Contributed by: Dr. Sharon Perry, December 2009
Timely diagnosis of active tuberculosis is a critical component of TB control, because treatment stops transmission as well as disease. Worldwide, the most common method of diagnosis is observation of acid-fast bacilli in a stained sample of patient sputum, a technique developed by Robert Koch near the end of the 19thcentury. While this method is quick and cheap, it misses up to 50% of cases. Growing organism from a patient sample takes more time, but improves
Pediatric TB patients
diagnosis by 30-50%. In addition, a culture is needed before tests for drug resistance can be carried out. In the Western World, routine culture and drug susceptibility tests are the standard of care. With the emergence of multi-drug resistant TB as a global epidemic, world health authorities have recognized the critical importance of developing these resources in every country. The DPRK National TB laboratory project, a collaborative effort undertaken by Christian Friends, Stanford University, and Mercy Corps in cooperation with the Ministry of Public Health, seeks to address this critical gap in the DPRK national TB program.
Since the famines of the mid 1990’s DPRK has experienced a serious resurgence of tuberculosis, a disease that thrives on malnutrition and other immune-compromising illnesses. In 2008, the rate of tuberculosis in DPRK was estimated to be 344 per 100,000 population, ranking it among the highest burden countries in the world. DPRK is also one of the only high burden countries in the world to lack at least one culture laboratory. Plagued by chronic shortages of drugs and laboratory supplies, in recent years, the proportion of patients who have failed an initial regimen of TB drugs, a high-risk group for drug resistance, has been steadily increasing. In the absence of capacity to culture TB and test for drug resistance, the true extent of their need and the drugs needed to control their epidemic cannot be determined.
A nearly completed Lab room
In 2006, a joint WHO/MOPH team designated a 2500 square foot space at the #3 TB Hospital in Pyongyang for development of DPRK’s first national TB culture laboratory. However, the space was never finished due to lack of funding. Following visits in 2008 by MOPH officials to Stanford and by CFK to the laboratory site in Pyongyang, our organizations raised funds to purchase TB diagnostic equipment and supplies and complete needed infrastructure renovations. During an unprecedented month-long visit this past November, CFK construction and installation teams, Stanford laboratory scientists, and their MOPH counterparts remodeled 13 rooms and installed nearly $300,000 in furnishings and diagnostic equipment. By the end of the visit, MOPH physicians successfully tested two culture systems, the first cultures to be processed at the laboratory site. While completion of this project should be envisioned as a 1-2 year scale up operation, and will likely require more fundraising, the November trip signifies a major milestone in a 2-year planning effort. As we return to families and friends for the holidays, there is much for which to be thankful. For we at Stanford, this includes the opportunity to work with CFK, and the many friendships we have formed along the way.
Lab demonstration by BATC scientist
Developing this laboratory is not unlike building a suspension bridge. A good suspension bridge stands as a testament not only to the harmony of structure and function, but also to sheer human organization. Geologists, mathematicians, civil engineers, divers, carpenters, cablers, cooks, and metallurgists—an entire microcosm of human society– assemble from all corners of the globe to camp out in special dormitories where they share colds as well as bathrooms, and learn that problem-solving is not an accident, but a routine. In the end, what builds a bridge is a common vision, and the human organization that unites behind it. Similarly, the legacy of a bridge is realized selflessly in the new connections it makes possible.
In the annals of civil engineering, what is affectionately known as “The Bridge” in San Francisco claims several distinctions that could also be applied to the DPRK national laboratory project: a lot of people said it couldn’t be done; it was funded entirely by voluntary contributions; it stuck to a schedule; and—something that certainly has not happened in bridge building since– it stayed on budget. When the Golden Gate was completed in 1937, its chief engineer, Joseph Strauss, wrote the following stanzas that I would like to dedicate to some very special bridge-builders. To Heidi Linton and the family at CFK, without whose vision, support, faith, and abiding love of the Korean people, the human community needed to build this laboratory, this new bridge of hope for TB patients in DPRK, would not be possible. Like the Golden Gate, may your efforts endure as a breath-taking symbol of the human spirit.
Ask of the steel, each strut and wire,
Ask of the searching, purging fire,
That marked their natal hour;
Ask of the mind, the hand, the heart,
Ask of each single, stalwart part,
What gave it force and power.
High overhead its lights shall gleam,
Far, far below life’s restless stream,
Unceasingly shall flow;
For this was spun its lithe fine form,
To fear not war, nor time, nor storm,
For Fate had meant it so.
From The Mighty Task is Done, by Joseph P. Strauss, Chief Engineer
Golden Gate Bridge and Highway District, May 1937
The Stanford/BATC orientation workshop team
Be strong and take heart, all you who hope in the Lord.
Be strong and take heart, all you who hope in the Lord.