I just got back from spending a few hours working in the clinic laboratory while the rest of the gang went downtown to do a little shopping. The lab is only open in the morning, so it´s been hard to schedule some time to get in there. Hugo, the technician (he´s also a pharmacist), showed me around a little at first... which didn´t take long. The entire lab, including the phlebotomy chair and a small bathroom, is only about 10 feet by 10 feet. Not long after I´m there, a patient knocked on the door needing bloodwork. Hugo asked if I wanted to collect the blood, and I told him I would be happy to. But as we got things ready I realized their process is completely different than what I´m used to, so I told him I´d rather watch him this first time and I can take over after. And I´m glad I did. My lab friends are going to love this....
Here in Alto Cayma, whenever a patient needs work to be done, whether it´s laboratory work, a surgery, dental care, etc... they are responsible for purchasing the supplies needed for that work ahead of time (I´ve heard stories of patients only getting half a surgery than what was actually needed because they couldn´t afford to get all of the supplies at one time). So, when the first patient came to the lab, she had in hand a small bag that included gloves and a needle. The only thing the lab supplies is the tourniquet and the glass vials that the blood is collected in (which are washed and reused after each patient). Nothing here is a one-time-use disposible device, except for the needle... and definitely no evacuated tube systems. As I watched Hugo collect the blood, I was amazed at his technique. First, he prepared the glass vial that would eventually hold the blood specimen. Because we were doing a CBC, he put a single drop of liquid EDTA in the bottom. Then, after securing the tourniquet and cleansing the site with alcohol, he inserted the needle (which is just a straight 21 guage 1.5 inch needle with nothing on the end) into the patient´s vein, and then simply held the small glass vial at the other end of the needle and let the blood drip into it. That´s it! That´s all there´s to it. When he had about 1 mL of blood in the bottom, he pulled the needle out, gave the patient a piece of cotton and let her go right away.
Testing at the lab is very "old school". All of the equipment is dated (I saw a chart on the wall that was published by DIFCO laboratories in Detroit from 1974!!) and most of the work is done manually. Gloves are hard to come by, so if you´ve got them you use them, but if you don´t it´s not a requirement. Pipetting by mouth is also a common practice... yuck.
I drew blood on a few patients, which once I got the hang of it ended up being not so bad afterall. My biggest concern was accidentally sticking myself, since there is no protective devices to help avoid that. I also helped Hugo do a few urine dips and spin a few tubes of blood. I wish I was able to do more, but the language barrier didn´t help much. The most common tests we did today were CBCs, urines and a few parasitology tests. Gastro issues in this area are extremely common. I thank the Lord we didn´t encounter any with worms. We also did a few glucose tests and CRPs. We also did an ABO/Rh on a 6-year-old girl... not really sure why, though. As you can imagine, DX codes are not a part of the their system. After the big rush (which was only 10 patients or so - but it takes so much longer to do the tests because everything is manual), it was time to wash the glassware, including the urine cups and pipettes. Hugo started resulting all of his work, which again was hand-written and delivered to the doctor. By noon, it was time to close up shop. I headed back up the mountain to the volunteer house where I waited for the rest of the group to get back from shopping.... and, yes... a quick nap was definitely in order!
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