IN THIS ISSUE:

Timing of Sample Crucial in Dengue Testing HIV Population In Focus at CCAS Meeting CARPHA from Vision to Reality

Gambling With Lives Lets Do No Harm

Keeping Focused on Lab Quality the Ultimate Quality Goal of Accreditation
Every medical laboratory has a primary duty and responsibility to DO NO HARM. This is not an easy goal to achieve since laboratory testing is exceedingly complex, involving many steps, from taking a patient sample to using the result to effectively manage a patient. Laboratory errors are common. A recent United States study estimated that 2.9 million errors occurred annually,causing harm to more than 160,000 patients.1 A truly frightening statistic! Millions of laboratory tests are conducted annually in the Caribbean. In the absence of laboratory regulations or standards, to DO NO HARM becomes exponentially more difficult. A publication of Caribbean Med Labs Foundation By the Caribbean for the Caribbean
Continued on Pages 4&5

ISSUE #3 MAY 2013

EDITORIAL
Leading From The Front
Dr Stephen King, Chairman, CMLF Dr King is an Independent Senator in the parliament of St Lucia, Laboratory Director, and former Chief Medical Officer in St Lucia.

CARPHA - from Vision to Reality

On the 1st January 2013, the long awaited Caribbean Public Health Agency (CARPHA) was established, with the challenge of creating an integrated regional public health agency through merging the five regional health institutions (RHIs), each with decades of valuable service Caribbean Environmental Health Institute, Caribbean Epidemiology Centre,Caribbean Food and Nutrition Institute, Caribbean Health Research Council, and Caribbean Regional Drug Testing Laboratory.

Laboratory Medicine is changing. The changes are driven by technology and changing clinical and public health requirements. We must respond and drive the evolution of our services to meet this changing environment. New technology means that we have the potential for greater capacity but it also means that traditional laboratory practice will become more threatened as point-of-care systems take up much of what we traditionally did. The challenges we face include repositioning traditional lab practice, keeping abreast of new knowledge and finding ways to apply it in our laboratory practice. We, traditionalists, must continue to increase the value we add to laboratory results. The development of a strong regional laboratory community that shares knowledge is one strategy to help us. The Caribbean Med Labs Foundation is committed to strengthening the laboratory community, but each individual needs to get involved. Each of us needs to extend our alliances and partnerships to benefit from laboratory networks and services within and outside our region. The foundation for this already exists but we must now make the effort to build on it. In this regard, the start up of the Caribbean Public Health Agency (CARPHA) in January, 2013, and the Caribbean Health Leadership Institute (CHLI) provide valuable opportunities to build on our knowledge and strengthen alliances. We are encouraged by CARPHAs commitment to engage civil society as an equal partner in its work. The process of accreditation helps strengthen the systems in the laboratory; this facilitates knowledge acquisition and application. Laboratory accreditation also helps to strengthen our dialogue and negotiation with partners. Having been through two cycles of laboratory accreditation, I can assure my laboratory colleagues that accreditation has major internal benefits; it is more than just a certificate on the wall. Accreditation is not something we should shy away from or believe that we are not yet ready for; instead, we should embrace it. From the time you make the decision to seek accreditation, the process of laboratory strengthening starts and there is a continuing snow-ball effect. The laboratory is a critical player in the health care team, but laboratory professionals must step forward and get more involved in the daily clinical and public health policy discussions and decision making. It is not just our results that the team needs. The health care team needs our total engagement.

At the official launch of CARPHA, in Trinidad and Tobago on 2nd July 2013, Prime Minister of St. Kitts and Nevis and CARICOM Lead for Human Resources, Health and HIV/AIDS, Dr Denzil Douglas, described CARPHA as an example of functional cooperation and a triumph of the spirit of regionalism.
In his address at the official opening, Executive Director of CARPHA, Dr James Hospedales, gave thanks to the Government of Trinidad and Tobago for agreeing to host the new agency and provide support for a new facility, and to the many partner agencies including Canadas Public Health Agency and Department of Foreign Affairs and International Trade,United States Centers for Disease Control and Prevention, European Union and Public Health England. Dr. Hospedales noted that the regional challenges are many. CARPHA will aim to reduce premature deaths from non-communicable diseases (NCDs), HIV/AIDS and injuries and violence by at least 25 per cent by 2025 and will include this goal as part of its post-2015 targets for the Caribbean. As a small Agency facing a large task, the CARPHA Executive Director is clear that partnership and networking will be a key strategy and he committed to pursuing this approach, and to include civil society as an equal partner. As a regional non-governmental organisation, we at the Caribbean Med Labs Foundation look forward to developing a successful, collaborative and mutually supportive relationship with CARPHA. This will be consistent with the tradition of strong international NGOs which work with governmental agencies and advocate for and support the implementation of governmental policies. Dr. Hospedales ended his address by noting that CARPHA has a rich tradition of the five (5) former RHIs on which to build. His priorities include the completion of the transition of 5 into 1, and crafting a new vision in collaboration with member states. Visit CARPHA at http://carpha.org

LABORATORYS ROLE IN DENGUE TESTING

Its the rainy season again, and dengue fever is on the rise in several countries in the Caribbean. As usual, the laboratory, which is one of the most silent of health support systems, is a key avenue for providing the information required for managing patients and guarding the publics health. >> What is Dengue?
Dengue is an illness caused by infection with any of the four types of Dengue virus (DEN 1, 2, 3 and 4), which are transmitted by the Aedes aegypti mosquito and affects an estimated 50 million people in approximately 100 countries every year. Infection by one DEN serotype confers long-term immunity to that serotype but not to the others, so persons can be infected by different serotypes at different times in their lifetime usually with increasing severity of symptoms. The majority of dengue infections (~75%) are asymptomatic. Testing for dengue infection can be somewhat bewildering because within a week to 10 days, this acute illness progresses from infection with the virus to production of antibodies against the virus by our immune system. The diagram below illustrates what happens during the course of dengue infection. fever subsides, the disease progresses to the critical phase which is characterized by a 24-48 hour period in which shock can occur due to increased capillary permeability and plasma leakage. The presence of these symptoms is now called severe dengue (formerly dengue haemorrhagic fever or dengue shock syndrome). Appropriate treatment is critical at this stage as patients can be at risk of death. Additional symptoms at this stage include abdominal pain, vomiting, thrombocytopenia and mild bleeding symptoms. The final convalescent phase of dengue lasts 4-7 days. taken at day 2 to 4 in the course of the illness should be tested for dengue virus. With the exception of the NS1 antigen test, such tests are much more complex and expensive and are generally only done at reference laboratories where more sophisticated facilities and specially trained staff are available. Anti-dengue IgM antibody is produced during the acute phase of the disease and is detectable by ELISA 3-5 days after the onset of illness. A sample taken at day 3-5 or later in the course of the illness is the correct one for use with the commonly used rapid and ELISA tests that measure ONLY antibody. Even persons who have had previous infections with dengue cannot be reliably tested with antibody tests before 3-5 days after onset of disease. Newer dengue rapid tests that detect both antibody and antigen (e.g. NS1) are now available and make it possible to detect dengue much earlier (i.e. within the first 3 days of illness) using simple technology. While it is not possible to rely on the more complex tests for testing every case of dengue infection, we need to do some amount of PCR testing and/or virus isolation because these tests provide information on the type of dengue virus causing the infection. It is important from an epidemiological point of view to track these circulating serotypes, as the incidence of severe dengue increases with changes in circulating serotypes.

>> Testing for Dengue

In a suspected dengue case, laboratory tests are important to determine infection and to analyse how severe the disease is. Measuring platelet counts gives an indication of severity a decrease indicates increased likelihood of bleeding and haemorrhagic symptoms. Doctors may monitor the patients platelet count and haematocrit (red cell volume) over time to see if there are any changes.

>> How do we diagnose dengue in the laboratory?

When the patient presents to the health care system, the timing of taking the sample to test for dengue is critical. Based on the diagram, it is clear that samples taken early in the acute febrile stage would contain circulating dengue virus. Assays suitable during this acute phase include those which detect dengue virus i.e. traditional virus isolation, or those which identify

>> Interpretation of Dengue test results

In testing for dengue, the following things are critical: Knowledge of the date of onset of symptoms to determine whether the patient will have only virus or whether they should already have started to produce antibody. Selection of the appropriate test to ensure that the correct methodology is used to measure the virus or the antibody as appropriate to the timing of sample taking. It is the laboratorys responsibility to validate that the selected tests work within the laboratory in the same way and under the conditions specified by the manufacturer and to ensure the quality of all results produced by the laboratory.

During the acute febrile phase of the disease, the major symptoms are 2-7 days of fever, with any of the following symptoms: retro-orbital pain, headache, bone, muscle and/or joint pain, rash, mild symptoms of bleeding (e.g. easy bruising, gum or nose bleeds, petechiae). As the

dengue RNA virus (Reverse Transcriptase Polymerase Chain Reaction RT PCR) as well as soluble antigen (i.e. NS1 antigen). Virus isolation is a relatively slow process (21 days), while PCR and soluble antigen detection are the more immediately available methods used today. Samples

The laboratory must also manage its resources to ensure appropriate utilisation. During a dengue outbreak, initially, samples from all patients exhibiting symptoms should be tested to identify the cause of the outbreak. Continued on Back Page

GAMBLING
WITH LIVES
Continued from Cover

>> Laboratory Error Hurts

The avoidance of laboratory errors presents a multidimensional challenge. Even accreditation, if not appropriately managed, may not guarantee that incidents of lab error are avoided. The 2004 experience of Maryland General Hospital (MGH) in the USA is instructive in this regard.2 MGH was a highly regarded laboratory, repeatedly accredited in 2001 and 2003 by the College of American Pathologists (CAP). In spite of this, a terrible preventable laboratory incident resulted in HIV infection of one staff member, over 2000 clients having to be offered free retests, the temporary closure of the laboratory and the convening of a US Congressional hearing at which it was revealed that the MGH was given high marks in an accreditation assessment process even while severe operational problems existed. Stakeholders discovered that Accreditation and Quality are not always synonymous. In a more recent 2012 occurrence, a crime lab chemist in Massachusetts (Mass) was arrested on suspicion of altering or faking thousands of drugrelated tests.3 As new information emerges it seems that almost 200,000 cases may have to be re-opened. Hundreds of persons may have been incarcerated unfairly and even more alarming, hundreds of dangerous criminals may have to be released due to untrustworthy evidence. This lab, which was not accredited, has been closed as investigations continue. What do both of these cases have in common? Their staff lost sight of their primary duty to DO NO HARM and failed to either comply with standard quality requirements (MGH) or to implement the required quality systems (Mass).

>> Standards, Quality Systems and Accreditation as Strategic Motivation

A laboratory seeking to DO NO HARM needs to adhere to the tenets of any quality-focused business operation i.e. identify an appropriate quality standard, implement appropriate quality structures and systems, work towards full compliance and seek credentialing of quality achievements. In 2004, Caribbean Governments agreed that the ISO 15189 Standard would be the benchmark for medical and related public health laboratory operations.4 Significant resources have been invested in laboratory improvements and the lure of accreditation is giving impetus to this effort.

effective recording and reporting procedures; excellent customer service and of course competitive costing of services. Becoming accredited means consistently aiming to DO NO HARM and taking the continuous quality improvement path.

>> How can accreditation work for your lab and for your clients?
The accreditation process requires specialist assessors to conduct a thorough evaluation of systems, people, infrastructure, equipment and client satisfaction. In order to maintain the integrity, credibility and trustworthiness of the accreditation process, a critical aspect must be that Accreditation Bodies ensure that assessors are competent to conduct evaluations and provide sound feedback.
Becoming accredited means having appropriately skilled staff; maintained equipment; efficient sampling; relevant technology; valid methodologies;

Some laboratories prepare for accreditation without fully engaging staff, management and key stakeholders in the quality improvement effort. These laboratories eventually experience significant quality systems gaps that inevitably lead to error incidents and possibly to a loss of accreditation.

No Accreditation Body can guarantee that a laboratory complies with standard requirements on a continuous basis or that every laboratory test will be accurate. Some Accreditation Bodies now include this disclaimer in their instructions.4

>> New Regional Accreditation Initiatives

Regional partners have recognized the challenges and have drafted a Stepwise Approach to Quality Improvement. This will be further discussed in a subsequent edition of this Newsletter.

quality systems, pursuing the accreditation goal and ensuring that laboratory quality and accreditation are synonymous.
Wendy Kitson-Piggott, CMLF Laboratory and Quality Systems Specialist.
Visit the CMLF website cmedlabsfoundation.net for a list of references for this article.

Let us not gamble with the many lives we hold in our hands. Let us ensure that we DO NO HARM by implementing our
Accredited laboratories are expected to comply with the quality and ethical requirements of the relevant standard on a day-to-day basis and to honestly present all laboratory data. They are expected to be transparent about possible conflicts of interests and avoid entering into unethical financial arrangements such as inducements to clinicians to refer clients.4 Noncompliance with these requirements can damage the image and reputation of a laboratory, can result in unreliable services, can diminish client confidence and above all, can erode trust in the accreditation process. Laboratories with multi-sites MUST ensure that both the main facility AND satellite sites or service centres are assessed for accreditation and that their accredited scope of testing is clear. Clients have a responsibility to choose their laboratory wisely.

>> Selecting an Accreditation Body

ISO 15189 accreditation certificates can only be issued by accreditation bodies affiliated with the International Laboratory Accreditation Cooperation (ILAC). ILAC-affiliated Bodies exist worldwide. Several other nonILAC affiliated bodies also accredit laboratories in conformance with the ISO 15189.

It is important to note that many non-ILAC-affiliated Accreditation Bodies establish their own standards for medical and public health laboratories that may take a somewhat different approach to laboratory improvement to those promoted by the ISO 15189 Standard. Significant differences in requirements may exist and laboratory assessments and accreditations may differ in focus and expected outcomes.

KEY: a. International Laboratory Accreditation Cooperation (ILAC) b. Trinidad & Tobago Laboratory Accreditation Service (TTLABS) c. Jamaica National Agency for Accreditation (JANAAC) d. Coordination Committee for Quality Assurance in Health Care Laboratories in the Netherlands (CCKL) e. Standards Council of Canada (SCC) f. College of American Pathologists (CAP) g. Joint Commission International (JCI)

Improving care for the Caribbean HIV population in focus at CHART-CCAS-CMLF Meeting
When Laboratory and other Public Health specialists meet in Nassau, the Bahamas, from August 25th to 29th, 2013, they will be working towards building on achievements in quality laboratory diagnostics, treatment and care for the Caribbean HIV population. Thats the remit of the 2nd Joint meeting of the Caribbean HIV/AIDS Regional Training Network (CHART), the Caribbean Cytometry and Analytical Society (CCAS) and the Caribbean Med Labs Foundation (CMLF). This meeting also doubles as the 10th CCAS HIV/AIDS International Workshop, successfully organised by Professor Clive Landis and his team of dedicated volunteers at CCAS, initially as a means of educating laboratory professionals about technological advances in laboratory support for HIV/ AIDS care and treatment. In subsequent years, the meeting was expanded with the participation of CHART, to address advances in clinical care and treatment of HIV infected persons, and with CMLF to support strengthening of regional laboratory networks. A look at the programme for the Opening Ceremony provides a glimpse of the extent of the collaboration and support which the host country is providing for this key event in the Caribbeans public health calendar. Not only will Bahamas representatives make presentations at the meeting, but the Minister of Health, Dr Perry Gomez, will participate in the Opening Ceremony, along with a number of officials from the Public Hospitals Authority. Over 150 participants and presenters will come from the host country, the wider Caribbean, United Kingdom, Canada, Costa Rica and Mexico. Students of the University of the West Indies and sponsors will be among the regional and international delegates. Presenters will address themes such as: the Public Health Benefits of Biological Prevention, Immunology and the Frontiers of Immunophenotyping including (for the first time) alternative uses of flow cytometry; Strengthening Laboratory Networks in the Caribbean; Laboratory Quality Management Systems (QMS) and Monitoring and Evaluation in a changing Environment; and Strengthening Counselling and Psychosocial Care. Delegates will present country reports on the existing services for laboratory support for HIV/AIDS care and treatment, and selected participants will provide updates on research being done into issues surrounding HIV/AIDS care and treatment within the Caribbean and Latin America. The Opening Ceremony Distinguished Lecture will feature Thomas Quinn, M.D., Professor of Medicine, Johns Hopkins Bloomberg School of Public Health and Director, Johns Hopkins Center for Global Health. Dr Quinn is well known for his investigation on the epidemiology, pathogenesis, and clinical features of HIV/AIDS internationally; and the interaction between STDs and tropical diseases on the natural history and spread of HIV/AIDS in developing countries. CMLF team members will be contributing throughout the meeting and workshop. Director-Laboratory Management Specialist, Valerie Wilson, will be part of the opening ceremony, serve as a session chair and present on QMS Implementation Using a Stepwise Approach. Immunologist and Laboratory Information Systems Specialist, Dr Wayne Labastide, will present on Leukemia/Lymphoma and Flow Cytometry and introduce the CMLF Electronic Log Book. Laboratory and Quality Systems Specialist, Wendy Kitson-Piggott, will present on 21st Century Economic Trends and Implications for Regional Laboratory Services and A Costing Framework for QMS Implementation. A presentation from the Caribbean Public Health Agency (CARPHA) will outline a New Public Health Vision for the Caribbean.

Caribbean Health Leadership Institute (CHLI) Cohort Five Valedictorian

As the Deputy Laboratory Manager responsible for advancing Quality Services at the Princess Margaret Hospital Laboratory (The Public Hospitals Authority) in The Bahamas, we manage over 100 staff members, and a host of internal and external stakeholders. We are expected to be effective leaders, focused on the organizations vision and mission. Obstacles; Step Six: Create Short-term Wins; Step Seven: Build on the Change and Step Eight: Anchor the Changes in Corporate Culture. The main learning period, which included web-based seminars incorporating core curriculum, guided our reflection and contributed to strengthening our network. We were reminded that as we seek to enhance our leadership skills, we must also understand ourselves; knowing our weak and strong areas was necessary. To accomplish this, many instruments were used, including:
FIRO-B, which afforded ways to identify a set of interpersonal needs that is most comfortable for us, as leaders. THE CHANGE STYLE INDICATOR MODEL was used to measure our preferred style in approaching change and dealing with situations involving change. THE 360 DEGREE PROFILE allowed us to review our leadership profile through the eyes of those we lead, or work with. Some of the responses were expected, others were unexpected, but they were all good, because at the end of the day, it was all about change and positive development.

Ismae Whyms

The eleven-month learning offered by the Caribbean Health Leadership Institute (CHLI) turned out to be another phase in my process of life-long learning of the principles and practice of leadership. The focus of the CHLI programme was to advance personal and professional development, with a view to strengthening leaders who will, in turn, influence the performance of work teams and contribute to the improvement of national and regional health systems. As the manager responsible for driving the laboratory into accreditation, I recognized that it is not an easy process and that change is necessary During our first retreat, in May 2012, each of the eight groups was given an Action Learning Project. As we reflected on our Action Learning Project, we adapted the eight steps in John Kotters book Leading Change: Step One: Creating a sense of Urgency; Step Two: Form a Powerful Coalition; Step Three: Create a Vision for Change; Step Four: Communicate the Vision; Step Five: Remove

As the Valedictorian for 2013, (CHLI Cohort Five) I can truly say that my leadership skills were enhanced and I was reminded to let go of those things over which I have no control. Within me, there is this desire to always look for opportunities to guide newcomers to the service and to share something of what I learnt from the Caribbean Health Leadership Institute, for it was truly a wonderful learning experience. As a member of the Triple-L, CHLI Life-Long Leadership Alumni Network, I look forward to wherever this leadership journey takes me.
Ismae Whyms, Ph.D., Deputy Laboratory Manager, The Bahamas

Laboratory Champions
In the second issue of our CMLF Newsletter (January 2013), we presented the first installment of an article in which graduates shared their views on a three-year training programme for laboratory managers conducted under the umbrella of The Strengthening of Medical Laboratory Services in the Caribbean (SMLS) Project. We also listed the key success factors identified by the five graduates who presented views. The full article can be viewed on the CMLF website at www.cmedlabsfoundation.net At the same time Trudy, in her role as laboratory and quality manager of a private facility in St Lucia, established her quality goals and dedicated considerable energy and passion to implementing a quality management system (QMS). She describes this experience as challenging but exciting and demanding 100% staff involvement and commitment. Even though she migrated in 2009, Trudy was thrilled when, in 2010, her St Lucia laboratory realised their dream of being the first laboratory in the country to achieve accreditation. In 2009, Trudy moved on to a laboratory in Canada. Here is a laboratory, she says, that lives and breathes continuous quality improvement (CQI) under the watchful eye of a Department of Quality and Regulatory Affairs. Daily reviews of quality indicators and team resolution of nonconformances are the norm. She says that she feels the same keen sense of excitement and interest that she remembers from her participation in the SMLS project and observes that this new experience has served to reinforce the message that the accreditation journey requires unrelenting attention to audits, external quality assurance (EQA), validations, standard operating procedures (SOPs), revisions, turn-around-time (TAT) tracking and safety among the many other quality factors. Trudy quietly reflects on how effectively she has been prepared for her new challenges by both her SMLS experience and the quality improvement effort in her previous St Lucia laboratory. She acknowledges that her training as an advocate, a leader and most importantly, an activist, has significantly contributed to the confidence she now brings to her functions in this new and high quality accredited environment.
Wendy Kitson-Piggott, Laboratory and Quality Systems Specialist, CMLF.

In this issue of the CMLF Newsletter we highlight the experiences, successes and challenges as reported by the graduates from St Lucia and Suriname.
Suriname: Haidi confessed that she had had mixed feelings about embarking on the Quality Management System (QMS) journey excited but also doubtful about her ability to manage what seemed to be a huge task ahead. She admitted that her many years of experience in managing a laboratory and support from the regional network of laboratory colleagues, all struggling to implement quality, gave her comfort and helped her to manage her doubt. She reflects on the lessons that she has learned as both a Laboratory Manager and in her capacity as the National Quality Coordinator at the Ministry of Health and advises that laboratories should ensure that the roles and responsibilities of the Quality Manager and the components of the QMS are clearly documented and understood. Like Rebeca, Haidi also emphasizes the absolutely critical importance of involving ALL staff in the quality improvement planning and monitoring efforts, from the very beginning. Celebrating small successes and achievements proved to be a useful motivational strategy for her. Managers, advises Haidi, must role model professionalism and they also need to establish their own peer support and de-stressing systems. It has taken some time, but on reflection, Haidi says she has observed the personal growth among technologists in the Public Health laboratory and is proud of the growing awareness of the importance of a QMS by technologists in Suriname.

Key Success Factors

Admittedly the quality journey is fraught with ongoing challenges -- time and resources being major deterrents. But what do these regional Quality Champions see as the critical success factors for implementing and sustaining laboratory quality? Recurring themes from these graduates have included:
100% support from administrators and laboratory management a clear institutional vision, shared by all fearless and visionary laboratory leadership thorough knowledge of the laboratory standard 100% staff involvement responsibility, accountability, dedication and commitment effective teamwork strong communication channels among staff, clients and stakeholders an effective staff recruitment process and structure and above all a collective will and seriousness of purpose and a primary focus on patient care and safety.

Trudy Leonce-Joseph

Haidi Tjon Kon Fat

St Lucia: As Chairperson of the St Lucia National Laboratory Advisory Council, Trudy used her SMLS preparation to inspire the Councils quality improvement efforts. Her advocacy at this level, she admits, contributed to the Councils accomplishments that included adoption of the ISO 15189 Standard as the benchmark for national medical laboratories, increased focus on human resource development at all levels of laboratory operations and the introduction of standardized methods for safety and microbiology.

Striving for a culture of sustainable laboratory quality in which doing the right thing the right way the first time and every time, has been the common goal for all of these laboratory managers who have truly become Champions of Laboratory Quality.

LABORATORYS ROLE IN DENGUE TESTING

Continued from Page 3 However, as the outbreak progresses, focus should be placed on selecting samples from patients living in areas where dengue has not been previously detected, for PCR testing, and testing of persons exhibiting symptoms of severe dengue. Later, as the outbreak subsides, testing of all persons exhibiting symptoms resumes during the inter-outbreak period. In the context of dengue outbreaks, the laboratory plays a key role in: Confirming dengue and identifying circulating serotypes Monitoring of patients for severity of disease Ensuring the quality of all results they produce Providing information for guiding the sampling of testing since it may not be possible to test all persons for dengue during a large outbreak Providing surveillance information for epidemiological analysis and to guide vector control activities.
References: 1. World Health Organisation , Dengue: Guidelines for diagnosis, treatment, prevention and control: 2009. 2. Johnson, B.W., Russell, B. J., and Lanciotti, R. S. 2005. Serotypespecific detection of dengue viruses in a fourplex real-time reverse transcriptase PCR assay. J. Clin Micobiol 43:4977-4983. 3. Peeling, R.W. et al. 2010. Evaluation of diagnostic tests: dengue. Nat Rev Microbiol 8:S30-38.

DID YOU KNOW

That as a user of laboratory services you should:
1. 2. 3. 4. 5. 6. 7. 8. 9. Choose your laboratory carefully Ask your referring doctor or the lab whether the lab is accredited Ask the referring doctor or the lab what is done to ensure consistently reliable results Ask the lab whether you can see their performance record for External Quality Assessments Politely ask to see the label or ID on your sample of blood or other specimen to ensure its accurate Ensure that you understand the implications of your test results Talk to your doctor until you do understand Trust your instincts - suggest a re-test to your doctor if results are unexpected or alarming Get a second opinion if you feel that you should its your right

10. Follow up with your doctor or lab. Do not assume that your results are negative or normal, if you dont get any feedback. 11. Remember that laboratories have a duty to provide a timely and reliable result to every client its your right.

Valerie Wilson, CMLF Director-Laboratory Management Specialist

Vision Mission

The regional champion for best practice in Medical Laboratory Services. Promote and support the achievement of quality laboratory services in accordance with appropriate standards, through advocacy, resource mobilisation, collaboration, research and education.

The broad objectives of the CMLF include:

Continued development of the supportive environment for the rapid expansion of high quality regional laboratory services Advocacy at the highest levels for the implementation of relevant laws, regulation and accreditation of regional laboratories Mobilisation of resources for laboratory strengthening efforts Mapping of a regional coordinating strategy to ensure sustained laboratory strengthening efforts.

The CMLF Board Members:

Dr. Stephen King, Chairman Independent Senator, Laboratory Director and former Chief Medical Officer, St. Lucia. Mr. Lawford Dupres, Deputy Chairman Former Director, Trinidad and Tobago Bureau of Standards and former Director, CARICOM Regional Organisation for Standards and Quality. Ms. Ingrid Lashley, Treasurer Director, Trinidad and Tobago Mortgage Finance Co. Ltd. Mrs. Marvo Harper, Secretary Legal Practitioner, Trinidad and Tobago. Dr. David Picou Former Director, Caribbean Health Research Council. Dr. Farley Cleghorn Senior Vice President and Chief Technical Officer, Futures Group, USA. Dr. Paula Burns Provost and Vice President (Academic), Northern Alberta Institute of Technology, Canada.

Valerie Wilson Director

Wendy KitsonPiggott Laboratory and Quality Systems Specialist

Wayne Labastide Louise Mathura Laboratory Administrative/ Information Finance Assistant Systems Specialist

Mr. Jones P. Madeira Manager of the Information and Protocol Division of the Judiciary of Trinidad and Tobago. Dr. Sonia Roache Caribbean College of Family Physicians, Private Practitioner, Trinidad and Tobago.

Cheryl ONeil, Editor Caribbean Med Lab News

63A Petra Street, Woodbrook, Port-of-Spain, Trinidad, W.I. | Telephone: 868 628 5911/4765 Fax: 868 628 4765 Email: cmedlabsfoundation@gmail.com Website: www.cmedlabsfoundation.net