Southern Ethiopia - Gwent Health Link

This is a report on the laboratory services available at Hwassa.

Being the first Biomedical Scientist in Biochemistry to visit Ethiopia and the Hawassa Referral Hospital, my main objective was to assess what equipment was available and what biochemical tests were being done. My prior information was that they did not do any biochemical tests, had just a basic photometer for measuring absorbance and some sophisticated, unused equipment in storage. I therefore assumed that what they needed was some old manual methodology. However, it was quickly apparent that this was not the case. I was pleasantly surprised by the equipment in use and the number of assays that were being done.

There were 2 Laboratories adjacent to one another, the Hospital Laboratory and the HIV Laboratory. The patients travelled long distances to both Laboratories, either on foot or by donkey carriage, to have their bloods taken at 09:00am. They then had to wait outside until all the bloods were processed, so that they could be seen by the clinic and then return home. A rapid turn-a-round time for tests was therefore essential for the needs of the patient. It is for this reason that manual tests would not be appropriate.

This Laboratory is funded by an American Hospital/ University.
It is equipped with a Humastar 80 Automated Clinical Chemistry Batch Analyser made by HUMAN, a German company. This analyser has the capacity to do up to 80 samples per hour, has 20 reagent positions and 54 sample positions. They use Human standards and controls and take appropriate action when controls fall outside the set ranges. This analyser is very reliable and remote support is given by the company when problems arise. I tried to find out what happens in a major breakdown, and was told that an engineer would come but was unable to assess as to what the timescale would be for this. I am assuming that the funding for this would be from America.
There was no external QC scheme.
Workload was approximately 30 samples per day, all in the morning. This was 20 samples from the HIV Lab, and 10 samples from the Hospital Lab.

The tests analysed on the Humastar 80 were as follows:

• Total Bilirubin
• Direct Bilirubin
• SGOT (AST)
• SGPT (ALT)
• Alkaline Phosphatase
• Urea
• Creatinine
• Triglycerides
• Total protein
• Cholesterol

This was a small laboratory with only one piece of Clinical Chemistry equipment. This was a RIELLE Photometer 5010 made in Germany. It is a semi-automatic, single-beam filter photometer. It can be programmed to measure end point reactions, bichromatic end point reactions, kinetic reactions etc., but can only do one test at a time. This was programmed for the following assays-

• Total Bilirubin
• Direct Bilirubin
• SGOT (AST)
• SGPT (ALT)
• Alkaline Phosphatase
• Urea
• Creatinine
• Triglycerides
• Total protein
• Cholesterol
• Glucose
• Albumin
• Uric acid
• LDH

However, they only had a limited supply of some of these reagents, and because this machine was tedious to use, the work was analysed on the Humastar 80 in the HIV Laboratory, which had a ready supply of the Human reagents. As in the HIV Lab., all the bloods were taken at 9:OOam. from the out- patients and were then analysed on the Humastar 80. This gave a much quicker service for the patient.

Others tests done in the hospital laboratory were as follows-

• Glucose - performed with a glucose meter
• Faecal occult blood- performed using a Hemospot test kit
• Uric Acid – performed using a Uric Acid test kit
• Urine Glucose, Protein, Blood etc – performed using Multi-test Urine Test strips

At the moment they have run out of urine test strips and glucose meter strips and don’t know when they will get more. There seems to be no system or finance to ensure continual supplies. They could do manual tests on these occasions, but as these are tedious to do, they prefer to send the tests to a private laboratory. I am told that the patients contribute towards the costs of their treatment according to their means.

Workload was approximately 10 samples per day, all in the morning, mainly from out-patients.

CONTACTS
Mr. Demissie Assegu - Head of the Hospital Laboratory

Assistance was also given by
Mr. Miscanaw Birhaneselassie
Mr. Yayehyirad Tassachew
Mr. Henock Ambichew

Mr. Mistire, the only lecturer in Clinical Chemistry was not present during our visit so I was unable to enquire as to what he was teaching the students and what practicals they did. In his absence I visited the University Laboratory and I have made an inventory of all the equipment and chemicals present. Mr. Mistire did turn up about 10 minutes before we left on the final day and I briefly managed to ascertain that they did not have enough facilities or equipment to do much practical work with such large numbers of students. They did, however, do manual urine tests eg. SSA for protein and Benedicts for glucose etc. The students also had practical experience on the 5010 and the Humastar 80. He did say that they had electrophoresis tanks but no power supply, and a Flame Photometer that did not work. However in my assessment of equipment in each of the labs I did not find the Flame Photometer, or any Electrophoresis Tanks, so I was unable to get the details and follow this up at this late stage.

CONTACTS
Mr Mistire Wolde

Assistance was also given by
Mr. Miscanaw Birhaneselassie

• TC 412 Thermal Cycler (TECHNE) – in Hospital Laboratory store.
• Autohumalyzer 900S Plus (HUMAN) - in Hospital Laboratory store.
• Biomate 5 Spectrophotometer (THERMO SCIENTIFIC) – in Hospital Laboratory store.
• PD-303UV Spectrophotometer (APEL) – in cupboard in Hospital Laboratory.
• DLC 20 Liquid Chromatograph (D STAR INSTRUMENTS) – in University Laboratory.
• Flame Photometer ( Manufacturer not known) – not sure where it was living.
• Electophoresis Tanks ( Manufacturer not known) – not sure where they were living.

STUDENTS

I gave a talk to 13, 3rd year students during the first week. I showed the students what a large working laboratory looked like, and the equipment that they could expect to find in a Clinical Chemistry Laboratory. Also, the tests that were done on these and why they were done. This was useful to them as they were going to Addis Ababa for 3 weeks later the next day and would be spending time in Laboratories there. I also gave them a talk on Protein Electrophoresis, the methodology, the various protein components demonstrable by electrophoresis, the clinical interpretation and significance of each. I also gave them examples of ones that I had prepared prior to going out. They asked if I could give them the information contained in the talk, so I spent the evening doing 250 photocopies of the theory content at an internet café, so they could each have their own copies. It was very encouraging and rewarding when they each came to find me individually the next day to get their copies.
During the 2nd week I gave a similar talk to 115, 1st and 2nd year students. They showed a lot of interest and liked the examples I had taken, also the wall charts. They also asked a lot of questions about the methodology and were keen to find out more about the identification and typing of monoclonal bands.

OTHER DUTIES

I also helped Paul Harding with his theory lecture and assisted in his 4 practical sessions when we blood grouped all the students.
I went on a visit to 2 Health Centres, Wendo Genet and Yir Gacheffe. In both of these the only biochemical tests done were on urine, using Multistix Urine Test Strips. I did ask if they would like anything else and they said they would like to measure Blood Glucose.