Surgery and Healing in the Developing World - Dartmouth-Hitchcock

CHAPTER 1
CHAPTER 8
Lab in a Suitcase
Christine A. King and James Kerr
Introduction
This chapter is aimed at those individuals travelling to and working in rural
settings who are limited to what they can bring with them in a suitcase on an airplane.
Individuals with no special training and limited equipment can perform many
laboratory diagnostic tests. The scope of this chapter is limited to only those investigations
that we believe are essential for basic patient care. We have tried to minimize
the cost and size of equipment needed to perform the laboratory analyses
described. Small equipment, however, may be expensive. We have tried to described
both the costly and low cost alternatives when available.
The one question that we frequently get asked is “How big is this suitcase”?
There is no one answer. In short, the suitcase is as large or small as you wish to make
it. Those with greater funds will be able to fit more equipment into a smaller suitcase
and increase the versatility of their lab without increasing the size or weight.
Equipment
A lightweight, portable, phase contrast microscope can be obtained from many
manufactures. The microscope should be fitted with both a power light source and
a mirror. This mirror can then be used in situations where power is not available or
when the power fails. The microscope should be fitted to include a 10X, 40X and
100X objective and an oil immersion lens. Don’t forget to bring oil immersion for
viewing. These lenses will enable the investigator to view many pathogenic organisms
including bacteria and some parasites. A hemocytometer, or counting chamber,
for assessing numbers of cells as well as glass slides and cover slips should be
included (Fig. 1).
Diagnostic tests including, but not limited to, MCV, Hb, Hct, electrolytes, PTT
& PT levels, are difficult to assess without the aid of a photometer. Although expensive,
some very good, light, small machines are available and should be considered
when gathering equipment. Many of these machines will perform a wide range of
diagnostic tests and require varied reagents. The amount of material needed and
their servicing requirements may discourage individuals from considering this piece
of equipment. Often such equipment can be purchased in the country visited and
thus will allow for servicing and reagent access.
Many of the laboratory tests can be done with the aid of self-contained kits that
not only provide instruction as to their use but also include all reagents necessary for
the analysis. These kits have been widely used and are deemed reliable. One drawback
of the kits is that many require refrigeration. If the destination is a place where
Surgery and Healing in the Developing World, edited by Glenn Geelhoed.