Academic journal article Bulletin of the World Health Organization

Microbiological Laboratory Results from Haiti: June-October 1995

Academic journal article Bulletin of the World Health Organization

Microbiological Laboratory Results from Haiti: June-October 1995

Article excerpt

Introduction

The purpose of a combat support hospital is to provide primary and tertiary care for eligible sick or injured personnel in the area of operations. All such hospitals include basic laboratory services, although differences in capabilities depend on the mission and the anticipated problems[1]. As the 86th Combat Support Hospital was deployed in Haiti, a tropical country with endemic malaria and infectious diarrhoeal disease, the fullest possible bacteriological and parasitological capabilities were included. Peacekeeping missions typically are carried out in areas with poor or disrupted public health infrastructures, and Haiti is no exception. Etiological diagnoses of infectious diseases not only aid in directing the clinical care of patients but also provide important surveillance data to guide preventive efforts.

The importance of the field laboratory has become more evident in the current era of emerging and re-emerging infectious diseases[2]. Military and peacekeeping forces are at risk for acquiring infectious diseases through their deployment in endemic areas. Non-immune peacekeepers can act as "sentinel" populations for infectious diseases in areas of the world where the threat may be poorly characterized. Illness in peacekeepers can provide indirect information on infectious disease prevalence in the host country[3]. The field laboratory can also be crucial in identifying and managing such infections at the site and time of their occurrence. The laboratory can furthermore ship specimens to collaborating laboratories for more comprehensive study.

In 1914 during the First World War, the first mobile laboratory, under the direction of Sidney Rowland of the Lister Institute, was deployed at the front lines[4, 5]. Its mission was to investigate the pathophysiology of gas gangrene, which had been responsible for devastating losses among Allied soldiers. The bacteriological findings of the laboratory played a crucial role in the control of this complication of modern warfare[6]. Forward laboratories have also played important roles in recent campaigns and military exercises[7, 8].

The 86th Combat Support Hospital provided medical support to the United Nations Mission in Haiti (UNMIH) from 12 June 1995 to 26 October 1995. The UNMIH consisted of approximately 7400 peacekeepers of whom 6000 (81%) were military and 1400 (19%) were civilian. Contributing nations to the military force included the USA (42%), Bangladesh (14%), Pakistan (14%), Canada (7%), Nepal (7%), Caribbean countries (4%), Djibouti (3%), Netherlands (3%), Guatemala (2%), Honduras (2%), and others. Over 20 nations were represented among the civilian contingent, the majority of whom were civilian police (64%). This article describes the microbiological and parasitological results of the 86th Combat Support Hospital's laboratory during its 5-month deployment in Haiti.

Materials and methods

Personnel, physical plant, and laboratory capabilities. The laboratory was a self-contained unit with electrical power, air-conditioning, incubators, freezers, semi-automated testing equipment, microscopes, and reference books. Full-time personnel included a laboratory officer, two senior medical technologists and four junior technicians. The laboratory director was an infectious diseases specialist. Microbiological capabilities included aerobic bacteriology with full identification of organisms and the determination of minimal inhibitory concentrations (MICs) of antibiotics. A library of American Type Culture Collection (ATCC) organisms was maintained for use in quality control. Microscopic examinations of concentrated stool for ova and parasites and the preparation of malarial smears were performed. Capabilities for anaerobic cultivation without identification were available. Stool culture could identify Yersinia and Campylobacter spp. in addition to the common enteric pathogens. Transport media for mycobacterial specimens were available. …

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