AACC Launches Emerging Countries Initiative

AACC Launches Emerging Countries Initiative
Wallace H. Coulter Foundation Gift Funds New Programs

By Bill Malone

Over its 62-year history, AACC has grown from a small, national association to a truly international organization. Today, one third of the association’s membership is international. With this expansion, AACC has built a reputation for world-class educational programs that take place around the globe, not the least of which is this Annual Meeting and Clinical Lab Expo, the world’s largest clinical lab conference with registrants from more than 100 countries.

Now with a major grant from the Wallace H. Coulter Foundation, AACC has embarked on a new endeavor that will continue to strengthen the association’s ties with laboratorians from other countries. The new emerging countries program funded by the grant aims to channel AACC’s educational expertise to bring high-quality programs that meet the unique challenges faced by emerging countries with limited resources. The program launched with a focus on Latin America, a region that has not received the same attention from other major philanthropic healthcare initiatives.

The emerging countries program’s first venture was a low-cost workshop held in Quito, Ecuador, on March 21 and 22 that addressed internal quality control (QC) with expert faculty from Ecuador, other Latin American countries, and the U.S. “AACC’s passion for educating its members and this funding from the Wallace H. Coulter Foundation are a perfect match,” said AACC past president Barbara Goldsmith, PhD, a member of the Latin American Working Group (LAWG) that coordinated the workshop in Quito. “Beginning with the workshop in Ecuador, the emerging countries program has inspired tremendous enthusiasm both from AACC members and from our colleagues in Latin America, all for a very worthwhile project that is truly needed.” Goldsmith is vice president of marketing, membership, and education at the Clinical and Laboratory Standards Institute (CLSI).

Building on Relationships

Straddling the northern and southern hemispheres on the western coast of South America, Quito was a fitting place to launch an educational program meant to bring together laboratorians from all of the Americas. Following the initial decision to begin the emerging countries program in Latin America, AACC drew on its relationships with national and regional societies to focus educational programming on the region’s needs. Members of the LAWG also include Stella Raymondo, PhD, of Uruguay, Rosa Sierra-Amor, PhD, of Mexico, and Consuelo Valencia, PhD, of Ecuador. After conducting surveys of laboratorians and consulting with leaders in the region, the LAWG heard a common refrain: the need for education on QC.

Faculty and organizers of the workshop in Quito, Ecuador:
Gabriel Migliarino, PhD; Ana Leticia Maselli, PhD; Sharon Ehrmeyer, PhD;
Barbara Goldsmith, PhD; Maria del Carmen Pasquel, PhD; Pamela Nash;
Maria Antonieta Garza Galindo, PhD.

“All of us agreed that it is the lack of doing internal quality control that is still a big issue for laboratories in the region,” said Rosa Sierra-Amor, PhD, a member of LAWG. “Not only is it expensive to run internal quality control, but in some countries, the regulations are not very deep, and many laboratorians don’t fully understand the purpose of internal QC.” Sierra-Amor is a member of the board of directors of Laboratorio LAQUIMS, S.C. in Veracruz, Mexico.

In Ecuador and many other Latin American countries, most laboratories are small, private institutions that send their complex tests to a handful of referral labs in larger cities, Sierra-Amor explained. These small labs often have not factored running internal QC into the cost of their tests and so feel they cannot afford to do it. To deal with these concerns, the recent workshop in Quito aimed to instill the importance of parameters that influence quality, and also how laboratorians with limited resources can prepare their own QC materials if that’s all they can afford.

In order to reach the broadest audience, the workshop was held just prior to the annual congress of the Ecuadorian Society of Clinical Biochemistry (SEBIOCLI), and the LAWG worked closely with the society’s president, Cecelia Paula, PhD, and the president of the congress, Maria del Carmen Pasquel, PhD. “The excellent attendance at the workshop, with more than 230 participants, really showed the great interest in this topic,” Sierra-Amor said. “At this workshop, we wanted to bring laboratories up to international standards, and this means helping both students and professionals become skilled in all areas of lab work, especially in quality control. We need more opportunities like this, because only continuous training will help clinical labs improve.” AACC also coordinated with the regional society, the Latin American Confederation of Clinical Biochemistry (COLABIOCLI), which has experience organizing conferences throughout Central and South America, most recently its own virtual course in quality management.

Translation Work

Beyond holding face-to-face educational workshops like the one in Quito, the LAWG also determined that boosting the number and quality of QC-related resources available in Spanish was essential for success. The group agreed that the obvious choice of where to begin was with the latest edition of the world-renowned book by James Westgard, PhD, Basic QC Practices. AACC contracted with Westgard, Inc. to translate the third edition of the book into Spanish, and will produce the volume in CD-ROM. Print versions are available now through the AACC online store and at the AACC bookstore during the Annual Meeting and Clin Lab Expo. The overall translation project also includes several relevant guidelines from CLSI, as well as monthly case studies from AACC’s journal Clinical Chemistry (See Box, below).

Emerging Countries Project Translates Lab Essentials into Spanish
Wallace H. Coulter Foundation Grant Opens New Possibilities

As part of the AACC emerging countries project currently focusing on Latin America, a major translation project is underway that includes Basic QC Practices by James Westgard, PhD, as well as case studies from Clinical Chemistry and guidelines from the Clinical and Laboratory Standards Institute (CLSI).

Clinical Chemistry Case Studies

Four case studies are already translated and will be posted at the journal’s website (www.clinchem.org). Next to the article’s English listing will be a separate link with the Spanish-translated pdf.

CLSI Guidelines

AACC has translated five CLSI guidelines into Spanish that were distributed at the QC workshop in Quito, Ecuador in March 2010 via CD-ROM. CLSI will also be selling the translations on its website.

C24-A3 Statistical Quality Control for Quantitative Measurement Procedures: Principles and Definitions

EP14-A2 Evaluation of Matrix Effects

EP15-A2 User Verification of Performance for Precision and Trueness

EP21-A Estimation of Total Analytical Error for Clinical Laboratory Methods

GP31-A Laboratory Instrument Implementation, Verification, and Maintenance


The latest edition of James Westgard’s Basic QC Practices has been translated into Spanish and verified by a second translator with specialized knowledge of laboratory practice. The book is available on CD-ROM and print versions. AACC sells both versions on its website, http://direct.aacc.org, and both versions also are available at the AACC Bookstore during the Annual Meeting and Clin Lab Expo.

In order to assure complete accuracy of all these materials, the English-to-Spanish translation is being performed by a technical translator and then verified by another translator with specialized knowledge of laboratory practice. “It was a significant achievement to develop a solid process for these translations,” said Goldsmith. “It’s important not just to get them done, but validated well to make sure that the translation is correct.”

Sierra-Amor emphasized the significance of making more material available in Spanish. “If you really want everyone to learn and then be able to teach others about a topic like QC, it’s so much better when people can learn and follow in their own language, especially when it’s technical material,” she said. “It’s expensive to get materials translated, and often manufacturers of test kits don’t fully translate the inserts or manuals, making QC even more difficult for laboratorians to understand.”

Just the Beginning

As the emerging countries initiative expands, excitement is building among AACC members and laboratorians in Latin America about the potential for the program. With this first venture in Ecuador, the LAWG now has a model for improving quality that has proven to work for the laboratorians it seeks to support.

Moreover, strengthened relationships with national and regional groups mean that going forward, the use of the funding from the Wallace H. Coulter Foundation will fulfill the vision of Dr. Coulter himself for “science serving humanity.” An innovator and entrepreneur, Coulter developed the Coulter Principle, the standardized method of counting and sizing cells and particles, which lead to breakthroughs in science, medicine, and industry. He also founded the Coulter Corporation, revolutionizing the practice of hematology and laboratory medicine and pioneering the fields of flow cytometry and monoclonal antibodies.

The emerging countries program will also reflect the true needs of emerging countries on their own terms, said Goldsmith. “We really learned that we have to be allied with local groups because we do not want to just impose something from the outside,” she said. “So developing these relationships has been absolutely essential.”

Other countries in Latin America hope to host similar workshops and continue to build upon the successful event in Ecuador. “We are so grateful for the workshop that took place in Ecuador, and now we look forward to the possibility of having a similar event in Guatemala,” said Ana Leticia Caceres de Maselli, PhD, president of COLABIOCLI and member of the LAWG. Caceres de Maselli is professor of chemistry at the school of medicine at the Universidad de San Carlos in Guatemala. “We are all concerned with quality assurance of results and clinical correlation in less time, lower cost, less risk, and greater satisfaction for patients,” she added. Paula and del Carmen Pasquel agreed that this kind of collaboration with AACC is important as it contributes to the continuous improvement of clinical laboratories in Latin America, and praised the work of Goldsmith as well as Pamela Nash, AACC’s director of international relations, for their leadership in developing the workshop.

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