Responding to a call “Are you in the lab?” Dr. Kim Yon Ok and I are smiling from the Haeju Hepatitis Hospital laboratory archway and most probably each thinking, “Where else would we be?” – the clinical laboratory, our favorite shared place. For laboratory professionals, that is our workplace “home,” where we are happy serving the needs of patient care by sharing our knowledge and expertise. For those not well acquainted with what a clinical laboratory professional does, if one thinks about visits to physicians, laboratory testing usually accompanies the visit. The physician may have made a comment such as, “I’m not totally certain what is going on, so I’ve ordered some tests and will get back to you when I have the results.” In Western-style medicine, where laboratory testing is readily available, the accepted estimate of the impact on physician decision making is that 70% (some authors say as much as 80%) of patient diagnostic decisions made by a physician are based on laboratory results. Now consider the difficulty for DPRK physicians where all too often only very basic and severely limited diagnostic tests are available.
Nine years ago, I first met Dr. Kim at the National Tuberculosis Reference Laboratory (NTRL), Pyongyang, DPRK, where CFK volunteers were in the process of renovating the laboratory. Dr. Kim had recently been appointed head of the of the new, modern clinical diagnostics (hematology, clinical chemistry, and body fluids) section for the NTRL. My responsibility had been to develop the clinical diagnostics section where none had previously existed. Appropriate and sustainable equipment had to be selected, all of which are completely unavailable in country. Dr. Kim and her colleagues had to be taught how to run a modern clinical laboratory beginning with the basics of equipment use and maintenance, making certain test results were accurate, reporting results, and permanent record keeping. What a joy to see their palpable excitement when they recognized they finally had the tools necessary to perform vitally needed patient testing.
However, test results are only helpful if the clinical relevance and implication of the different diagnostic tests are linked to the health and well-being of the patients. Visit by visit, years of mentoring, teaching clinical relevancy, and how to perform quality diagnostic testing, have now gone by, each trip with my ultimate goal of “training trainers.” As time passed, Dr. Kim proved herself to be the one individual who stepped up to the daunting challenge of being the resource and reference person who could support and assist in improving laboratory diagnostics across her nation. How would one know that all of those years of building capacity for support of tuberculosis patients would prove essential for CFK to branch into another aspect of patient outreach – hepatitis B assessment and treatment? Until the Pyongyang Hepatitis and Kaesong Hepatitis Hospital laboratories could be built, literally thousands of samples from the hepatitis patients were taken to the NTRL for testing. Without the experience and willingness of the NTRL staff and the laboratory capacity, the hepatitis B project could not have gone forward.
As each new hepatitis hospital laboratory was built, first in Pyongyang and then in Kaesong, Dr. Kim was essential in helping her colleagues develop the same high level of diagnostic expertise. The needs for laboratory testing are tremendous. Now, on each CFK trip into the countryside, Dr. Kim, my dear colleague, accompanies me, bouncing along over the amazingly bumpy roads in the back of one of the vehicles on our way to work with the laboratory staff in Kaesong or Haeju. We smile often at each other as we watch the views of the beautiful countryside pass before us and know that the workload to come will be enormous, the hours long, and the challenges sometimes almost overwhelming. Yet, we both recognize that the years of working together have forged a shared confidence and that we are up to the challenge. And so, we smile!
Contributed by: Marcia Kilsby