The Urine Test

There are some standards of care in the US that we don’t come close to meeting here in rural Ethiopia. For example, we aren’t able to monitor the baby’s heart rate in a pregnant woman during labor. Nor do we have easy access to chest x-rays to allow diagnosis of common diseases like pneumonia and TB. By necessity, we must lower our standards, treat empirically, and cross our fingers. There is one exception to this rule – the urinalysis. A urinalysis is a more sophisticated name for a urine test. It routinely consists of two distinct entities – examining the urine using a dipstick and also under the microscope. The dipstick is quite simple – you must dip a thin stick into a cup of urine and then look at the color changes on the stick for the result. Not rocket science. The second portion of the test requires microscopy and genuine skills.

Our lab technician is slow, and I’ve tried to make his job easier by deferring some labs to other folks. The urine dipstick was one of these labs. It can easily be done by other members of our staff. But, repeatedly, he has rejected this as an option. It must be done by a “trained professional,” he claims. In the US, I did urine dipsticks all the time, with no formal training in laboratory technology whatsoever. I guess Ethiopia’s standards of care for urinalysis are just a step ahead.

The other day I was interviewing another lab technician for the job. He noticed how busy it was in the lab, and asked what we do if the lab is overcrowded. I brought up the example of the urinalysis, arguing that other folks can do this particular test to save the lab tech some time. I thought maybe the disagreement I had had with our current lab tech was just a unique case. I thought wrong. This candidate to work in our laboratory, who I was currently interviewing for a job, began a long tirade on how urine tests must be done by a “trained professional.” And on and on he talked about it. Only in Ethiopia do we require such high standards for a simple test, and only here would you get lectured by an applicant you’re interviewing! When you have such limited access to good diagnostic tools, I guess you have to take pride in the labs you can do.