Safe, Efficient and Effective

Investing in laboratories in Burma

In 2015, there were 2,793 laboratory confirmed multidrug-resistant tuberculosis (MDR-TB) cases in Burma, over half of which were found in Rangoon, a region in lower Burma. In contrast, there are only three biosafety level 3 (BSL3) laboratories located in Rangoon, Mandalay and Taunggyi. BSL3 laboratories play a critical role in the diagnosis of TB and the monitoring of drug-resistant TB patients. This means the National TB Reference Laboratory (NTRL) situated in Rangoon, needs to handle an average of 150–200 sputum samples per day from seven states and regions in lower Burma and two states from northern and eastern Burma. Definitive laboratory results from the NTRL are crucial for getting fast and appropriate care for MDR-TB patients, and for monitoring their ongoing treatment. To get these results, laboratories must be able to run tests effectively, prevent specimen contamination, all the while keeping laboratory personnel and the environment safe.

Laboratory workers in the newly certified BSL3 laboratory, Rangoon, Burma — Photo: FHI 360

The hub of laboratory safety is the biosafety cabinet (BSC) — an enclosed space that uses a system of airflow and filters to keep workers from breathing in dangerous biological and chemical substances, and preventing the samples from becoming cross-contaminated. In the NTRL, getting BSCs into the laboratory was an important step in being able to properly conduct the necessary procedures for the diagnosis of MDR-TB in patients. However, simply equipping laboratories with BSCs is not enough, every year they must be certified as working properly, and they need to be regularly maintained by certified technicians.

When the NTRL was upgraded to BSL3 in 2012, a local company was employed by the NTRL to provide annual maintenance. However, in 2015 when a Challenge TB laboratory specialist visited, it was found that the maintenance of BSCs was not being done properly and that the airflow was insufficient. To address this situation two technicians from the Supranational Reference Laboratory in Gauting, Germany, were employed to provide BSC certification and maintenance training to the staff of the TB laboratories in Rangoon, Mandalay and Taunggyi. The technicians also checked, calibrated and certified the existing BSCs.

Checking the airflow in a BSC at the BSL3 laboratory, Rangoon, Burma — Photo: FHI 360

Now the three TB laboratories in Burma not only have staff trained on how to conduct proper maintenance and certification of BSCs, but have also ensured that they are working in a safe environment. In this way, the USAID-funded Challenge TB project has brought safety systems into laboratories that are essential for quick and appropriate management for both drug-sensitive and drug-resistant TB patients in Burma. This ensures that patients are put on appropriate and effective medication, and are ultimately treated successfully.