The questions about when and how we return to continue our infectious disease field work in East Timor started on our last day in the Bairo Pité Clinic. Previous field lab visits to central Sri Lanka and northern Malaysia had prepared us for the stress of separation. Managing expectations comes with the territory.
We aim to develop, deploy and demonstrate capability, but our small team does not yet have the capacity to continue a prolonged campaign on our own. What we did last week in Dili was more like a preliminary reconnaissance; a feasibility study for future in-country development activity.
This first formal project by Lab Without Walls looks a bit like a road show, with its supporting cast of logistic and technical experts. Experience has shown that it is these support activities that make or break a field lab deployment. Interesting then that inspiration should come from the entertainment industry via the inner pages of the West Australian weekend paper. The up-coming U2 gig will feature a huge 360º stage known as ‘the Claw’ for the band that takes 4 days to assemble and two to pack up. We can do better than that with our malaria/TB/dengue/septicaemia/STD lab – one day to set up and run technical checks; a few hours to dismantle and pack away. And the mobile module can be set up to support a remote clinic in around 30 minutes. Just imagine what could be achieved with a logistic support team of 240 roadies in a country the size of East Timor. But this doesn’t quite answer the question.
We have demonstrated technical capability. The next stage of development is gathering financial, technical and ongoing technical support. If the dream of TB, malaria and HIV eradication is to be realised in a population around the size of the Perth metro area, we need to find Timorese staff to take the toolbox outside the capital, operate it to support community health programmes and develop an accurate appreciation of how to target scarce resources. This may all take a bit of time. The quicker we can raise the support, the sooner we will return.
So why all the emphasis on one of the back office functions of medical care? Well, if you think how much decision-making depends on pathology tests, try re-imagining your doctor working out what antibiotics to use, how long to use them for and how to cope with a serious outbreak in a country where no hospital currently cultures any clinical sample, where no antibiotic sensitivities are tested and where no definitive tests are available to check screening test performance. We might not be able to do it all on a shoestring budget, but there are new lab methods that would take the guesswork out of tackling headline infectious diseases like TB and malaria. Small lab footprint; modular concept; flexible test repertoire. The Lab Without Walls Team demonstrated that capability under austere conditions last week.