Lipid profile test helped us recruit a lab technician

Recently we received a generous philanthropic contribution at our rural clinic and are in the process of setting up a basic laboratory service. One of the greatest challenges has been recruiting a laboratory technician. There are many young boys and girls in the local villages who have completed their diploma in medical laboratory technology, but they are not choosing medical laboratory work. While the market rate of salary for a fresh medical laboratory technology graduate is about 7 to 8 thousand rupees a month, they would get double the salary if they went for job as labourers in local manufacturing and textile export companies.  Among the few applications that we received, many of them had no practical exposure in laboratories, because they had gone away for work in these factories. We decided to take any young enthusiastic person interested in the work, train them for this purpose and gradually create a sustainable model of laboratory services. But we have been having a minor worry regarding quality of the lab tests, and ensuring reliability of the lab findings. Will we be able to provide good quality laboratory service with a locally trained person? Or should we pay a higher salary and find someone who is more qualified? Will we be able to afford a higher salary? How to maintain a low cost affordable laboratory service if we have to pay higher salary for a more qualified laboratory technician? 

In this context, we conducted interviews yesterday to recruit a technician. Five people from the local villages had applied for the post and two turned up for the interview. One of them was a fresher, a young innocent girl, who was currently working in a clinical laboratory in the nearby town. The other one was an older woman, mother of two children, currently working in a textile export company. We had a senior laboratory consultant screen them for their basic knowledge level. He spent the entire morning with these two applicants. He came to us around 12.30 PM and said, "Doctor, these two girls have absolutely no clue about laboratory tests. They have both studied in some small local college and obtained their diploma. Neither of them currently has any relevant knowledge that is required for running a basic clinical laboratory service." His report was quite disappointing. We decided to have a  conversation with them and send them on their way. 

The conversation turned out to be very meaningful for us in many ways. Each of them gave us some very interesting perspectives. We asked the young girl who was a fresher, "Tell us about your work experience in the nearby town. What tests do you run there? How do you do the tests?" She rattled out the name of some tests. One of the tests that she mentioned was the lipid profile. This caught our interest. Flash back 2 weeks - While ordering reagents for the lipid profile test for our lab, the supplier, a very friendly young man, advised us, "Sir, please get Total Cholesterol, Triglyceride reagents alone. These two reagents are cheap. With this you can give the report of the entire lipid panel." I was not convinced. Because based on what I knew, we need at least Total Cholesterol, Triglycerides and HDL to be assessed and then we can calculate the LDL from these three values. So I told him, we will require the reagent for HDL also. To this he replied, "Sir, none of the local labs to which we supply reagents buys HDL sir. HDL reagent is costly. If you assay HDL the cost of the lipid test will go up and so people will not be able to afford it. Just go with Total Cholesterol and Triglycerides and do the tests sir. That is how all local laboratories here report the lipid profile. Don't waste money." But this made no sense to me and so I ordered the HDL reagent anyways. We did a costing exercise for the lab test. After including the water, electricity, rent, Human Resource, biomedical waste management, reagent, and consumable costs, the cost of a lipid profile test is 300 rupees with the HDL and about 270 rupees without the HDL assay. The local labs were charging an average of 350 - 375 rupees for the lipid profile. It made no sense to charge this much, but not do a HDL assay, other than pure greed! 

Coming back to the interview, this young girl told us that she knows how to do a lipid profile test. So we asked her to explain. She said, "We will first add reagent for Total Cholesterol and Triglycerides and assay them and write down their values. Then we will take the HDL to be 34.6. Then we will apply these values to the formula that they taught us and we will get the LDL value. We will write all this down." I asked her, "How do you get the value of 34.6 for the HDL?" To this she replied, "The seniors in the laboratory taught us to take the HDL value as 34.6." The girl was innocent and did not even know that they were faking the value of HDL to cut down the cost of the test, to make profits. This was a revelation for us and we were thinking, "We were worrying about quality of test if we employed unqualified technicians, but seems like any test we do with the right intentions would be better quality than what is currently happening around!" 

The senior woman who had come for the interview recollected stories of her past experience in a hospital laboratory before her marriage. She had been a multitasking staff, trained in operation theatre technology, ultrasound scanning as well as laboratory. She had been the most in-demand staff in her hospital. She recalled how patients would connect with her and ask for her before they got discharged from the hospital to go home. Marriage had changed everything for her. She teared up when she started talking about work and how marriage stopped her from continuing to work. She even said, she had kept her certificates and diplomas in her paternal home to protect it safely and did not bring them to her natal home. There was a tinge of melancholy in her narrative. She confessed that she is completely out of touch with laboratory work, but she wants to reconnect with medical work and contribute to the society. She said, "My father used to tell me that medicine is a noble profession and no job gives us the kind of satisfaction and fulfilment that helping sick people gives us." She said she was very keen in doing this work. Her enthusiasm and her emotions could be very easily felt by all of us in the room. It was sad to see an enthusiastic woman forced to take a huge break in her work life because of social norms. 

After the interview, we discussed among ourselves about whom to select. All three of us in the panel had been impacted by the enthusiasm and sentiments expressed by the second candidate. We decided to take her for the job and send her for a practical training with the medical laboratory of a friend. Not only would we have someone with the right attitude and temperament to do the laboratory work, we would have someone who comes with a clean slate with very little things to unlearn from the bizarre things that lab technicians are forced to do in other laboratories to make profits. We eagerly look forward to working with her, empowering her and empowering our local community with good quality laboratory services.