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Friday, December 9, 2016

A Continent of Quality Success



The following is an abbreviated history of events and not absolutely accurate, but is close enough to give a clear picture.  

About 2002 (or there abouts)  in response to the appalling epidemic of HIV/AIDS in developing regions, developed countries and regions poured money, medical support, effort and energy into regions around the world, including but not limited to Africa.  Bush 43, created the program President’s Emergency Plan For AIDS Relief (PEPFAR).

The weakness in ability to investigate and diagnose disease could not be addressed until the laboratories achieved a new appreciation and recognition of laboratory quality standards and practices.  It was fairly quickly appreciated that asking laboratories to jump to an internationally acceptable level of laboratory  quality in one go was both unfair and unrealistic, but could be attained through a series of progressive steps, until the level of sufficient  competence could be achieved.

Now, near 15 years later, the situation is not perfect, but the amount of progress is spectacular.  

This is in large part due to the tremendous efforts of laboratorians, educators, governments, and the massive generosity of the American taxpayer (who in my experience nearly always gets left out of the recognition). 

Five years ago, in order to coordinate efforts, a new organization the African Society for Laboratory Medicine (ASLM) was created.  One of the missions of the ASLM was to create a forum for discussion and debate and celebrate success, which lead to the development of the ASLM Conference.  

Over the last week, ASLM hosted its Third ASLM Conference.  This year it was held in Cape Town.

This year I decided to attend the conference for the first time, in large part because I had had the opportunity to work with PEPFAR in the early days and (along with others) developed an early program of stepwise progress through ISO 15189:2003 Particular Requirements for Quality and Competence.  

This program was created while working with the PEPFAR partner Clinical and Laboratory Standards Institute (CLSI) and took laboratories through 3 levels, the first being very basic steps of laboratory quality (a form of 5S, SOPs, Quality Manual, etc).  I was backed up by continuing education, mentorship and progressive assessment.  I could be wrong, but I think that our program was the actual model for what ASLM later developed and called its Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) programme.

Following those early days, I was able to offer more help through assisting countries develop or improve national EQA programs.  

But enough about me (for a moment).

This meeting from my perspective was a massive success.  Presentation after presentation showed how much progress is being made in countries all over the continent.  Where laboratories were once a shamble of erratic tests by technologists trying their best without any concepts of laboratory quality and competence has been replaced with focused interest, skill mentoring and cross mentoring.  Presentations highlighted progress and approaches to improvement that would leave many laboratories in developed regions awash with eye-blinking amazement.  Presentations were professional and tight even when English was not a first (or second) language.

Not everything was perfect, indeed some of the presentations were shoddy and indeed terrible.  Of interest, the two worst presentations were done by people representing large international universities.  Their studies were severely flawed, full of mistakes, and yet presented with what can only be described as intellectual fraud and arrogance.   I am sorely tempted to describe their truly tragic performances, but (a) they know their work was atrocious crap and (b) hopefully is not typical of what other more competent people do in their institutions.

But for the moment, more about me (I have to do something about this overactive ego).  

At the closing ceremonies, awards were handed out to individuals and organizations that deserved recognition.  One of the categories was laboratories that had progressed to the level that they achieved recognition at meeting the requirements of ISO 15189:2012 (or ISO 17043:2010 – Proficiency Testing) as assessed and measured by international accreditation bodies.  By my count there were 18 laboratories meeting that level, and of them, 6 (!!!) were laboratories that I had had a direct hand in assisting.  Five were in Tanzania and one was in South Africa.  I could not be more proud of their success.

Congratulations goes to all the laboratories, to ASLM, to SLIPTA, and to the organizers and participants in an incredible conference.  

I am looking forward to the next ASLM to be in Abuja Nigeria in December 2018.
If Quality is your thing, you might want to also plan to attend, if only to get inspired.


Save the Date
POLQM Quality Conference
Vancouver BC Canada
October 1-3, 2017

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