1.06.18

Jennifer Palmer » Humanitarian diagnostics for sleeping sickness in Uganda

A key impetus for the invention of a Rapid Diagnostic Test (RDT) for sleeping sickness (also known as human African trypanosomiasis or HAT) was the persuasive advocacy for better ‘field ready tools’ by medical humanitarian agencies such as Médecins Sans Frontières. They were engaged in fighting outbreaks of this disease, which is fatal if untreated, in contexts of weakened health systems and mass displacements during the Central African wars of the 1990s.

1.06.18

Ilana Lowy » Ultrasound as a diagnostic tool in Brazil: celebrating babies, blurring problems

This is a photograph of a publicity for a “street corner” obstetrical ultrasound in Brazil. It proclaims: “ultrasound examinations at low prices.” The advertised “low prices” can be indeed be very low: some clinics charge less than US $10 for an ultrasound examination. The aim such examination is to confirm the existence of a pregnancy, provide reassurance, but above all to tell the pregnant woman what the sex of her future child will be, and produce the “baby’s first photograph.”

1.06.18

Diagnostics without diagnosis: RDTs for sleeping sickness in Uganda

Diagnosing sleeping sickness (also known as human African trypanosomiasis (HAT)) is complicated, requiring the alignment of clinical suspicion with serological, parasitological, and molecular confirmation to determine appropriate treatment. Previously, diagnosis was carried out by mobile lab teams which confirmed cases in village screenings and transported patients for treatment. Since cases have declined however, expensive active screening campaigns have been phased out and replaced with passive, symptom-based algorithms.

1.06.18

Emma Harding-Esch » Diagnosing trachoma for elimination

To certify as having eliminated trachoma, countries submit a dossier to WHO, including showing that the prevalence of TT unknown to the health system is <2 cases per 1000 population aged ≥15 years, and that the prevalence of TF in 1-9 year-olds has fallen below 5%, and that this has been sustained for at least two years, in each formerly endemic district. However, the presence of clinical signs of active trachoma (TF and TI) is poorly correlated with detection of infection, especially after MDA where clinical signs tend to over-estimate prevalence relative to infection. The result is that: 1.) We may be conducting unnecessary rounds of MDA; and 2.) Countries may have eliminated ocular chlamydial infection, but not be able to certify as having eliminated trachoma.

1.06.18

Louise Bezuidenhout » Laboratory capacity building and the open hardware movement

Through my work in African laboratories I am regularly made aware of the challenging equipment shortages faced by research laboratories in many low/middle-income countries (LMICs). This extends far beyond the absence of “state-of-the-art” equipment and shiny, new models regularly produced by commercial companies. These shortages include the availability of what would normally be considered ubiquitous laboratory equipment – PCR machines.

1.06.18

Imogen Bevan, Alice Street, Ann Kelly » ReEEbov: developing an Ebola rapid diagnostic test at research ground zero

In June 2015, as Sierra Leone and Guinea was experiencing new surges in clusters of Ebola virus cases, Nature published a news article asking why an inexpensive test that “could save lives” was not being deployed to the field. Indeed, while it seemed obvious to many policy makers and health experts that Ebola rapid diagnostic tests were urgently needed, the question of how these objects should be implemented and used ‘in the field’ remained uncertain.

1.06.18

Shona Lee » Global Health Diagnostics Workshop Summary

On January 17th, 2018, participants from the UK, Europe, and India gathered in Edinburgh for “Investigating Diagnostic Devices in Global Health”, a workshop that also marked the launch of the ERC funded DiaDev project. Hosted by the DiaDev team, Alice Street, Ann Kelly, Nanda Kannuri and Eva Vernooij, the multi-disciplinary workshop

1.06.18

Alice Street » The Testing Revolution: Investigating Diagnostic Devices in Global Health

The origins of laboratory medicine are often traced to the establishment of a small clinical laboratory in Guy’s Hospital, London, in 1828. Here, in a small side-room, medical students used sterilisers, incubators and microscopes to identify bacteriological organisms in biological samples taken from the patients in the ward next door. In this simple removal of bodily fluid from the patient’s body and its transfer to a laboratory bench a few metres away, it is possible to see the ‘laboratory revolution’ that transformed European medicine in the mid-nineteenth century (Cunningham and Wiliams, 1992). With the rise of the laboratory, the site of production of medical knowledge and authority shifted from the hospital bed to the laboratory bench. Medical scientists and students identified diseases within disinterred organs, tissues and fluids, rather than the patient body, laboratory technology came to dominate medical practice, and the biological and experimental sciences exerted a new supremacy over clinical medicine.

Yet, in 2003 when I was a PhD student in social anthropology setting off to study the practice of biomedicine in Papua New Guinea’s public hospitals and clinics, the story of laboratory medicine told by European medical historians provided little insight to the everyday clinical work of doctors, nurses, or indeed laboratory technicians.

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