Primary health care is conceived as a key approach to achieving health for all and must be implemented especially in the developing countries.

These strategies represent a comprehensive approach by the health sector to the promotion of health, prevention of disease, appropriate diagnosis, adequate treatment and measures for rehabilitation. For these strategies - preventive, promotive, diagnostic, therapeutic and rehabilitative components of health care, proper surveillance with a sound and efficient network of laboratories is essential. At present, Laboratory support at the Primary Health care level is not fully developed in the most developing countries and the programmes for continuous medical education and quality control are limited. In the case of emergencies like the present one in Asia , it is simply non adequate. 

At the same time, several communicable diseases and especially new several emergent diseases are prevalent in these countries, in relation to which early diagnosis and well - defined laboratory - based epidemiological information could yield favorable results for the patient as well as the community, particularly at the peripheral level.

ORLANDO SYSTEM Inc., USA, member ABSA and EBSA, (with its division in Europe, ORLANDO Telecom SRL) , which developed this project, is proposing a Programme for a network of MOBILE MEDICAL and BIOLOGICAL LABORATORIES - Containerized [medical laboratory - standard and extended], independent, towed or installed on a 4 WD truck, boat or any other platform + as a part of a Mobile Laboratories Network in the Developing Countries and other areas. 

The level of the Mobile laboratory must be equivalent in the "Standard version" to the Peripheral laboratory, and in its "Expanded version" to the Intermediate laboratory. Usage of Rapid Tests in the Mobile Peripheral laboratories will allow prompt patient management and better disease surveillance as primary health care.

The OSI Mobile Laboratories and Clinics will also support the control of the quality of water and food, the environmental pollution and its hazards and, if possible, monitor the various vertical national health programmes. One of the special tasks of Mobile laboratory is to participate to the control of bioterrorism - diagnosis and collection of specimens from area concerned by bioterrorism.

Some of the Identifiable diseases are: EBOLA, SARS, HIV, Variola, Malaria, Cholera, Tuberculosis, Polio, West Nile , Hepatitis, Anthrax, Ebola, Botullinic Toxin, etc.  Control of epidemic conditions like EBOLA, SARS, as far as human or animal farm infections are fully considered as part of this project, started in November 2001. The present requirements for protections re EBOLA, SARS (as of April 27 th , 2003 and 2004) are met. Avian flu H types are also considered.

The Mobile Medical Laboratory networks should be an integral part of National Health Service, and should be developed within its framework, in the pyramidal structure of laboratory network from the developing countries.

The level of the Mobile Medical Laboratory must be equivalent in the "Standard variant" to the peripheral laboratory, and in its "Expended variant" to the intermediate laboratory . Our lab project has gone a step further and raised the Safety Level to BSL2 as far the Hood and as some functions of the Lab itself. A low cost Level BSL3 model is also available.

In the organization of the Mobile Laboratory priority should be given to the appropriate technology and tests of clinical relevance, applicable to the local circumstances and conditions. Conventional laboratory tests, though sensitive and specific, are often time-consuming, difficult to perform and need many reagents and much and expensive equipments.

Therefore, there is a clear need to introduce more RAPID TESTING as simple, reliable, reproducible, and cost - effective via a Mobile delivery method. The introduction of RAPID TESTING in the Mobile Peripheral laboratories will allow prompt patient management and better disease surveillance, which will be a great support for primary health care.

Common diseases for which laboratories at this level can help include:

- "standard variant"
- a " plain vanilla " system, with standard equipment and reagents (BSL1), about 3 to 3.5 meters, but with a limited cost; And an;
•  " Extended variant " - longer, 3.5 to 4 meters, with a built-in Sample entry and Decontamination room, with optional equipments and reagents, with BSL2 and 3, with Negative pressure, HEPA air filtering available, etc.
•  The applications are: for Human and/or Veterinarian use, Vaccinations, etc,  

Basic microscopic examinations at the standard level may include the following

- Faeces for exudates [amoebic/bacillary dysentery], trophozoites, ova and cysts;
- Vaginal swabs - wet preparations for Trichomonas and Gram stained smears for candidiasis;
- Urethral discharge - Gram stained smears for gonococci;
- Sputum - Ziel Neelsen stained smears for acid fast bacilli;
- Skin - Ziel Neelsen stained smears for acid fast bacilli [AFB] and direct wet preparations for fungi;
- Nasal smears for AFB [Ziel Neelsen stain];
- Blood films for malarial parasites and microfilaria [Romanowsky stain];
- Urine deposits for cells, casts and parasites;
- Pus and exudates - Gram smears for bacteria;
- Cerebrospinal fluid [CFS] - Gram stained smears for bacteria, wet preparations for parasites and cell count in counting chambers:
- Semen examinations;

Clinical chemistry examinations should include the following:

•  Urine examination for glucose, protein, ketones, bile pigments and salts; and pregnancy tests;
•  Faeces for occult blood;
•  Blood examination for glucose, protein, bilirubin, creatinine, etc

  Hematology examinations should include the following

•  Hemoglobin estimation;
•  Total leukocyte counts;
•  Differential white cells counts;
•  Erythrocyte sedimentation rates [ESR];
•  Packed - cell volume [PCV];
•  Platelet counts;
•  Raeticulocyte counts;
•  Peripheral blood smears for cells morphology.

Serology for indirect identifications of infection, by means of determinations of antigens and / or antibodies, by rapid tests [including ELISA], for:

•  Viral, bacterial and parasitic infections.

Additional examinations include those for water, food and environmental contaminations.

In some infections, referral to higher-level laboratories should include:

•  Dispatch of faecal samples, for cultures, in suitable transport medium in cases of cholera, dysentery, diarrhea, etc.;
•  Serum / blood samples for culture and serology;
•  Water, food and environmental samples for analysis and culture;
•  Dispatch of appropriate samples during outbreaks. Technicians at the periphery must be trained to respond rapidly and appropriately in cases of outbreaks.

EQUIPMENTS / SUPPLIES
Some of the Necessary equipments and supplies (as recommended by our experts, but to be revised by the local end-users) can include:

•  1 binocular microscope with in built light ;
•  1 dark field microscope ;
•  1 centrifuge for vacutainers ;
•  1  hemoglobin meters ;
•  1 ESR stand ;
•  1 hemoanalyzer - 8/18 parameters [ optional ] ;
•  1 minianalyzer for chemical chemistry [ soft for 30-40   analyses ] - optional
•  1 reader ,1 washer and 1 incubator for  ELISA serology - optional ;
•  4 automatic pipettes [ 20 + 50+ 250 m monocanal + multicanal 250 m ] and devices for pipeting ;
•  1 micro analyzer for radiation - optional;
•  1 micro analyzer for chemical weapons - optional;
•  1 laminar flow cabinet ; Bio Safety Level II, or mobile BSL3- optional
•  1 Refrigerator - for samples ;
•  1 Refrigerator - for reagents and for vaccines - optional 2 ;
•  1 freezer - for samples ;
•  air conditioned system + filters for dust and BIOLOGICAL / chemicals - optional;
•  1 computer [laptop] - optional
•  reagents and kits for - microbiology , hematology , serology [Conventional , rapid and ELISA tests ] ;
•  reagents and kits for - water , food and environmental analysis [ bacteriological and chemical assurance ];
•  vaccines for National immunization programmes
•  special supplies for sample collection , transport and storage ;
•  culture and transport media for microbiology ;
•  laboratory materials for single use ;
•  sterilized syringes and needles [ single use ] ;
•  sterile collection bottles and tubes for water, food and environmental  analysis ;
•  deionized / distilled water [ bottles ] ;
•  PCR and ELISA tests equipment. Locally recommended supplies
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Mobile Laboratories
TECHNICAL SPECIFICATIONS
Typical Lab Working SPACE:
Standard: 2.00mH x 2.00mW x 3.00/3.50m Length
Expanded: 2.00mH x 2.00mW x 3.50/4.00m + Length

Mobile Medical and BIOLOGICAL Laboratories available are defined by size (3-6m long, 2x2m wide and tall), Biosafety Level 1-3 (Single and Dual rooms) and applications (Human and/or Veterinarian use, Vaccinations, etc).

The ORLANDO Mobile Medical and Biological Laboratories are containerized, can be installed on self-supporting trailer with air-shocks or can be transferred to Transit type, 2 - 2.500kg capacity small trucks, ships, etc. It also has an optional large tent on the right side, with access to the 220VAC and 12VDC power outlets, as well as the Autoclave and Decontamination unit.

CONCLUSION
Mobile BIOLOGICAL Medical and Veterinarian Laboratories are of great use in Epidemiological or Bioterror situations requiring Biosafety in sample collection and analysis.
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