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AT MICROFICHE REFERENCE LIBRARY A project of Volunteers in Asia A Medical Laboratorv for Develoninu Countria by: Maurice King Published by: Oxford University Press/East & Central Africa P.O. Box 72532 Nairobi, Kenya Paper copies are $22.50. Available from: Oxford University Press 16-00 Pollitt Drive Fair Lawn, NJ 07410 USA Reproduced by permission of Oxford University Press, East and Central Africa. Reproduction of this microfiche document in any form is subject to the same restrictions as those of the original document. c3 .:-I ‘3 I , -i . I . ., I , a. I B’ . z b This book aims to bring the mini~mum level of pathological services within the range of everyone in developing countries and is written especially for laboratory and medical assistants who work in health centres and district hospitals. Each piece of equipment needed in a medical laboratory is fully described and illustrated in detailed drawings. Every step in the examination of specimens is simply explained and the method of performing it illustrated ; the methods chosen are those that give the greatest diagnostic value at the minimum cost. Ways of obtaining specimens are given, and where it might prove helpful some anatomy, physiology and a brief account of treatment is included. The last chapter contains a detailed equipment list. This book goes a long way towards de- fining a complete ‘health case package’ in an important and neglected field. 1 net i,. -.. Oxford University Press ISBN 0 19 264910 8 OXFORD MEDICAL PUBLICATIONS A Medical Laboratory for Developing Countries To all those who might so easily be diagnosed and treated if only someone knew how. A Medical Laboratory for Developing Countries MAURICE KING M.D. (Cantab.), F.R.C.P. (Lond.1 WHO Staff Member, the Lembaga Kesehatam Nasional, Surabaya, Indonesia. Late& Professor of Social Medicine in the University of Zambia and Visiting Professor in Johns Hopkins University LONDON OXFORD UNIVERSITY PRESS DELHI KUALA LUMPUR 1973 Oxford University Press, E& House, London W.1 GLASGOW NEW YORK TORONTO MELBOURNE WELLINGTON CAPE TOWN IBADAN NAIBOBI DAB ES SALAAM LUSAKA ADDIS ABABA DELHI BOMBAY CAI.CuTfA MADRAS KARACHI LAHOBB DACCA KUALA LUMPUR SINGAPORE HONG KONG TOKYO Hardbound edition ISBN 0 19 2649 16 7 Paperbound edition ISBN 0 19 264910 8 0 Oxford University Press, 1973 AN rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of Oxford University Press Filmset in Photon Times IOpt. by Richard Clay (The Chaucer Press), Ltd., Bungay, Suflolk and printed in Great Britain by Fletcher & Son, Ltd., Norwich First Preface in Standard English This book has a critical purpose. It aims to bring a minimum level of pathological services within the range of evevone in the developing countries. It is thus firstly for the laboratory assistants and medical assistants who work in health centres and district hospitals, for it is they who must investigate and treat such common and important conditions as anaemia, malaria, leprosy, tuberculosis, trypanosomiasis, and a variety of helm&h infestations. Unless such diagnoses as these are routinely confirmed in a laboratory, the medical care that is provided for the millions who suffer from them must inevitably be inadequate. But it is not enough to know how to take and examine a skin scraping for leprosy. All the necessary equipment, most of which is very cheap, has to be available-the mere provision of a microscope alone is not enough. Hence the last chapter contains a list of everything that a health centre laboratory requires, so that it can be inserted in a medical stores catalogue and packed as a complete kit that nzuy be obtainable through UNICEF. If the doctors of the developing countries are to rise to their challenge, which is to care for all the people, they must lead and teach the other members of the health team. Medical students must thus also become expert in the methods described here, so that they can both do them themselves, and later hand on their skills to others; for these same methods are required in ward side rooms, in the consulting rooms of general practitioners, and also in the laboratory that should be an integral part of every outpatient department. Many readers will not have had much education; so this text has been made as complete as it can be, and written with a strictly limited vocabulary in the simplest possible way. A count of 5,000 words chosen from randomly distributed sections showed only 550 different ones, and it \ is probable that its entire vocabulary contains less than fifteen hundred. Even so it is hoped that the more learned reader will not be offended by its style. If he will only bear with the way in which it had to be written, he may be able to make good use of what it has to say. Laboratories have to be numerous and cheap if every anaemic child is to have his stool examined for hookworms, when there is perhaps only about a dollar a year to be spent on health services of ail kinds. The methods have therefore been chosen to be of the greatest diagnostic value for the limited funds available; the total cost of the equipment in the basic list given here being about $500, including the microscope. This then is a medical laboratory at the level of an ‘intermediate technology’, which is in sharp contrast to the costly and increasingly automated laboratories of the industrial nations. <. Because laboratory methods are only part of the clinical process, they have been set here in the practice of which they form part. Thus the indications for doing many of the methods have been given, as have ways of obtaining the specimen and interpreting the result. This has sometimes led to a brief account of treatment, and, where this might help, some anatomy and physiology have been included. This text is one of the components of what is coming to be known as a health care package. By this is meant ‘an integrated series of components assisting the application of a particular group of interventions for the improvement of health care under specific socio-economic conditions’. In this case the interventions are the laboratory methods applicable to health centres and district hospitals, while the socio-economic conditions are those of the developing countries. Other components include the kit of equipment, and the associated teaching aids and examination methods described in Section 13.15~. The importance of such packages is that the combined usefulness of their components is likely, to be more than