Rapid Tests: valuable helpers for use in the field

Interview with Jens Hahn, MD, Internal Medicine and Intensive Care Specialist, Doctors Without Borders

Infectious diseases are widespread in conflict areas. When basic medical care is lacking on location, people cannot be appropriately treated. Laboratory tests are limited in the field. Rapid diagnostic tests make it possible for medical personnel to quickly and accurately test patients for several infectious diseases, for instance for the presence of malaria or HIV infection.


Photo: Jens Hahn

Jens Hahn; © privat

MEDICA.de spoke with Jens Hahn about his work with Doctors Without Borders in Afghanistan and in South Sudan, the medical situation on location and the use of rapid diagnostic tests.

Mister Hahn, what does your work look like in conflict areas such as Afghanistan or the South Sudan?

Jens Hahn: That’s hard to generalize since every conflict area has its own structure that depends on the respective security situation. How freely can you move as a medical team? Can you actually perform the classic work of Doctors Without Borders (Médecins Sans Frontières, MSF)? Can you drive to the site with your Jeep and provide primary healthcare to people or does the security situation not allow it? In Afghanistan for example, the treatment needs to focus on the centers. Here you can move freely only in the hospital or your living quarters.

What types of diseases and injuries do you need to be prepared for there?

Hahn: That also strongly depends on the situation. In classic settings like in South Sudan for example, these can be tropical diseases such as malaria, hepatitis or tuberculosis. A large number of war wounds is added in the increasing conflict areas with violent battles. Here you need to increasingly treat gunshot wounds. Infections that results from bullet or stab wounds and other acts of violence are also a part of our daily routine.

So you need to battle a lot of infectious diseases?

Hahn: Yes, classic infectious diseases such as transmissions of bacteria, viruses and parasites. But there are also many cases where people with bullet wounds cannot be medically treated until after a few weeks have gone by. The severely infected wounds need to first receive first aid and then generally require subsequent surgery.

What resources are available for you on location?

Hahn: You also need to differentiate in this instance: when we need to drive a long way from our base camp to a village, we can only take a limited amount of material with us, meaning only those items that fit into two Jeeps for example. In terms of primary healthcare, malaria or respiratory diseases in children, for instance, can be treated on a larger scale. Therapeutic foods for malnourished children and hygiene products like soap also have room in the Jeep. Many infectious diseases can occur because the simplest resources are not available on site.
Photo: white Jeep

With the Jeep doctors can drive to areas to treat people who otherwise would have no access to medical care; © Jens Hahn

Is laboratory testing actually possible in the field?

Hahn: Laboratory tests can only be done on a limited scale, especially in remote areas. A small test kit, for example, could make it possible to detect anemia on location. Yet this test is rarely conducted because you typically can’t perform a blood transfusion in this type of setting. By now we commonly use rapid tests that are able to detect malaria within a few short minutes for instance. You can envision this like a pregnancy test, only this test isn’t done with urine but with one drop of blood and an indicator. The HIV rapid diagnostic test also plays a relatively big role in the field. These types of tests are not available for all diseases, however. From a medical point of view, it is rewarding to fall back on your manual skills and get away from just treating people with medical devices.

Which rapid diagnostic test is used most frequently?

Hahn: The malaria test. In the best case scenario, we regularly visit different places after we have informed the community members in advance. Oftentimes, about 250 children are waiting for us in a malaria-infested area. If a child exhibits an increased body temperature or other symptoms, we perform a rapid diagnostic test. Since this is often the case for at least one-third of the people or more, you quickly need dozens of tests. Yet not all of them turn out positive. The children frequently also have other diseases.

Are you personally more susceptible to infectious diseases in conflict areas? Do you need to take special precautions?

Hahn: That strongly depends on the area. During the Ebola epidemic for example where Doctors Without Borders was able to very quickly set up tents, you definitely had to protect yourself. We are dealing with a disease where drugs don’t provide any protection. This is why we are just as vulnerable as the people that live in this area. I didn’t perceive the risk as much greater in Afghanistan than I did at home. Sure, tuberculosis is a major problem there but this is a disease that primarily affects people with weak immune systems. Yes, there is an increased risk in some countries for certain diseases such as malaria for example. However, the risk to get sick yourself is not exorbitantly higher. We need to pay more attention to hygiene. The local standards oftentimes don’t meet our own standards.
The interview was conducted by Kilian Spelleken and translated from German by Elena O'Meara.