The district hospital lab was an interesting experience. I got several good ideas for possible design projects and I learned a lot about the limitations that they’re working with here. Tests that we take for granted in the States aren’t possible here on a regular basis, and some not at all.

The blood chemistry analyzer is out of order (and has been for months) so all of those kinds of tests are impossible. No cell counts. No enzyme levels. No basic diagnostic tests like those!

 The automatic hemoglobin reader was also out of order. They were doing hemoglobin measurements by taking a hematocrit (they fill a capillary tube with blood, spin it in this special centrifuge, then use this device with an arm that you point at the division of plasma and blood and read off the packed cell percent. They then divide that number by 3 to get the Hb.)

 They were using a glucometer like the ones that are over the counter in the states for diabetics to do blood and CSF glucose levels. For now, this is working. But when they run out of the proprietary test strips, they’ll be out of luck on glucose tests.

 They don’t have a histology department anymore because the pathologist left.

They do the “heat until the fluid begins to vaporize” step of the TB stain procedure by lighting a piece of cotton wool on fire and holding it with tongs. So not safe. (I watched the guy nearly light his sleeve.)

There is one person who spends his entire day reading malaria blood smears. (Most are negative, as it turns out.)

 I’m interested now in seeing a rural health center (if I can) when we go out to Rhumpi or Chitipa. Because those are where the bulk of health care in Malawi actually happens, and Ellie says they are woefully underfunded and understaffed. She says it will be even less capable of conducting basic tests than the MCH lab. What a thought.

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