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Taking Technology for Granted

Posted by Mara Gordon
Lilongwe, Malawi
February 24, 2011

Note: The author, Mara Gordon, is a Global Health Corps fellow working to support the Foundation’s work in HIV prevention, care, and treatment services for women, children, and families in Malawi. In 2010, the Foundation and GHC partnered to improve health services and contribute to a strong and lasting health workforce in Malawi. This blog originally appeared on the GHC website.

In my introductory biology class, we did an experiment where we checked if food had been genetically modified. We brought in tortilla chips from Trader Joe’s and spinach from local farmers’ markets, and compared DNA in our lunches to altered DNA. Even at a small liberal arts college without a lot of fancy lab space, we were able to use DNA PCR and gel electrophoresis to do the experiment, amazing and widely-used technologies that can replicate and identify different genetic sequences. My biology professor wanted to make sure everyone really understood the experimental technique, since it served as a model for understanding wider issues in human genetics.

DNA PCR occupied a lot of my attention that fall, as I clumsily struggled with pipettes and spilled all sorts of genetic material around the lab. While our professor warned us she did not have infinite patience for botched-and-then-repeated experiments, resources were never in short supply — using this incredible technology to determine the genetic content of my bagel was simply part of taking Bio 101.

Now, in Malawi, DNA PCR also occupies a lot of our attention at the Elizabeth Glaser Pediatric AIDS Foundation. That’s because we need the same technology as we used in my biology class to test babies for HIV. Since normal rapid HIV tests actually test for HIV antibodies — your immune system’s response to the virus rather than the virus itself — they aren’t effective for infants, who may have antibodies from their mother’s breastmilk in their bloodstreams. The DNA PCR test looks specifically for HIV sequences in a newborn baby’s cells.

Unfortunately, we can’t be quite as cavalier about DNA PCR here in Malawi as we were in my biology class back in the United States. There are only a few hospitals with the technology in the entire country, so health centers must send samples of babies’ blood over hundreds of miles and down flooded, bumpy roads just to get an HIV diagnosis. When the samples reach the central hospitals, in major cities like Lilongwe and Blantyre, lab technicians can then run the HIV tests, sending the results back down the same difficult roads to the health centers that await them. The process often takes longer than two months, if the test results reach the tiny patients — and their mothers — at all.

We spend a lot of time and energy thinking about how we can make this process smoother: developing transportation systems and logbooks to keep samples organized, making sure health centers have the equipment they need to take babies’ blood, working with big hospitals to speed up the turnaround after they run the tests.

But all this effort is because of one overwhelming fact. The entire country of Malawi probably has as many DNA PCR machines as we had for my biology class of 80 people.

The disparities in health technology can be a little overwhelming. It’s one thing to compare rural Malawian health centers to major American academic medical centers, but it’s another to compare the tertiary referral hospital in Malawi’s capitol city to my freshman-level bio class.

Not that Americans can’t learn from what we’re trying to do with early infant HIV diagnosis here in Malawi. Because resources are so limited, we’re working to streamline the process and maximize the efficiency of what we do have. We’re forced to get organized and document which babies get tested and where their blood samples travel. And because tests of this nature are so expensive and so limited, there’s a much greater emphasis on preventative public health projects — something the MRI and CT scan-happy American healthcare system could really work on.

But the basic inequality remains. My classmates and I ran banana DNA through PCR machines while HIV-positive newborns went undiagnosed — and probably died, as a result — in Malawi.

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