Kalingalinga Lab work, etc!

Hello everyone! it seems like so long time since I last posted; so much has happened since the roach and gecko fight...which..I wish I could tell you was an isolated incident, but unfortunately I don't have much say in the matter as there is a pretty nice size crack under our doors and these critters seem to know the place better than we do haha. I will tell you that I was chased out of my room by a jumping insect the other day...Erik claims it was just a cricket, but we all know crickets don't look or jump like that. Erik also saw this critter enter my room, but failed to notify me...hmm..call for revenge?...

Anyways! Working in the lab has been very very busy these past two weeks. It's been wonderful to be able to contribute my time and i have learned so much being there!

The first test I have been running is the HIV-DNA test, which tests for the presence of the actual HIV virus. For this we get simply a positive or negative result back (or "equivocal" if something goes wrong!) One of the main things we are working on in the lab is quality control regarding the dry blood spots that we receive. There are five blood spots on each patient's sample card, containing the patient's ID information, which we receive from the surrounding clinics. We use hole-punchers to punch exactly 6mm of this into each individual sample vial in order to run the tests. These small amounts of blood are ideal for testing infants so that they do not have to give up too much blood. It's important for the blood spots to be in the right amount (contained in the marked circles on the card) or the patient will have to have blood drawn again. Rejecting samples to be re-done should be avoided for a number of reasons. 1) this is a waste of time for the people in the lab and the nurses drawing the blood, but especially for the patient. Many people walk 10-20 miles to clinics that are far enough away from their homes so as to avoid being seen by others and the stigma that comes along with attending these clinics. 2) This shows the lab in a negative light. There are endless rumors and false speculations concerning the lab, and when others hear about people having to be bled numerous times, they are often less likely to want to have blood drawn themselves (more on this later!) So, in conclusion, it is very important to be able to keep track of the samples that come in and the clinics in which they comes from. I've had the opportunity to be helping in this in creating logs and recording percentages of samples rejected. This way we can track not only the number of samples being tested each day, but also if it seems a large number of rejected samples are coming from a certain clinic, we can notify and possibly further train the nurses at those clinics about taking correct blood samples. Keeping track of samples is important for another big reason: charting the number of samples coming in helps us to predict the increase in samples coming in for future months...and therefore can give insight in the ways the lab needs to continue to grow to accomodate! The clinics started giving out free ARV treatment in 2004, so the idea of getting tested at no cost of the patient is relatively new. While it has taken a little bit of time to spread the word and for people to feel comfortable trusting their information with the nurses (as this is true for anything new), now the number of samples being tested each month is growing significantly! As a matter of fact, in the next year, the number of samples will double. This will happen again the year after that. Ordering the correct amount of supplies to handle this growth, taking more people on to work, and starting night shifts are all important things to think about in the up and coming year.

The viral load test is designed to test for the quantity of the HIV virus in the patient's blood. All of the samples in this case come from HIV positive people, and for this reason, the result of this test is a number, and there are cut offs to determine what is ok and what is not. When the amount of the virus is too high, the patient may be progressing to a further stage of the sickness, may not be responding to the medication he is on (and therefore may need to change), or may not be taking the medications appropriately. This test utilizes two machines: the Ampli-prep(for extracting and preparing samples) and Amplicor(for amplifying samples and detecting the amount of RNA virus). Both of the machines require correct preparation and loading of reagents. In my next blog entry, my goal is to be able to describe what the machine is doing, and what the reagents are each for! Also, I am typing up a standard operating procedure for the DNA Dry Blood Spot test, so i will hopefully have more of a handle on that one as well!

Performing the two tests here is a very different experience than performing them at home. There are a lot of things to take into account! It makes me glad that I am being challenged and more informed of how things are. it also makes me homesick for the comforts of home!...for the people who know me well, and who I feel like I can talk to about anything! Last year, living with all of my friends at college park and my wonderful roomies ...I felt like I never had to really worry about things, everything was right there - classes, food, friends it was so comfortable - and after a long day, we'd come back and sit on eachother's beds, and talk for hours, or eat cookie dough and have a spur of the moment dance party! Here I have to think about things, determine the best thing for myself. Like drinking water- must be boiled first, bubbling for at least 3 minutes!- buying food- I walk to the nearest market and carry it home..going to work, I either have to time the transport, or I walk(which I enjoy, but it takes like 1.5 hours to get there)... walking in general, we're supposed to avoid it when it gets the least bit dark...showering - it happens when there is water and better when that water is hot (this one i like b/c there is little pressure to smell nice and some of you know I'm not the biggest fan of taking showers...haha)
Thinking about things you wouldn't normally have to is also true for the lab. As I said I have been helping to create logs and records for the number of samples that come in. Friday, in between running tests I was trying to determine the number of viral load test kits to order for the next two months. Because some of the records showed different numbers, and some of the records were actually non-existent, this definitely took longer than expected. Ordering the supplies as mentioned earlier involves charting the amount of samples received in the previous months and predicting the projected amounts of samples for the months to come. Also, an 8-10% of additonal supplies are purchased as a buffer for unforseen events (i.e. the machine breaks down in the middle of a run and samples need to be run again, but the reagents have already been used, or more samples are received than predicted.) One might think we should just order 100s of kits to be kept in the fridge just in case. But cost and expiration of supplies need to be taken into account! Test kits are very expensive - its roughly 800$ for each test kit. The DNA test kits run 86 samples (plus 10 controls) and the viral load test kits run 45 samples (+3 controls). This means that each DNA test costs roughly 8 dollars and each viral load test costs about 16$. These numbers do not even include all of the man-power and consumable lab materials such as pipette tips and gloves. For this reason, it is extremely important to make sure just enough supplies are kept on hand so that the test kits do not expire (800$ down the drain) because they could not be run due to lack of adequate lab materials.

Working in the lab has been wonderful for a number of reasons.
1) I am learning a lot about the science behind the lab procedures (which I find to be very ineteresting!)
2) I feel like I am able to work hard and contribute in different ways to the lab
3) I love talking to my fellow lab techs! It's a great way to find out more about them and the culture!
The two people training me and working along side of me are Eugene and Ngambo. They are both very nice and really efficient workers. They take a lot of pride in their work. Also, we have had some very fun and interesting conversations. One day Ngambo was telling me that she is trying to eat more so that she can get bigger. She puts her hands around her like in a big circle and she's like "I want to be BIGGG!", and as she says this, her eyes get wide! Ngambo is this beautiful woman who is naturally very thin and it's funny as she says this because I told her when I came in to start working, I felt a bit big next to her. She started laughing and she is like "You are crazy! I eat and eat to look like you, but nothing ever happens! I felt too skinny next to you!" And I was laughing because I was like do you understand that people in the states pay embarrassing amounts of money to look like you with all their dieting? I was telling her that she would fit right in with the celebrities in the U.S. and would be the definition of what men find attractive! Also, she was saying that people here bleach their skin and spend lots of money on creems to make their skin darker. Again, I told her that she would be perfect in the states because everyone else is getting skin cancer to have darker skin. Everything got funnier when Eugene told me later as I was pipetting some mastermix that his wife is FAT with a capital F. I gave him a look and I was like, "Eugene! she just had a baby!! give her some time!" and then he goes - "no i mean i love it!"
Everyone at the lab is just so nice and warm. I got homesick one day and Eugene kind of slapped me on the back and told me not to cry! erik said he WOULD give me a hug but he didn't want to contaminate me, how thoughtful, haha. Aleen, a woman who works with a lot of Quality control type-stuff is also very sweet. She is 36 and has these two little cute kids and lives with her husband just 5 minutes from the lab. She invited me, as well as the other interns, to her house for dinner last friday and took me to a book club a few nights ago. At her house, I ate buffallo tongue!! Also, Ron, someone who works for CIDRZ at a different location, had a party the weekend before and we all ate wharthog! I love dancing at these parties! The music is loud and I feel so free and wonderful.

I will share one more lab story (afterall this entry is entitled kalingalinga lab work!). Thurs of two weeks ago was amazing, by far one of my favorite days here! The lab is very number oriented; we deal with samples and results, and the community is all about these people, their faces, their families, their stories. It makes sense that people would wonder what goes on in the lab. ARV treatment, as I said before, is relatively new and when new things happen it is always common, and healthy, to question. However, false and negative ideas not only prevent people from being tested, but perpetuate further stories, that can get a little bit out of control and lead to unsafe situations. For example, the common question is, what does the lab do with the blood taken, and why do we have to take so much blood for the different tests. Rumors about satanistic activity have spread, like the people in the lab drinking all of the blood received. This lead to talk about people breaking into the lab to destroy the machines. In response to this, my boss invited over 100 religious leaders from around the community to come and see the lab firsthand. People got to come in and walk through and I got to be a part of it! They asked a lot of questions and wanted to see everything going on with the tests.
I admired the lab leaders so much that day. They did an incredible job of providing information and also emphasizing the point that this is not our lab to run our own experiments, but it is a lab for the people. They said the lab is always open to the people and that they should feel welcome anytime. My boss also said that he took a survey of what the community felt they needed the most, what was most urgent. He said they reported that they needed new bathrooms in the Kalingalinga school. During the rainy season, with the inadequate bathrooms they had, it was very easy for sickness to spread. My boss then announced that he heard what they had said, and that he has gotten permission and raised money from the states; there will be new high quality bathrooms installed before the rainy season comes this november. It was such an amazing thing to me, that he did not decide to do what he thought was best, but instead listened to what the community actually needed. By the end of the day, the community people and lab people were intermixed, talking, planning. It was so wonderful to see!
I think the connection to the people we serve is so important. It adds such a humanistic side to the work done in the lab, and helps me to further understand and see the importance of things like quality control...how these things directly affect the people. (like before when I was talking about trying to increase quality of samples to avoid having to make people come to get re-tested. At first it seems like a stat. But, what really makes that stat so important? I can think about how re-testing someone takes that extra time, may subject those people to stigma...those things i mentioned earlier...) Seeing people come together at the lab was truely meaningful and was something that gave me hope for the future!

All of the housemates are wonderful :) Everyone is just so sweet and it's fun to be sharing this new experience with them! The other night, Laura, Kim, Connor, Nikki and I went to this Indian place to eat and then got ice cream and yesterday I went into town with Laura to buy some fabrics to make a chetenge, the traditional skirt (you just wrap and tie fabric around your waist) We also went to this comedy show last night and it was soo funny because we understood the jokes at the beginning in English, but then when they were speaking in Nyange, the whole group of us were lost. Personally I kept laughing because everyone else was, and also because all of the interns had confused looks on their faces!

Today was soooo great! This past week I was getting a little bit homesick and missing my bible studies. Today I went to this Christian church here and just felt like I came home. It felt so great to be able to pray with all of these people, some who don't speak my language, but to know that we have these beliefs in common. I loved singing the songs, some in nyange and some in English. The homesick feeling kind of went away today, it felt like it was kind of filled up.

Hope you are doing well:) I think of everyone often! Also, I really realllllly love reading your comments on the blog although i don't know how to respond and I really really love getting emails! have a superb labor day and rest of the week!