September 26, 2007
State Public Health Laboratory: Focused on the Future
By Jon Ebelt
DPHHS Information Center
Explaining the purpose of the state public health laboratory is a complex task. But the staff of the Montana Department of Public Health and Human Services (DPHHS) makes it look easy.
To be sure, subject matter in a conversation with microbiologists and molecular laboratory scientists can prove to be a little slippery for a science novice.
But when the talk turns to candy, well, that’s a topic that can bring us all together.
Susie Zanto, supervisor of the microbiology section of the lab, remembers picking through a bowl of jelly beans while at an out-of-state conference several years ago. A colleague standing nearby reminded her that the goodies might be laced with viruses or bacteria.
“You’re at the risk of whoever put their hand in the bowl before you,” Zanto said. “I didn’t even think about it. But, you know, people don’t think about that.”
It hadn’t occurred to her then what is obvious now. “If some candy lover had harmful germs on their hands, they just contaminated all the food,” she added. “Chances are you’ll probably be fine, but you’re at the mercy of how well somebody washed their hands if they had been sick.”
In truth, talk of jelly beans and candy dishes barely scratches the surface when one considers the role that the public health laboratory plays in the lives of all Montanans.
Unlike private clinical labs, the public health lab focuses on the big picture, not just the health of an individual.
“The community is our patient,” Zanto said. “Because if you did eat those jelly beans and get sick, we’re concerned about the individual, but more specifically, we’re focused on preventing the disease from spreading.”
The responsibility of watching out for the individual and community is interwoven into the job of the 18 employees who work in the lab. They spend their days conducting scientific testing and fielding questions from private labs and physicians who call to consult on patient diagnosis on issues of public health concern, such as tuberculosis, a respiratory illness, or chlamydia, a sexually transmitted disease.
They hope that this exchange of information will lead to a speedy recovery for the patient.
“We get to be part of the team that helps patients and the community recover from an illness,” Zanto said.
And, if that happens, the chances of preventing the spread of disease are increased.
Happy endings make it worthwhile for the lab team.
For example, one particular case last summer involved a patient with tuberculosis. Fortunately, the young lady made a full recovery, but it was the testing work in the public health lab that led to the diagnosis of the type of tuberculosis.
“All of us that worked on that case were really proud we made the diagnosis so quickly,” Zanto said. “It’s very rewarding to hear the patient is on the road to recovery. We were part of the team that got her better and therefore helped prevent spread of the disease to others.”
Newborn Screenings, Bioterrorism and Field Mice
The pace at the public health lab is fast and furious.
Whether handling the daily dose of newborn screenings, dealing with the threat of bioterrorism, or even analyzing blood specimens taken from field mice, the public health lab is equipped to handle the job.
The events of Sept. 11 changed the nation’s philosophy in many arenas, and the public health world was no different. Since that time, the lab has been forced to prepare for unpredictable bioterrorism events. About $1.5 million in federal grant money from the Centers for Disease Control and Prevention (CDC) has been spent upgrading the unit to a secure Biosafety Level 3 facility. (By comparison, Rocky Mountain Laboratory in Hamilton is building a level 4 unit, and most clinical labs are at level 2.)
The lab features new high-tech equipment geared to handle testing of bioterrorism agents, such as anthrax. Also, tighter security measures allow for only authorized personnel to access the hallway leading to the lab and adjoining offices.
The newborn screening workload is changing as well. The number of mandatory tests for each baby will be increased next year from four to 29. The state has offered the additional screenings on an optional basis for the past several years, but the new rules will make it a requirement for all babies to be tested at birth for all 29 disorders.
The procedure involves taking a few drops of blood from a baby’s heel before sending the sample in for testing. Early detection is important since, in most cases, symptoms associated with these metabolic or genetic disorders may not surface until several months or years down the road. And the impacts are greatly reduced if caught in time.
“Most of the diseases being tested for can be treated with a special diet, but some are more serious and require medication,” said Denise Higgins, supervisor of the newborn screening section of the lab.
Aside from the normal day-to-day duties, lab scientists are also involved in ongoing research projects, including one with Montana Tech of the University of Montana.
Since 1994, Montana Tech has been studying Hantavirus in mice at six locations throughout the state, including Cascade, Cut Bank, Wisdom, Polson, Gold Creek and near Roy. Throughout the year, mice are trapped at the sites before blood samples are taken and then sent to the lab for analysis.
From the outset, the study confirmed what many suspected: Hantavirus is quite prevalent in field mice in Montana.
“As it turns out, we have a lot of mice in Montana, and a lot of them are infected,” said Montana Tech biology professor Dr. Rick Douglass, who directs the federally funded study. Some of those funds are used to pay the state lab to test the samples.
The study focuses on how the disease moves through mice populations and how it’s transmitted to humans.
“It’s not that Hantavirus is so dangerous to the (human) population, because it’s hard to get it,” he said.
But it does happen. A total of 27 cases have been confirmed since 1993, resulting in seven deaths. The most recent claimed the life of a 44-year-old Bozeman woman last January.
As one of only a few labs in the state that test for Hantavirus, the relationship has helped both the public health lab and Montana Tech. Without this agreement, Douglass would be forced to send the blood samples to CDC headquarters in Atlanta. The state offers a much quicker turnaround for results.
“It’s just been a real positive thing,” Douglass said.
DPHHS lab technician Dwain Lowry said the opportunity offers a nice change of pace.
“I think it’s pretty interesting, it’s a different slant than what we usually do with our clinical work,” he said.
Shortage of Clinical Lab Professionals
For the most part, changes in the profession, such as additional newborn screenings, are positive moves forward. All Montanans should have an equal opportunity to start out with a shot at a healthy life, according to Anne Weber, DPHHS laboratory services director.
But there is one negative result: a shortage of clinical lab professionals at all levels.
There are several factors, but Weber points to one main reason: “The concern is we’re just not training enough students or bringing enough students into the profession,” she said.
The profession is expected to grow 17 percent over the next 10 years, with a bump in workload adding to the dilemma. The threat of bioterrorism, higher life expectancy, and new technology are three of the main factors that could cause that expected growth.
Currently the state lab is fully staffed, but there is a shortage of lab scientists in Montana and throughout the nation. A survey performed four years ago found that 40 percent of the estimated 800 or so registered clinical laboratory workers in Montana would be eligible for retirement over the next 10 years.
That information will be updated this fall when a new regional survey is completed that studies average age, job recruitment, and incentives used to retain clinical lab employees. The study targets Montana, Wyoming, Colorado, Idaho, and Utah.
When the new study is released, Weber won’t be surprised to find the average age of state clinical laboratory scientists to be close to 50 years old.
Based on that prediction, she says it’s only a matter of time before the shortage issue creeps into the public health lab. “We’ve been lucky so far,” she added.
Last year, three people retired from the DPHHS Laboratory Services Bureau, which also includes the state environmental lab. This year, Weber said, several more are eligible for retirement.
“Whether are not they are going to do that remains to be seen,” she said.
Looking to the Future
As one way to highlight the profession, the state public health lab invites area college students in for a tour of the facility each year.
This spring, nursing students from UM-Helena College of Technology (HCT) and MSU-Great Falls College of Technology took in some practical experience while learning how to test antibodies and identify salmonella under the microscope.
The opportunity was an amazing thrill for one participant.
Ashley Wade walked away hoping to one day wear a white lab coat.
Unfortunately for Weber, Wade is just a middle school student in East Helena and won’t jump into the workforce for at least another eight years. Wade made the trip with her mother, Tina Wade, an HCT student. After finishing high school, Ashley Wade already has plans to attend Eastern Washington University to study microbiology.
According to Tina Wade, the tour only reaffirmed her daughter’s desire to pursue that interest.
“Ashley loves learning about disease and germs and dissecting what works and why,” Tina Wade said. “She was just in awe of everything.”
Although Ashley Wade is quite aware the profession exists, the word needs to reach others, Weber said.
“We’re more of a silent profession, because most of the testing we do is not with patient contact,” she said. “We’re kind of the unsung heroes.”
Still, one statistic is hard to ignore. Over 70 percent of health care decisions made by physicians are based on tests results done by clinical laboratory professionals. Accuracy is the number one priority.
“The test results can only be as good as the specimen,” Lowry said.
That point was made to that batch of HCT nursing students who one day will be taking blood samples from newborns. For example, when the blood droplets are soaked onto a card at the hospital, the samples should be a certain size and in a uniformed row, not muddied together.
It’s that attention to detail Weber looks for when hiring. After over 25 years in the business, she knows the qualities that make for a strong candidate.
“The people who go into this profession are very detail-oriented and very precise,” she said.
And they don’t eat out of just any candy bowl.
