By Stuart Drazich-Taylor
One month into his placement, microbiologist Stuart Drazich-Taylor describes how sample processing works in Kampala and the critical role microbiology laboratories play in the surveillance of antimicrobial resistant organisms.
Norfolk & Norwich University Hospital (NNUH) microbiologist Stuart Drazich-Taylor and Cambridge University Hospitals Trust (CUH) pharmacist Bobby Shum are mid-way through a three-month placement in Kampala. They’re working alongside Ugandan colleagues as part of the CGHP-supported Kampala-Cambridge health partnership that is tackling antimicrobial resistance and optimising prescribing practices to improve maternal and neonatal health. One month into the placement, Stuart describes how sample processing works in Kampala and the critical role laboratories can play in the surveillance of antimicrobial-resistant organisms.
From left to right: Bobby Shum, Kawempe Hospital pharmacist Ronald Onegwa, and microbiologist Stuart Drazich-Taylor.
“The Kampala Cambridge Antimicrobial Stewardship and Infection Control Project is focused on improving maternal and newborn health at Kawempe hospital in Kampala, Uganda. The project is helping to develop the systems necessary for diagnosing and managing infection. This includes mentorship in the microbiology laboratory and delivering training on antimicrobial stewardship and infection, prevention and control practices. These aspects are vital as antibiotic resistance is a major problem throughout the world but particularly in Africa, where there is extensive resistance and challenges in accessing necessary medications.
Kawempe hospital is a large and very busy maternity hospital with approximately 80 births a day. Many patients utilise its services on a daily basis with newborn vaccinations, outpatient paediatric, obstetric and gynaecology care all free at the point of access. There is a neonatal intensive care unit and adult intensive care unit where the sickest mothers and babies are looked after.
Adjusting to life in Uganda
I am currently half-way through my 3-month placement. One of the reasons for taking on this role was to gain greater management and leadership experience in an unfamiliar and challenging setting. One of the initial culture shocks was the concept of time. Life in Uganda is at a more relaxed pace and time is more fluid here. One recommendation: always bring a book, you could be waiting a while!
Sending samples to the laboratory
As a microbiology doctor, one of the aims of my project was to see how the laboratory at Kawempe hospital works. Compared to a UK laboratory, more of the processing is done manually which is time consuming, but this is mitigated by a reduced sample burden. For such a large hospital, not many samples get sent to the laboratory. Some of that is due to organisational culture, and some is due to logistical challenges.
A difficulty that clinicians face in managing patients with infection and suspected sepsis is that they do not have ready access to blood culture bottles. These are little glass bottles (a bit like you would find in a mini bar), into which a blood sample from a patient is inoculated. The bottle contains growth media for microorganisms and is a vital tool in helping to diagnose bloodstream infections. As it stands, a junior doctor would have to go out to a nearby pharmacy, buy the bottles (with the patient’s money) and bring them back to use. In my role, I have been liaising with the hospital director and microbiology reference laboratory to see if they can source a reliable stock of blood culture bottles. We are waiting hopefully.
In the laboratory I have been working with the lab technologists on helping to make agar plates for bacterial culture, developing standard ways of processing samples and reviewing stock levels of key laboratory components. The staff have all been very warm and welcoming and responsive to my input.
Connecting with colleagues at the Uganda Cancer Institute
I’ve been fortunate to be put in touch with microbiology technicians at the Uganda Cancer Institute. This is located right at the top of a hill in Kampala with the giant marabou storks circling overhead. It is a national referral centre for patients with cancer. Patients and their families often relocate to the surrounding area while undergoing treatment. There are many people who sleep on mats on the ground outside the hospital. There are makeshift washing lines. People are trying to live as best as they can in very trying circumstances. For me this really emphasizes how much people value healthcare and secondly, to a degree, how much we take the NHS for granted.
The microbiology laboratory at the Uganda Cancer Institute is small but has a machine that can identify organisms and determine antibiotic sensitivities without much manual work. Wonderful! However, the laboratory has not been fully functional for the last six months due to a lack of agar plates for bacterial growth. During this time patient samples had to be referred to a different hospital. Luckily, I was able to have useful conversations with laboratory managerial staff and I am hopeful the lab will be up and running again imminently. Furthermore, in reviewing their previously grown organisms I was struck by the extent of antibiotic resistance. Many of the isolates were resistant to several important antibiotics and their resistance was of a nature that could be spread around the hospital. This highlights the necessity of the microbiology laboratory facilitating surveillance of resistant organisms and the need for a fully functioning infection, prevention and control (IPC) team.
Through undertaking this project, I will return to the UK with a greater appreciation of the resources and structures that we have available. It has also ignited a passion in global health that was previously unlit.
The importance of an IPC team
Within the UK, the IPC team is responsible for managing outbreaks of infections within a hospital e.g. flu and isolation of potentially infectious patients. In the UK the microbiology laboratory has a close working relationship with the IPC team. At Kawempe hospital, staff responsible for IPC do not have dedicated time for these activities, instead having to carve out time amongst their other work responsibilities. In addition, there is currently limited interface between the microbiology laboratory and IPC team. One of the proposals we will discuss at the Medicines and Therapeutic committee is the routine informing of IPC whenever a resistant organism such as MRSA is cultured (Methicillin Resistant Staphylococcus Aureus – sometimes known as a hospital superbug). This would help to reduce the spread of resistant organisms throughout the hospital and potentially improve patient outcomes.
Personal and professional growth
Uganda is a wonderful country to visit. Our local partners have made us feel extremely welcome both inside and outside of work. Kampala is a hustling and bustling city of loud motorbikes, honking horns, giant malls and twisty backroads. When the sun gets too hot, you can be guaranteed a thunderstorm to cool things off. The flora and fauna have been incredible, and my fellow CGHP colleague Bobby and I had an incredible experience at Murchison Falls. This is a national park in northern Uganda where we were lucky enough to see elephants, giraffes and many other creatures. The food has also been excellent, anyone undertaking a marathon should try some Ugandan food: with matoke (cooked bananas), posho (boiled maize flour), sweet potatoes and yam you would be guaranteed to run a personal best!
My experience has cemented to me the value of a career in microbiology and what can be done with it. Through knowledge of infection, laboratory practice and hospital systems you can make a difference to the health of a large number of patients. Within Uganda there is a huge scope for growth of this specialty and an urgent need for laboratory development and training of microbiologists within the country.
Through undertaking this project, I will return to the UK with a greater appreciation of the resources and structures that we have available. It has also ignited a passion in global health that was previously unlit. I am hopeful that in the future I will be able to further expand upon my work in other similar settings.”
Find out more about the Kampala-Cambridge AMS partnership.
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