Introducing a lifesaving diagnostic tool in Uganda

Daisy WinnerBlog, Featured, Sharing Strengthening Saving, Uganda, Uncategorized

Jenifer Lasman (2nd from right) on the ward at Mbale Hospital with (left to right) Habert Omusei, Christine Khayiyi, and Esther Cherop

Jenifer Lasman (2nd from right) on the ward at Mbale Hospital with (left to right) Habert Omusei, Christine Khayiyi, and Esther Cherop

Global Health Service Partnership (GHSP) Volunteer Jenifer Lasman arrived at Mbale Hospital in Uganda in September 2015, shortly after Dausan Wanyibe began working as a technician in the hospital’s laboratory. Seven months later, Lasman and Wanyibe are both playing leading roles in introducing a lifesaving tool for analyzing blood samples to the hospital.

Lasman had used an i-STAT® handheld blood analyzer during her residency training in the US. She knew that it could provide quick, accurate results that can spell the difference between life and death in an emergency – lab results that she discovered often aren’t available in Mbale, where the laboratory staff has to cope with limited and often malfunctioning equipment, as well as shortages and occasional stockouts of supplies.

Dausan Wanyibe

Dausan Wanyibe

As a member of that laboratory staff, Wanyibe had seen “tools related to i-STAT® but not the i-STAT® itself” during his training as a lab tech. But when Lasman brought the new piece of equipment to the hospital and started teaching people how to use it, he took to it right away. “The first time I saw the real i-STAT®, I fell in love with it and I learned it within a few minutes,” he said. “It’s a very good innovation.”

Lasman credits a movie – “The Martian” starring Matt Damon – for inspiring her to request Seed’s help in obtaining an i-STAT® for Mbale Hospital. “I watched the movie,” she recalled, “and I was like, ‘Dude, we have the technology to do all this stuff and still I’ve got all these young people dying’ ” for lack of the blood analysis needed to diagnose and treat them effectively.

Particularly troubling to Lasman were frequent and entirely preventable deaths of young people with Type 1 (juvenile) diabetes.

“As a doctor in the US, I’ve never participated in a patient’s care where they died from diabetic ketoacidosis [DKA, a condition in which patients’ blood becomes very acidic and they lose a lot of potassium],” Lasman said. Almost always fatal prior to the introduction of insulin therapy in the 1920s, DKA now carries a mortality of less than one percent with adequate and timely treatment. But in Uganda, Lasman said, “It was not uncommon for me to lose patients to diabetic ketoacidosis, because I couldn’t get potassium levels. I was just guessing potassium levels and replacing it, and that’s really dangerous.”

Lasman knew an i-STAT® would allow her to get potassium levels and put an end to the dangerous guessing and needless deaths. So she did a little research on the website of Abbott Laboratories, which makes the machine. Then she made the case for acquiring a machine to Seed’s Chief Medical Officer Sad Sayeed and Senior Program Manager Katelyn Fleming, using a three-pronged argument that echoed the three goals of Seed’s mission – “Sharing knowledge, strengthening health systems, saving lives.”

First and foremost, she argued, the machine would improve patient care and outcomes. Second, it would strengthen education of students, which is Seed and GHSP’s core function –“because it’s pretty hard to teach medicine with laboratory functions when the lab functions are so hard to get,” Lasman explained. And finally, it would help build capacity in the hospital lab system.

Sayeed and Fleming endorsed the proposal, Seed followed up with Abbott, and Abbott agreed to donate not just the single i-STAT® Lasman had requested but four machines and a year’s supply of the test cartridges to go with them for use at Mbale and other Seed sites.

Peter Onyas, Clinical Officer Intern, using i-STAT at Mbale Regional Referral Hospital, Uganda.

Peter Onyas, Clinical Officer Intern, using i-STAT® at Mbale Regional Referral Hospital, Uganda.

Lasman is the first to point out that major challenges remain, starting with the fact that the machine itself “doesn’t like the African heat. It was made for more of a Boston environment.” But they have managed to keep the machine functioning by storing it in a refrigerator when it’s not in use and in a portable cooler with ice packs when it’s on the wards.

The cartridges used in the machines also pose both financial and logistical challenges. “You have to use a whole cartridge for each test, and cartridges cost between $10 and $12,” Lasman said. “So it is not cheap.” They also have to be kept cold every step of the way from point of purchase through transport to Uganda to delivery, storage and use at the hospital.

But Lasman and Wanyibe both believe the i-STAT® will prove to be well worth the investment and the effort.

“i-STAT® has already been really helpful for a number of patients and for teaching,” Lasman said. “In my little calculation, it saved one person’s life in just the first two weeks – a 19-year-old boy who came in really sick but with very nebulous symptoms.” The i-STAT® confirmed that he was suffering from life-threatening hypoglycemia (low blood sugar), which they corrected. And after he relapsed several times, “it was able to tell us really quickly when he was in renal failure, his kidneys were failing.”

Paul Kipsongi Limo (2nd from left) and other staff with i-STAT at Mbale Hospital

Paul Kipsongi Limo (2nd from left, facing camera) and other Mbale Hospital staff with i-STAT at a patient’s bedside

“We’re still trying to work up his diagnosis,” Lasman continued. “Frankly, I didn’t think he was going to survive because we were needing to constantly replace his blood sugar. But miraculously, he is now able to hold his own blood sugar. So that’s been a nice case for i-STAT®. And hopefully we’ll figure things out a bit better for this boy and he’ll be able to go home.”

That would make him the first patient whose life was saved by i-STAT® in Mbale. But he definitely won’t be the last, as more doctors, students, and laboratory staff learn to use the machine to help diagnose and treat diseases ranging from DKA to renal and liver failure to heart attacks.

“We now have our first real tool to be able to think about myocardial infarction heart attacks,” Lasman said. “We don’t have an EKG machine here. So there’s been no conclusive way to say somebody is having a myocardial infarction. I-STAT® will allow us to correct that problem.”

Wanyibe agrees. “The i-STAT® is very ideal because it has some tests that you just don’t do in our setting [without it]. Things like blood urea nitrogen [important to measure kidney and liver function], we were not doing it. Things like carbon dioxide and data monitoring of glucose.”

“Trust me, we are doing miracles here,” Wanyibe concluded. “Life is changing. Life is improving among our people. And that is our target as health workers – that when patients come to the hospital, they go out smiling.”