News publications and other organizations are encouraged to reuse Direct Relief-published content for free under a Creative Commons License (Attribution-Non-Commercial-No Derivatives 4.0 International), given the republisher complies with the requirements identified below.

When republishing:

  • Include a byline with the reporter’s name and Direct Relief in the following format: "Author Name, Direct Relief." If attribution in that format is not possible, include the following language at the top of the story: "This story was originally published by Direct Relief."
  • If publishing online, please link to the original URL of the story.
  • Maintain any tagline at the bottom of the story.
  • With Direct Relief's permission, news publications can make changes such as localizing the content for a particular area, using a different headline, or shortening story text. To confirm edits are acceptable, please check with Direct Relief by clicking this link.
  • If new content is added to the original story — for example, a comment from a local official — a note with language to the effect of the following must be included: "Additional reporting by [reporter and organization]."
  • If republished stories are shared on social media, Direct Relief appreciates being tagged in the posts:
    • Twitter (@DirectRelief)
    • Facebook (@DirectRelief)
    • Instagram (@DirectRelief)

Republishing Images:

Unless stated otherwise, images shot by Direct Relief may be republished for non-commercial purposes with proper attribution, given the republisher complies with the requirements identified below.

  • Maintain correct caption information.
  • Credit the photographer and Direct Relief in the caption. For example: "First and Last Name / Direct Relief."
  • Do not digitally alter images.

Direct Relief often contracts with freelance photographers who usually, but not always, allow their work to be published by Direct Relief’s media partners. Contact Direct Relief for permission to use images in which Direct Relief is not credited in the caption by clicking here.

Other Requirements:

  • Do not state or imply that donations to any third-party organization support Direct Relief's work.
  • Republishers may not sell Direct Relief's content.
  • Direct Relief's work is prohibited from populating web pages designed to improve rankings on search engines or solely to gain revenue from network-based advertisements.
  • Advance permission is required to translate Direct Relief's stories into a language different from the original language of publication. To inquire, contact us here.
  • If Direct Relief requests a change to or removal of republished Direct Relief content from a site or on-air, the republisher must comply.

For any additional questions about republishing Direct Relief content, please email the team here.

Labs for Life: Ethiopia (Part Three)


This is the third Labs for Life report from Ethiopia (read Labs for Life: Ethiopia – Day 1 and Labs for Life: Ethiopia – Part 2).

It’s a wet and chilly Monday morning outside the Addis Ababa Regional Laboratory (AARL). The thick metal gates open wide and a motorcycle with knobby tires and a tall yellow container attached to its rear roars up to the front reception area. In large block letters the container reads, “Ethiopia Mail.” Inside the yellow container is a battered blue cooler with peeling biohazard stickers affixed to both sides. Specimens in Ethiopia move through an agreement with the postal service.

Potentially HIV positive and high-viral-load blood specimens are transported via motorbike.

The driver dismounts, removes the blue cooler, and carries it over to the receptionist’s desk. She extracts a pair of translucent plastic packs, which in turn contain a set of thin, stoppered vials full of dark red blood. The vials each have barcode stickers, which are read by a hand scanner. The receptionist also enters several columns of information manually into a spreadsheet. This includes information on the specimen’s origin and its departure and arrival time, which is connected to the laboratory information system.

We’re witnessing the intake process for potentially HIV positive and high-viral-load blood specimens.

Notebooks and pens in hand, we pepper the staff with questions: Is there a regular schedule for the referral of testing samples from healthcare facilities to the regional lab? Yes. Can we have a copy for mapping? Of course, but it’s all on paper. How often does any particular facility send samples to the lab? Once per week. Do you know how long it takes to return the results? It should be about one week, but it could be longer.  Does part of the intake process always involve manual data entry? Yes, unfortunately, but some diagnostic machines such as CD4 and hematology are linked directly to the LIS. Is there anyone checking on this data in terms of structure and quality? The lab has a data quality team of 5 persons. Are all of your machines functioning right now? There’s one that’s been out for a little while, but it should be on the repair list.

Later, when we’re back at EPHI, I check my freshly built map. It tracks the national inventory of CD4 counters, and, sure enough, there’s a point for the AARL indicating that a machine is in need of repair.  All of this process graphing points to positive signs that our spatial data integrations could work.

One of the LIS staff from EPHI has accompanied us to AARL. We brief the lab director about the BD-PEPFAR program and our GIS project for viral load testing and equipment maintenance tracking. Meanwhile, the LIS staff downloads five years of viral load specimen data for us onto a USB stick. We’ll be able to pair this dataset with the one from EPHI.

Our assessment takes about an hour and a half. Anmol has a conference call to make, so the rest of us decide to walk the ½km back to the hotel to work. Before we’re even past the laboratory gates a man walks up beside me and spits on the ground, getting a few flecks of it on my pants. I try to explain that everything’s fine and not to worry while I walk, but he insists on wiping the side of my leg with a cloth.

Abruptly the man turns to leave. I quickly realize that my Android is no longer in my pocket. I stop him just before he darts into the street. He returns my phone with a sheepish shrug. I suppose no harm has been done, but from now on I’ll keep my phone in my zippered pocket.

Back in our hotel conference room, Adam loads the AARL data into Tableau while Jessica and Anmol take over on Excel. We grind through another marathon geocoding and data cleaning session. By late-afternoon Monday, our vision is blurry, and the team is in dire need of food and caffeine.

But there’s good news: the data model derived from our EPHI work last week turns out to work for us once again, with only minor variations. We can see age and gender distributions sprouting, along with the spatial distribution of the specimen network for Addis subdivided by scheduled day, testing frequencies and viral load results. Now that we’ve completed data cleanup and formatting on a second major lab, there’s every reason to believe that most every LIS system in Ethiopia — at least those from the same vendor — ought to allow us to back out a spatial understanding of the specimen referral network.

My long-deferred idea from four years ago is one small step closer to reality.

Giving is Good Medicine

You don't have to donate. That's why it's so extraordinary if you do.