Mali: New bacteriology laboratory at the Koutiala hospital
January 28, 2014
Interview with Jean-Baptiste Ronat, laboratory coordinator at MSF headquarters
In December 2013, MSF began reorganizing and renovating the central laboratory at the Koutiala hospital, where it manages the pediatrics department. The new laboratory will have a bacteriology department that can diagnose all bacterial illnesses of early childhood. This is a first for MSF in a long-term project.
Why create a bacteriology department?
Jean-Baptiste Ronat: The goal is to improve the laboratory diagnoses in order to meet quality of care requirements at the hospital. Thanks to this department, MSF will be able to diagnose all childhood bacterial illnesses. Thirty percent of mortality among severely malnourished children is linked to septicemia (blood infections) of unknown cause. Bacteriology will allow us to culture bacteria to identify the cause of septicemia in children and recommend appropriate treatment, using antibiograms.
How is an antibiogram used?
J.B.R.: An antibiogram is a bacteriological test that doctors use to choose the best antibiotic that will provide the most effective treatment. It tests the sensitivity of a bacterial strain to one or more known antibiotics. The bacterial culture is thus exposed to antibiotics and its development and survival are examined. Children will thus benefit from a targeted treatment ensuring faster recovery, thereby reducing the length of hospitalization. The other advantage is that choosing the antibiotic treatment based on antibiogram analysis will help to reduce the growth of antibiotic-resistant strains.
What problems do antibiotic-resistant disease strains cause?
J.B.R.: Resistance to antibiotics is a critical issue for the coming years. In the near future, people may die from benign illnesses, such as bronchitis or angina, because antibiotics will have become ineffective. When the bacteria are exposed to antibiotics and mutate, they may acquire resistance genes. That is why the correct antibiotic – the one that will kill the bacteria – must be used. If the bacteria resist the antibiotic, they will grow and promote the development of resistance. We’ve got to make move research and innovation forward in this area. The laboratory will participate in that effort.
How will the new laboratory be organized?
J.B.R.: The other laboratory services will be organized within the main department and the blood bank. The main department will be responsible for 'traditional’ tests, such as biochemical, hematological (blood tests and blood disorders) and AIDS screening. The blood bank will have high-quality equipment and supplies so that it can handle all transfusions performed at the hospital (nearly 6,000 perfusions/year). MSF would also like to set up a blood donation system with the support of community organizations. The issue is to create loyal blood donors within local communities.
What is MSF’s goal for this laboratory?
J.B.R.: MSF would like the laboratory to become a training center both for its lab technicians based in other countries and Malian Ministry of Health employees. Between June and September 2014, we will host six to 10 interns from laboratory assistant training programs. The lab is intended to become a reference center in the area of quality control and will also support medical research on severe malnutrition and monitoring of bacterial resistance in the population.
Construction, which began in December 2013, is scheduled to be finished in late February 2014. An architect assigned by MSF supervises the work on-site. The new laboratory will be approximately 2,000 square feet, with approximately 750 square feet devoted to the new bacteriology department. The project budget totals 96,000 euros (60,000 euros for construction and 36,000 for the purchase of machines and supplies).
MSF’s work in Koutiala: MSF has been working on a pediatric treatment project in Koutiala, Sikasso region, with Mali’s Ministry of Health since 2009. The goal is to define a minimum package of free pediatric health care services in order to reduce the number of hospitalized patients, allow children to grow properly, and avoid a large number of early deaths. MSG manages a pediatric unit at the Koutiala hospital. Capacity can reach 300 beds during seasonal peaks. MSF also supports access to free primary care in five outlying health centers and transfers the most severe cases to the hospital.