine virtual blood smears for each activity. Several practice questions are provided for each scenario, challenging the learner’s comprehension. APHL CD format allows for training at the convenience of the laboratorian. This basic course offers 2 contact hours through the ASCLS P.A.C.E.® Continuing Education Program.

In addition to our On-Demand line up of programs, APHL strives to provide and encourage high quality Continuing Education and Training Programs using a variety of different presentation formats, including seminars, hands-on laboratory workshops, teleconferences and webconferences. Check out the link to APHL’s Featured Training and all our program offerings!

The Michigan Laboratory System Advisory Group Experience

By Patty Clark, M.P.H., Michigan Department of Community Health Bureau of Laboratories

The first meeting of the Michigan Laboratory System Advisory Group (LSAG) met in November, 2009. The LSAG was formed as a direct result of the Michigan Laboratory System Improvement Program (LSIP) held last March. The intent of the LSAG is to provide a forum where Lab System partners can meet, discuss issues affecting system partners, and participate in workgroups by interest and need to solve common problems. During the LSAG meeting, a brainstorming session created a list of areas where system partners felt there was need for improvement. The items on this list were prioritized by voting as high, medium, or low priority. At this point, system partners were asked for input as to how they would like to see the group move forward. Some partners voiced a concern that we had not captured all data from the original LSIP meeting in our priority voting and all were confused as to how to proceed. The intent to get buy-in from partners by involving them in the decision making process resulted in confusion and the inability to move the group forward. We ended the meeting assuring partners we would revisit the LSIP documentation, review the brainstorming and priority lists, and get back to them with a comprehensive list from both the LSIP and the LSAG. My suggestion for others planning such a meeting is to provide more direction and ask for opinions from the group rather than expecting the group to make decisions, at least in the initial meetings.

Staff Burnout in Flu Response: Tips from Montana

At the Montana public health laboratory, we are concerned about staff burnout. We don’t have enough staff cross-trained on the influenza test platforms, and our testing volume is highly variable depending upon the patterns of influenza and influenza-like illness circulating in the state. We are testing a representative sampling of specimens from across the state to detect seasonal influenza when it begins circulating. We anticipate that the volume of testing will increase when it becomes important--based on the different resistance patterns in seasonal influenza A--to know the influenza A subtype.

While I don't have great suggestions for reducing staff burnout, here are some measures that have helped us to cope. We activated a limited ICS structure and dedicated a single call-in line for questions about influenza testing. We also added staff to support critical tasks (e.g., today you will run the testing, process specimens, log in specimens, take telephone calls, etc.) and rotated responsibilities so that no one person had sole responsibility or the same responsibility for days on end. In addition, we stepped up our communications to staff and clinical partners via a weekly influenza update.

Susanne Norris Zanto, CLS(NCA) SM(NRM)Montana Public Health Laboratory

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

Toxic Chemical Policy Reform: Low-Hanging Fruit?

As Congress takes on some major issues, toxic chemical policy reform seems to be one that might be low-hanging fruit. It is a rare thing, when EPA’s principles for toxics reform line up with industry’s principles and environmental advocacy groups'. . . but as with health reform, the devil will be in the details. For example, industry wants to use terms like “safe for intended use” but it is not always the intended use that ends up resulting in exposures. From the laboratory perspective, all sides appear to agree that biomonitoring will play a key role in prioritizing chemicals for assessment. It will be important to take advantage of this opportunity to emphasize the need to build state and local biomonitoring capability.

The Power of APHL

by Karen Rogers, senior specialist, communications

The American Society of Association Executives (ASAE) recently interviewed APHL’s executive director, Scott Becker, as part of a new campaign, “The Power of A,” which showcases examples of collaborative problem solving at associations. ASAE is the national association representing trade and professional associations.

During the interview, Becker discussed members’ response to the novel H1N1 virus and their dedication to APHL as well as the urgent need to build national capacity for electronic reporting of laboratory data. The video is available on YouTube and on ASAE’s The Power of A website.

A New Frontier for Public Health Laboratories

by Norman Crouch, APHL Emeritus Member, Guest Blogger

Dr. Norman Crouch, is a well known figure in the APHL community. Earlier this year, after 16 years with the Minnesota Department of Health, Dr. Crouch announced his retirement. As laboratory director and assistant commissioner, Dr. Crouch worked closely with APHL, serving as a member-at-large and secretary/treasurer on APHL’s board of directors, APHL president from 2003-2004, and a member of numerous APHL committees. The post below is adapted from the keynote address he gave at APHL’s 2009 Annual Meeting.

I believe these are exciting times for state and local public health laboratories. Despite current difficulties caused by severe budgetary reductions that impact operations, as well as workforce training and recruitment, our laboratories in public health have entered a new frontier. Major changes are occurring to accommodate advanced technology and address increasingly complex health threats caused by natural, accidental, and deliberate public exposure to infectious or toxic biological and chemical agents. Today, our public health laboratories play a key role in emergency preparedness and response, food and water safety, and the expansion of newborn screening. It is becoming increasingly clear to both governmental and private sectors that our health laboratories play a unique and essential role in protecting the public.

Based on experience as a state public health laboratory director, I believe this new frontier embraces a significant change in laboratory culture. In the past, most public health laboratories were described as being independent, focused on providing routine and rare laboratory services to support public health-related programs. As the role of the public health laboratory has changed in response to technology and need, the laboratory culture has become one of interdependent connectivity and high expectation. There’s been a shift from the independent analytical testing of the past to an innovative culture of communication, collaboration, and cooperation with a multitude of essential partners. Today’s partners include (1) infectious disease and environmental epidemiologists, (2) sentinel clinical laboratories, (3) local and state first responders, (4) other state agencies, (5) numerous federal agencies, and (6) state and local health officials. This connectivity, I believe, will be a major strength for our public health laboratories in the future. Such connectivity will result in better understanding of the public health laboratory’s value, giving our laboratories a priority status not experienced in the recent past, which will foster robust inter-partner advocacy essential for sustaining laboratory operations relevant to public health and safety.

To convince key partners of the value of our public health laboratories, we must continually demonstrate that our mission is markedly different from other laboratories, and that our laboratories are indispensible in the broad scheme of health protection. To be convincing, our laboratories must show their value, not just say it is so. We must show our partners strong professional leadership, our worth to the public health cause, and our willingness and ability to go beyond expectations.

In a sense, this is a “golden time” for public health laboratories. With recent national food borne disease outbreaks detected by our PulseNet laboratories, with our laboratory response to rapid introduction of the novel H1N1 influenza virus, with the widely recognized critical role of our national Laboratory Response Network in biological and chemical surveillance, with our leading effort to expand newborn screening, and with the construction of new, high-tech laboratory facilities, public health laboratories are in the spotlight. Even the public now awaits identification or confirmation of an unknown biological or chemical agent in samples sent to the public health laboratory for analysis. They know this is critical information that determines what actions will be taken to protect their health and keep them safe. Additionally, each state now recognizes the importance of expanded newborn screening to detect treatable inborn errors of metabolism and congenital defects.

With this current visibility, I believe our public health laboratories are viewed with respect and high expectation. By continuing to demonstrate that our unique operations are indispensible for local, state, and national health protection, our public health laboratories will survive and thrive in this new frontier.