Our current laboratory capacity is suited for our role as a regional health center providing diagnostics services for primary care, obstetrics and gynecology, pediatrics, and emergency services.  This page provides a concise overview of the services that we currently provide; operations details are provided on our Laboratory Manual.  In addition to our laboratory, we have initiated a diagnostic imaging program to serve the diagnostic needs of our clinical team.  Additionally, this overview of our clinical programs provides a description of the services that our laboratory serves. 

As part of our overall task-shifting strategy, we are training midwives to perform certain basic laboratory tests.  These are marked with **stars.

Colorimetry-Based Tests

The colorimeter has a photometric settings of 450, 470, 510, 520, 540, 570, 600, and 670 nm.  This is adequate for most colorimetric applications.  The current tests include:

• Hemoglobin (Drabin's), primarily for antenatal screening
• AST (DNPH), primarily for evaluation of patients on antiretroviral/anti-tuberculosis therapy
• ALT (DNPH), very occasional use among complex patients
• Bilirubin (DMSO), primarily for triage and evaluation of neonatal jaundice
• Creatinine (Jaff), primarily in triage of acutely ill patients
• Glucose, Serum (Glucose Oxidase)
• Albumin (BCG), occassional use in evaluation of malnutrition 

Routine Microscopy:

• Gram Stain
• Wet mount
• KOH prep
• Sputum for acid fast bacilli (integrated within Nepal government's national quality control system-- we send all positives and 10% of negatives to national lab) 

QBC AutoRead Plus Tests**:

• hematocrit,
• hemoglobin
• mean corpuscular hemoglobin concentration,
• platelet count
• white blood cell count
• granulocyte count and percentage
• combined lymphocyte/monocyte count and percentage

Rapid Kit-Based Tests**:

• RPR
• HIV
• Anti-ABD, pregnancy screening
• Glucometer and cuvettes
• Urine, protein/glucose, for use in antenatal screening
• Urine, 9-panel, for use in UTI evaluation
• Urine, beta-HCG for pregnancy 
• Helicobacter pylori

Blood Electrolytes: i-STAT®1 analyser**

• Sodium, Na+
• Potassium K+
• INR

• Capacity can be expanded to the measurment of blood gases, chemistry, cardiac makers and hematology by purchasing additional cartridges: http://www.abbottpointofcare.com/istat/www/products/cartridges-family.htm 

Equipment list at Bayalpata Hospital 

• 1 light microscope
• 1 fridge
• 1 centrifuge
• 1 photometer
• 1 weighing scale
• 1 QBC counter
• 1 QBC centrifuge
• 1 incubator (broken)
• 1 I-STAT 
• 1 VDRL rotator (broken)
• 1 Paralens (advanced TB microscope, not currently being used due to lack of auramine stain)
• 3 micropipettes

   

• Desired Equipment
  • new light microscope
  • backup micropipettes
  • hot air oven for reagents
  • incubator

Expansion

As Nyaya Health expands its diagnostic capacity, the following testing systems will be additionally integrated into the laboratory services at the clinic:

• Culture Microbiology
• Additional colorimetry-based tests (amylase, lipid profile, CSF Protein, CSF Glucose)
• Technician-based Microscopy (Stool examination, CSF cell count, thin blood smear, urine sediment microscopy)
• Blood transfusion laboratory tests (HBsAg, HCV, DAT, IAT, RBC antibody, crossmatch)
• Chemistry analyzer
• Immunodiagnostics (e.g., Thyroid Function Tests) 

Links 

Guidelines for laboratory services:

http://www.phclab.com/images/MCH.pdf

http://www.phclab.com/images/Nepal%20SA.pdf

http://www.phclab.com/images/PHC.pdf

http://www.icddrb.org/images/HSB_Eng51_essential.pdf

--books: http://www.phclab.com/Resource%20Centre/RCbooks.htm

--documents: http://www.phclab.com/Resource%20Centre/RCdocuments.htm

--training: http://www.phclab.com/Training/Trainingprograms.htm

Other References

District Laboratory Practice in Tropical Countries By Monica Cheesbrough

http://www.globalgiving.com/pfil/1651/projdoc.doc

http://jcp.bmj.com/cgi/content/full/58/1/56

http://members.tripod.com/~LouCaru/index-5.html

http://tropej.oxfordjournals.org/cgi/content/citation/38/2/50