Uganda has on several occasion in the past been hailed for taking incredible strides the medical field. In the early 90s, Uganda took a lead in the the fight against HIV and AIDS and reduced the HIV prevalence from 30 per cent to about 10 per cent between 1992 and 2002 according to ministry of health. In 2000, Uganda was hailed for it’s fast interventions in the fight against the unusually deadly scourge that Ebola was. These are few of many cases. Such reports of Uganda’s medical successes have become so many over the years that they no longer make news.
This could explain why, today, only a handful of people are aware that Uganda holds a leadership role in TB diagnostics on the continent. The National Tuberculosis Reference Laboratory (NTRL) is barely known by anyone outside the medical world, yet it serves 21 African countries, including Ethiopia, Seychelles, Zambia, Zimbabwe, Somalia, Mozambique and among others.
The story of this ultra-modern lab has its beginnings in the late 1950s. It was started by the East African Community as the Uganda Bacteriological Investigations Unit. Its role at the time was to participate in anti TB clinical trials and drug toxicities under the then British Medical Research Council (MRC).
After the collapse of the East African Community in the 1970s, the laboratory was placed under Uganda’s Ministry of Health where it continued doing diagnostic work on a national level.
After political stability that came after 1986 gave the lab a draught of fresh water. The lab enjoyed fresh beginnings and the staff became more stable and innovative.
It soon changed name to Uganda National Tuberculosis Reference Laboratory and was placed under the National TB and Leprosy Programme of the Ministry of Health.
The director NTRL Uganda, Prof Moses Joloba, whose work at the lab is still evident since those fresh beginnings in the early 90s says, “The role of the lab was (and still is) to advise and guide policies, standards, technical and operational guidelines for all TB labs in Uganda. To that effect, we set diagnostic standards for all TB labs in Uganda.”
When the lab received accreditation from the World Health Organisation (WHO) in April 2013, the event did not come near to making headlines.
International accreditations are a big deal. It’s a mark of an organisation’s excellent internal processes. It is a pat on the shoulder that an institution has managed their processes well in ensuring quality assurance.
Prof Joloba couldn’t be prouder of the lab’s achievements. “The lab received the WHO accreditation in 2013 because of our overall good performance in TB diagnostics. We are gratified to have achieved that international recognition,” says the professor.
The accreditation transformed the humble establishment into a Supranational Reference Laboratory (SRL) overnight. That is another way of saying ‘international reference lab’. This came with new international partners, modern equipment, better diagnostic systems and on the whole improved it’s capacity to deal a death blow to TB. It would turn out to be the only one of a kind in East Africa and the second in Sub-Saharan Africa, the first being in Algeria.
There are only 33 such labs in the world. A few years after the international recognition, the lab that had been based in Wandegeya for over half a century moved to a new property in Butabika.
On the one hand it is a national reference lab for all TB labs in the country and on the other hand, it is an international reference lab.
“While we continue to execute our internal mandate, we also have the added responsibility of supporting other National TB labs in East, Central and Southern Africa. We currently support and mentor national TB Labs of 21 countries to build resilient and sustainable TB diagnosis systems,” says the professor.
The extra responsibility has dramatically improved the overall capacity of the laboratory in terms of human resource, cutting-edge technology and overall improvement in testing for TB in Uganda.
The lab has become a centre of excellence in TB diagnostics in Africa and as such, serves as a last resort where many countries send multi-drug resistant strains of the TB virus for further investigations. These are viruses that are drug resistant at a genetic level, according to the laboratory manager Kenneth Musisi.
Musisi says, “On top of doing diagnostic work for Uganda and other countries, we serve as a demonstration site. We offer training and peer-to-peer mentorship for both local and regional lab personnel. Our target is to mentor other countries in our network to build their own sustainable TB Lab systems.”
The human resource of 67 at the lab is constantly on the move. The team makes several visits to various labs in country and in the region to train, mentor, encourage and challenge the personnel to do better.
“Over the last five years, we have supported labs in Kenya, Tanzania, Rwanda, Namibia and Eswatini (formerly Swaziland) to get WHO accreditation,” Musisi says.
The Ugandan team is currently helping Mozambique in the process of attaining a Supranational Lab status.
A scan through the facility
Located opposite Butabika National Mental Referral Hospital in Luzira, Kampala, this facility is, for lack of a better expression, a medical marvel. A tour of the facility feels like a teleportation into science fiction. Completely alien.
From the outside appearance to the inner-workings of the laboratory, every detail exudes a sense of modern technology.
For instance, the sputum samples from health facilities across the country and the region are conveyed to the laboratories high up the building by a pea-sided electric elevator called a damp waiter. Up here in the refrigerated labs, the levels of sterilization are simply out of this world. Every door has precaution codes.
Simple things like opening and closing a door has been refined to a science. Ventilation ducts are electronically controlled and fitted with suction pumps and filters.
The whole process, called ‘negative pressure’ ensures that no contaminated air gets into, or out of the lab. If outside air gets in, it could contaminate the samples. If inside air got out unfiltered, it would cause a national epidemic. Lab technicians in gas masks sit semi-motionless, working. Every move of the hand is accompanied by deep thought. Every action meticulous.