Did You Know Panama Has a Biosecurity Lab?

Yes, actually Panama has this type of labo, and we bet many of you didn't know about it. In August 5th, 2010, the president visited the GMI to open officially the knew lab of the institution. Mr. Martinelli said the GMI has first level equipment, keeping it updated to the constant changes of the public health area. This lab has the capactity to contain very dangerous microorganisms that cause severe or deathly diseases. The staff working here, is having a training in regards to containing dangerous elements.

President Martinelli checking the new lab.

This project came true with the cooperation of the Department of Health and Human Servicesof the United States of America, with $256,346 dollars. 

Interview Experience

We had the opportunity to visit the Gorgas Memorial Institute, to learn about their structure, IT elements and future plans on this subject. What you are about to read is a quick view of our experience there. 

We were received by two members of the IT department, they were Johny Gonzalez and Gilberto De Leon. We sat on a round table and started discussing their future plans on Information Technology updates on their equipment, as well as the functions and history they have as an institution. 

They explain IT Deparment develops tools that are vital; those elements are the key to the success in the functions of the medical staff this institution has. For example, using a program called Epi Info, which helps to analyze the data they get in field investigations or examining patients. It generates a series of graphs and statistics based on that information. Using this, obviously reduces the time necessary for accomplishing investigations that involve a lot of people, with different characteristics and located all over the country.

One of the immediate questions our team asked, was the budget thing. This insitution executes very important things, however, how much money is it necessary to achieve their goals? They didn't gave us a specific number, but they told us they receive economic support from the government and international organizations, and is a lot of money. They smiled after saying this, a real smile that confirmed us that important changes are being done in the panamanian health system, but we are not aware of them.

Another interesting thing is the institute works as a reference laboratory for others in Panama, such as Raly and others. When those laboratories need to check up their results on any analysis, the place they call is the GMI. It is also for Central America reference, when some country needs a detailed description of a tropical disease, the institute inmediately serves as a reference point. A well-known case, is the AH1N1 disease, which affected several Central America countries. The GMI did the studies that determined which was the strain of the disease, making it easier to elaborate an effective cure and help hundreds of ill patients. The servers and wires that serve as core for the IT functions need to be in a cool enviroment, reason why there is an isolated room where all the sensitive structures are kept with air conditioners in the appropiate temperature.

Equine encephalitis analysis being confirmed by virologists of the GMI. July 2010.

One of the topics was the Information Technology and Telecommunications Panamanian Camera, that is looking forward for the generation of thousands of IT professionals, that are able to work and be updated in this area, avoiding outsourcing the labor of foreigners in future projects. This reality is an indicator of the need of IT preparation in Panama, necessary no only for public health issues, but also for a lot of different activities of daily life, important for our country development.

Pictures

GMI Facts

Here are some quick facts about the Gorgas Memorial Institute:

• It is controlled by the law 78 of december 17th, 2003.
• It receives money support from the panamanian government and from international organizations.
• It is the reference point for every laboratory in the country.
• They are trying to unify their data base in order to make it easier to handle the information they obtain from research and patients.
• They are in charge of the sanitary register of the medicines sold in Panama.
• They invest in the improvement of Geographic Information Systems.
• They have a tropical disease clinic, where they organize field research.

Epi Info: Analysis Tool

One of the important tools that the Gorgas Memorial Institute uses to register and analyze data, is called Epi Info. Epi Info is public domain statistical software for epidemiology developed by Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia (USA).

Epi Info has been in existence for over 20 years and is currently available for Microsoft Windows. The program allows for electronic survey creation, data entry, and analysis. Within the analysis module, analytic routines include t-tests, ANOVA, nonparametric statistics, cross tabulations and stratification with estimates of odds ratios, risk ratios, and risk differences, logistic regression (conditional and unconditional), survival analysis (Kaplan Meier and Cox proportional hazard), and analysis of complex survey data. The software is in the public domain, free, and can be downloaded from http://www.cdc.gov/epiinfo. Limited support is available.

 

Features

From a user's perspective, one of the most important functions of Epi Info is the ability to rapidly develop a questionnaire, customize the data entry process, quickly enter data into that questionnaire, and then analyze the data. For epidemiological uses, such as outbreak investigations, being able to rapidly create an electronic data entry screen and then do immediate analysis on the collected data can save considerable amounts of time versus using paper surveys.

Epi Info uses three distinct modules to accomplish these tasks: MakeView, Enter, and Analysis. Other modules include the Report module, a mapping module, a menu module, and various utilities such as the NutStat program.

Electronic questionnaires, also known as "views" in Epi Info terminology, are created in the MakeView module. Individual questions can be placed anywhere on the screen and across multiple pages, with the user given complete control over appearance and function. The user defines both the question's prompt and the format of the data that is to be collected. Data types include numbers, text strings, dates, times, and yes/no. Users can also create drop-down lists, code tables, and comment legal fields. One of the more powerful features of MakeView, however, is the ability to create "check code". Check code allows for certain events to occur depending on what action a data entry person has taken as they are typing. For example, if a user enters "Male" into a question on gender, any questions relating to pregnancy might then be hidden. Skip patterns can also be created so that if a user enters "No" to a question on whether or not they smoke, the cursor skips past any fields related to smoking. Relational database modeling is supported, as users may link their view to any number of other views in their database.

The Analysis module is where users analyze their data. Import and export functions exist that allow for file types to be converted between plain-text, CSV, Microsoft Excel, Microsoft Access, dBase, FoxPro, and other formats. Many advanced statistical routines are provided, such as t-tests, ANOVA, nonparametric statistics, cross tabulations and stratification with estimates of odds ratios, risk ratios, and risk differences, logistic regression (conditional and unconditional), survival analysis (Kaplan Meier and Cox proportional hazard), and analysis of complex survey data.

Using the Epi Map module, data can be displayed either by geographic reference or by GPS coordinates. The Report module allows the user to edit and format output from various Epi Info tools and modules. The resulting HTML document can then be printed or emailed to others.

Gorgas Memorial Institute: Pioneers in Scientific Research

The Gorgas Memorial Institute for Health Studies (GMI) has been an institution dedicated for more than 80 years to research of diseases in the tropics and preventive medicine. Its expertise in studying diseases of the tropics originated from the necessity to consolidate and maintain one of the greatest triumphs in the history of medicine, the eradication of urban yellow fever and the control of malaria in the cities of Panama and Colon with the construction of the Panama Canal.

This triumph, led by Dr. William C. Gorgas in the first years of the 20th century, was achieved by one of the largest and most successful community-level public health interventions ever recorded in the history of medicine. Since then, many emerging and reemerging diseases have been studied at GMI and physicians and scientists of many nationalities working there have made significant contributions to medicine in the tropics. These collaborations and lines of investigation have continued up to the present.

GMI has excellent parasitology, immunology, genomics, entomology, water and food chemistry, bacteriology, entomology and virology laboratories. Besides having an epidemiology and biostatistics department, it conducts research on health administration, chronic diseases and human reproduction. GMI has contributed to better the health of Panama and the Central American countries by acting as a reference laboratory to diagnose diseases like yellow fever, malaria, measles, arbovirus febrile illness, viral encephalitidies, influenza, dengue and hantavirus cardiopulmonary syndrome. Jorge Motta, MD, MPH, has been the Director General since 2004.

Most recently GMI became a World Bank-Pan-American Health Organization reference laboratory for human immunodeficiency virus (HIV) for the Central American region. Its lengthy tradition of service in the region has permitted GMI to maintain and nurture close contacts and rapid communication with all the public health installations of Panama’s Ministry of Health, with the health installations of the Social Security System and with the main private hospitals of the country.

In 2006, GMI signed an MOU with the Department of Health and Human Services and was also awarded two grants, one to increase its virology diagnostic capacity and to strengthen the surveillance of influenza virus in Panama and Central America and the other to develop a Regional Training Center for community health care workers of the Central American Region.

 

The Regional Training Center is an educational facility dedicated to community health care workers and clinicians of Central America to prepare them to provide better primary and preventive health care to underserved rural and poor urban communities and indigenous populations. These health care providers are trained to provide the first line of response to health needs of their communities, especially in areas related of infectious diseases, pandemic illness response and the attainment of Millennium Development Health Goals.

GMI's has research agreements and research projects with academic centers like the Johns Hopkins University, George Washington University, the University of South Florida, the University of New Mexico, and the Walter Reed Institute of Research. GMI has developed strong links with the epidemiology programs and the extended immunization programs of all the countries in Central America, with the World Health Organization (WHO), specifically with the Special Programme for Research and Training in Tropical Diseases (TDR) and influenza program, with the Center for Diseases Control of the United of America (CDC-USA) and (CDC-MERTU-G), with the Pan-American Health Organization (PAHO) and with institutions like the Smithsonian Tropical Research Institute (STRI).

Today GMI is an autonomous public institution that works closely with the Ministry of Health. Its vision is to improve the health of Panama and Central America. Its mission is to develop health research in Panama, to fulfill the functions of a national public health laboratory and to provide education to health care workers of the region. GMI is evolving to become Panama’s national public health institute and will continue serving the Ministry of Health by providing the best evidence available to develop public health policy.

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What is e-Health?

e-health is an emerging field in the intersection of medical informatics, public health and business, referring to health services and information delivered or enhanced through the Internet and related technologies. In a broader sense, the term characterizes not only a technical development, but also a state-of-mind, a way of thinking, an attitude, and a commitment for networked, global thinking, to improve health care locally, regionally, and worldwide by using information and communication technology.

The term can encompass a range of services or systems that are at the edge of medicine/healthcare and information technology, including:

* Electronic health records: enabling the communication of patient data between different healthcare professionals (GPs, specialists etc.);
* Telemedicine: physical and psychological treatments at a distance;
* Consumer health informatics: use of electronic resources on medical topics by healthy individuals or patients;
* Health knowledge management: e.g. in an overview of latest medical journals, best practice guidelines or epidemiological tracking (examples include physician resources such as Medscape and MDLinx);
* Virtual healthcare teams: consisting of healthcare professionals who collaborate and share information on patients through digital equipment (for transmural care);
* mHealth or m-Health: includes the use of mobile devices in collecting aggregate and patient level health data, providing healthcare information to practitioners, researchers, and patients, real-time monitoring of patient vitals, and direct provision of care (via mobile telemedicine);
* Medical research using Grids: powerful computing and data management capabilities to handle large amounts of heterogeneous data.

* Healthcare Information Systems: also often refer to software solutions for appointment scheduling, patient data management, work schedule management and other administrative tasks surrounding health.