Fieldset
Not just for COVID: How modern testing methods are changing refugee healthcare in Greece

We know that getting the right treatment, fast, makes all the difference for people caught in a crisis. But the right treatment relies on the right diagnosis. Lab specialist Kate Baldwin explains how she helps teams take a new approach.

A patient has come to the MSF day care centre from one of the refugee camps on the outskirts of Athens. We’ll call her Sadia*. She’s pregnant and she needs a test for a possible sexually transmitted infection (STI).

The extent of the refugee crisis in Greece has largely been overlooked by the world, but the figures speak for themselves. In 2019, 75,000 refugees reached Greece. More than half women and children.

Mostly from Afghanistan, Syria and parts of Africa, they have fled from the most unimaginable trauma. Most live in horrendous conditions in camps that are up to 500 percent over capacity.

Sexual health

The sexual and reproductive health unit of our clinic here provides a free and safe environment for women to access comprehensive care including family planning, termination of pregnancy, antenatal check-ups and mental health support.

From the outside, it looks like a simple grey box, generally small enough to sit comfortably on a desk. Inside, this sophisticated piece of equipment is fast, versatile, easy to use and maintain.

Getting an accurate diagnosis for patients like Sadia is an important step in providing the right care. Left untreated, STIs can lead to long-term complications including infertility, birth defects and pelvic inflammatory disease.  

A diagnosis is extra important for pregnant patients so that any infection can be treated before birth and prevent infections being passed on to newborns. 

My role

After a supportive consultation with Sadia, the midwife takes a swab for testing, but she doesn’t send it to a lab…

This is where my role as a lab specialist with MSF comes in. Part of my job is implementing new equipment and training staff in how to use it.

In Greece, many of our patients live in refugee camps outside of the city, or in precarious arrangements with little means of transport or financial assistance. Waiting for an external lab to process test results means they face the difficulty of travelling to the clinic twice – once for the test, and then again for any necessary treatment.

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Conditions inside a refugee camp on the Greek island of Samos
Conditions inside a refugee camp on the Greek island of Samos

We saw the opportunity to bring in “point of care testing” (POCT), where teams can carry out rapid testing in the clinic without the need of fully functioning laboratory.

But, to adopt this approach, we would need some new equipment. The Cepheid GeneXpert® analyser is a strong favourite amongst clinical laboratory professionals who have seen the huge benefits of rapid molecular diagnostics, especially recently, with COVID-19.

From the outside, it looks like a simple grey box, generally small enough to sit comfortably on a desk. Inside, this sophisticated piece of equipment is fast, versatile, easy to use and maintain. Most importantly, it produces results with a high level of accuracy that could take conventional laboratory methods days to detect. 

How we’re using GeneXpert® in Greece

In our project, we are using this analyser to detect the two most common sexually transmitted infections – chlamydia and gonorrhoea.

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Cartridges being loaded into a GeneXpert® machine at an MSF lab
Cartridges being loaded into a GeneXpert® machine at an MSF lab

The test takes just 90 minutes for a result. A swab is taken from the patient, mixed in a tube and transferred into a GeneXpert® cartridge – they look a bit like printer cartridges.

The cartridge is then placed into the GeneXpert® analyser. If the sample contains the target DNA (in this case, the DNA of chlamydia or gonorrhoea) it will be amplified into millions of detectable copies. The high-tech software then translates this data into a positive or negative result. 

Costs and profits

Of course, equipment like this comes at a cost – aside from the high initial cost of the analyser (in the region of $20,000) the cartridges required are also expensive. It can quickly add up to sums that healthcare systems in low-income countries simply cannot afford.

I’m also worried that in times of a global pandemic, there is the risk that other infectious diseases may be forgotten in the public eye

It is so disappointing that this company (and many others) which have made such an impact in this area of healthcare have also been profiteering beyond reasonable limits in some places.

You can read more about the MSF campaign to change the amount charged to the poorest countries here.

For NGOs like MSF, the cost-to-benefit ratio and long-term savings must be justified before that kind of budget can be allocated. But, where external lab tests are expensive and time-consuming to arrange, and a rapid diagnosis is key to ensuring the best outcome for the patient, a point of care testing set-up can be the best choice.

Testing in the time of COVID-19

In an era where infections are capable of destabilising the entire planet (of course, COVID-19) and antibiotic resistance is classed by the World Health Organization as a global threat, the difference diagnostic tools such as the GeneXpert® can make to controlling such disasters are incredible.

But I’m also worried that in times of a global pandemic, there is the risk that other infectious diseases may be forgotten in the public eye.

From common sexually transmitted infections like chlamydia, right through to diseases like HIV and tuberculosis (TB), I feel compelled to remind people that we cannot afford a decrease in awareness of such important healthcare issues.

Good news

Around 90 minutes after the swab was taken, the midwife checks the report from the GeneXpert® machine: Sadia’s test results are negative.

It’s good news, but if the results had been different, Sadia would have been able to start a course of antibiotics immediately, taking care of her health and preventing complications with her pregnancy.

* Name changed to protect her identity

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Read more: Stories from the refugee crisis in Greece

Greek refugee crisis: "How could this ever become normality?"
“I cannot even look our patients in the eyes anymore”