Preface| Volume 38, ISSUE 1, Pxv-xvi, March 2018

Pathology: Central and Essential

Published:December 12, 2017DOI:
      There is no other portion of a health care system that links patients to more diagnoses and treatment plans than the laboratory, and diagnostic tests determine more than 70% of all health care decisions. Communicable and noncommunicable diseases alike rely on parts, or in some diseases states like cancer, nearly all of the laboratory to provide crucial details for establishing a diagnosis and creating a feasible treatment plan. Regardless of whether a person is born in New York City, rural Oklahoma, Rio de Janeiro, Accra, Mumbai, Moscow, or Hanoi, high-quality laboratories are essential for diagnosing their symptoms accurately and rapidly. That only the privileged or the wealthy (relative or actual) who can afford laboratory testing is a “fact of life” is simply a travesty and a tragedy. As social justice advocates opine that “health care is a human right,” they do not mean only medical doctors or only nurses or only surgeons. They mean health care is a system, and such a system only functions with a laboratory at its center to provide the essential bridge to appropriate care that every patient deserves.
      The challenge of laboratories is not in knowledge but in access. A successful laboratory test requires trained personnel, equipment, reagents, reporting system, controls, quality control, and stable environment. These are all based in real dollar costs or functioning systems that require constant vigilance. It is not good enough to say that a laboratory is doing a perfect job 99% of the time. If we used that logic with airplanes, 1 in 100 would crash. Patients, no matter where they live, deserve 100% high-quality laboratory testing at all times. Thus, our challenge in meeting the needs of patients around the world is to insure they have access and that their laboratorians have access to all the tools that are needed to return a useful laboratory result. This starts with government recognition of the power and value of laboratory professionals and their laboratories. This includes recognition at all levels from government, through hospitals, to clinicians, and last, with patients of the laboratory and the laboratory professionals who use their expertise every day to save lives. This ends with the patient who is ultimately saved or unfortunately dies because all the pieces of the puzzle that make up a functioning health care system were or were not in place. The laboratory, its personnel, and their tools make up a vast number of pieces and, in all cases, complete the puzzle for best patient care.
      In this issue, we take a detailed look at several different aspects of the laboratory and global health from personnel training through research. We have perspectives from clinicians as well as laboratorians, including voices from the field. There is a very great and positive future for the lowest resourced places on the planet if we just take the time to think outside the box and recognize that no human should suffer a disease simply because of where they were born.