It’s Tuesday afternoon during Ethiopia’s rainy season. I’m standing before a pull-down screen filled with digital maps in a humid conference hall on the third floor of the Centers for Disease Control (CDC) building inside the compound of the Ethiopian national reference laboratory. It’s difficult to make myself heard above the downpour beating on the sheet metal roof. There’s a persistent drip to my left that makes the floor slick.
Representatives from the Ministry of Health and the Clinton Health Access Initiative are here, alongside multiple branches of the Ethiopian Public Health Institute (EPHI), the CDC, and my team of invaluable professional volunteers in the BD-PEPFAR Labs for Life program. That team includes Adam Yeung, a health data and market analysis specialist from BD’s France offices, Anmol Chopra, a research and development specialist from BD’s India offices, and my new colleague at Direct Relief, Jessica White, who has just joined us from Stanford University. We’re here to teach basic skills in geographic information systems (GIS) to our local counterparts and to build a set of prototype mapping applications targeted towards strategic improvements in Ethiopia’s national system for diagnosing and treating HIV and tuberculosis.
Every day, across Ethiopia, blood is being drawn and sputum collected from people suspected of infection with some of the world’s deadliest diseases. Without timely results their conditions will worsen, many of their lives will be threatened, and the risk of transmission to others will increase. Those specimen samples, once collected, are sent to hospitals and regional laboratories, usually in special packaging designed to be carried safely by the Ethiopian postal service. CD4 counts are run, viral loads are tested and TB samples are sequenced, then returned back to health clinics and hospitals where they inform medical judgments about treatment regimens and patient well-being. Sometimes, perhaps far more often than anyone would like, no diagnosis is possible because the specimens arrive at their destination unable to be read. In that case people who may be carrying serious viral infections, do not learn their status and cannot be treated appropriately.
The diagnostic system is literally the lifeblood of the healthcare system, constantly producing the epidemiological equivalent of actionable intelligence. It’s maybe a truism, but without accurate diagnosis there can be no effective treatment. Yet up until very recently there was no systematic overview of Ethiopia’s national laboratory system because there was no map. Questions like, “where are MDR-TB cases emerging most rapidly?” or, “which labs are having the hardest time meeting quality standards,” or “what is the best way to scale up HIV viral load testing throughout the country?” had to be answered for the most part without detailed spatial information. As a result, analysis was delayed too long, hypotheses went untested, leads went unfollowed, and epidemiology lagged behind the events of the world, sometimes to alarming extents.
The BD-PEPFAR Labs for Life program is a public-private partnership which aims to make a systematic, long-term intervention in the laboratory systems of multiple countries in Africa and Asia through a combination of training, improvements in equipment and supplies, and targeted informatics. GIS is being used in this program to establish baseline conditions for spatial analysis of specimen referral, viral load testing and core lab systems effectiveness. The maps that we build here, even if only in their prototype form, will hopefully allow EPHI and others in the CDC and the MOH to make more rapid, intelligent and targeted decisions based on detailed, accurate and timely spatial information.
By the end of today’s initial training exercise the rain has subsided, my voice has recovered and I’ve somehow managed not to slip on the floor and break my neck. We have people lined up three and four deep to install software on their laptops and get logged in to ArcGIS Online to join groups we have set up as virtual collaborative workspaces. There’s a palpable sense of anticipation around the projects we’re planning to do together. Although GIS is brand new to many of the people in the room, we have an excellent mix of experience and enthusiasm. In the hallway I debrief with Gonfa Ayana, the Director of the Regional Lab Capacity Building program. He’s eager to connect us with data and set up targeted training sessions around specific problem sets.
Our BD-PEPFAR team is in Ethiopia until the 4th of September, during which time I’ll be relaying our progress and conveying the ups and downs of geographic analysis and map development for some of the world’s most challenging problems, as our work unfolds, in near real time. Check back for updates.