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IFCC VLP in Montevideo (Uruguay)

A Step Back in Time in Montevideo, Uruguay (IFCC VLP)

By Bernard GOUGET, chair IFCC General Conference and chair IFCC Nominations Committee

When a French guy travels to Montevideo, he immediately thinks of the  popular epic of L’AEROPOSTALE with Jean MERMOZ who developed the South American routes with the help of other experienced pilots including Antoine de SAINT-EXUPERY, Henri GUILLAUMET, to name some of the better known. Mermoz planned and built the Northeast route through Uruguay and Brazil from the base in Buenos Aires.

In October 2015, after a 16-hour flight from Paris with a 2-hour stop in Buenos Aires, I was wowed by the remodelled Carrasco Airport, which looks like a flying saucer; thanks to the curved roof that measure nearly 1,000 feet across. I left this “boutique” terminal and headed up by taxi to the Rambla, the 14-mile-long avenue that runs along the river, where you will find a splendid building with stunning, French-influenced architecture: the old Carrasco hotel. First opened to the public in 1921, the five star hotel re-opened its doors in 2013. It is a very luxurious comfortable and probablypleasant place to live. What a contrast to the style of the former President, José Mujica, possibly the most popular president in the region. He enjoyed plenty of international goodwill because he kept his promises and said great things such as, “Living better isn’t just having more, it’s also being happier.” He donated a large part of his salary to charities that benefit poor people and small entrepreneurs, living modestly on a small farm, and in keeping with this country’s long-held progressive spirit. He has also opened debate on many controversial topics such as drug trafficking, poverty and social injustice. After 40 minutes by taxi, we arrived at the Dazzler hotel, 21 de Setiembre 2752, located in Punta Carretas, residential neighbourhood of Montevideo. The Dazzler is surrounded by attractive commercial, cultural and gastronomic centers. Having just arrived, I was thinking that Montevideo is a city of art, dear to the heart of the French since she gave birth to three of our great poets: Lautréamont (1846-1870) ( Songs of Maldoror, Jules Laforgue ( 1860-1887 ) and Jules Supervielle (1884 -1960 ) (Man of La Pampa ) who wrote:

"In Uruguay on the Atlantic;
The air was so binding, easy,
That the colours of the horizon approached to see the houses."

A quick look at a brochure in the lobby allowed me to expand my knowledge rapidly: Uruguay is on the south-eastern Atlantic coast of the Southern Cone of South America, bordering Argentina to the west and south and Brazil to the north. The country lies east of the Uruguay River, a major tributary of the Rio de la Plata estuary. About half of the population (3.3 million) lives in the capital, Montevideo, and its metropolitan area. Montevideo is a modern city with a European flavour. Often playing second fiddle to Buenos Aires, Uruguay´s capital is stealing the show thanks to a wealth of dazzling cultural offerings, one of the many reasons the city gained the status as the Culture Capital of Latin America in 2013.There are many museums and galleries. Some of the best-known painters are Pedro Figari, a postimpressionist who specialized in bucolic colonial and early twentieth-century scenes and Joaquín Torres Garcia, a constructivist who lived in Paris at the beginning of the last century. Uruguay is a republic characterized by the presence of representative democracy at all levels of government. The colour sky-blue (celeste) is a powerful symbol that represents freedom and independence. It is present in the four horizontal stripes of the flag that alternate with five white ones (a sun with a face in the upper corner also symbolizes independence). It is also the colour worn by the national soccer team. Soccer is the national sport and occupies a central place in the life of the nation.

Private non-profit collective health care associations known as mutualistas covers approximately 60 percent of the population. Free coverage through the Ministry of Public Health covers approximately 20 percent of the population, and military and/or police or private company insurance covers approximately 10 percent. Cardiovascular diseases are the leading cause of death, and hypertension is among the primary causes for medical visits. Dietary factors are involved in this pattern: fat consumption is very high, and fibre intake is low. A high prevalence of obesity is associated with a high incidence of diabetes. Cancer accounts for 23 percent of all deaths. The high rate of lung cancer is related to the prevalence of smoking. Most research in the sciences and humanities is done in the universities, and government institutions.

The X Congreso Uruguayo de Bioquimica Clinica «Automatización: Evolución, Tecnologías y Estrategias (22-24 October 2015), organized by ABU (Asociación Bioquímica Uruguaya), was held at the auditorium for conferences of the Telecommunications Tower, also known as the ANTEL Tower (2002). This building is the tallest building in Uruguay. It stands 158 meters (517 feet) tall and it is situated across the street from the commercial harbor on the Bay of Montevideo. The Uruguayan architect, Carlos Ott, who also built the Opera de la Bastille in Paris (1983), designed it. A special elevator goes to the top floor to allow one to experience the panoramic view. 300 specialists of lab medicine and students were present at the opening session.

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Rosana Pirotto, President of the Congress and Bernard Gouget

Siemens, Wiener Lag group, Biodiagnostico, Microlab, Bionova-Biko, Bioquim, CECC, Delec, Eubiosis, Izasa, Nipro, Novamedical/Zigel, Roche, Biriden, Castro Gherardi, Tresul and Visur presented the products and innovations offered by the major IVD companies and distributors.

After a warm welcome presented by Dr Rosana Pirotto, President of the congress, we participated into the morning session on quality management chaired by Beatriz Varela, a dynamic and supportive young colleague! I was impressed by the first presentations delivered by BC Gonzalo Pacheco (a student of Beatriz), on Quality Control Management Tools, a very clear and detailed presentation. Dr Gabriel Migliarino reported the Argentina experience and I described the impact of the new French regulatory framework. The French regulatory context is arguably the most constrained of the major European markets. It is also highly complex and, in recent years, in continual change. The 2010 law helped reduce some of the operational barriers to consolidation, but did not address the issue of ownership and shareholder structuring. In May 2013, a new law brought a number of changes, one of which is having a real impact on how consolidation and investment can be completed in France. A key element of recent legislation has been the contentious issue of ISO 15189 accreditation. The French government has decided to impose compulsory accreditation by 2020 for 100% of tests. This will generate a cost of investment and increase running costs for lab structures, therefore driving consolidation further. But accreditation is giving a formal recognition of competence, facilitates exchange between laboratories, provides management tools, and ensures the requirements of both clinicians and patient. The accreditation improves laboratory management and its performance and the competitiveness. After a short break, I gave a plenary lecture on how great improvements in automation technology have impacted the biochemistry, analytical instruments, infrastructure, and the management of clinical laboratories. The motivations for automation include a rapidly rising cost of medicine, intolerable error rate, and a need for increased hospital efficiency. In addition, technology is allowing the laboratory to collaborate with physicians in providing rapid and reliable testing leading to better diagnosis and justifiable therapies. Considerable efforts are needed to overcome the problems associated with adjusting to a new system, new software and new working procedures. Implementation of automation of a laboratory is a formidable task, if the overall planning process is well organized. By coupling these principles with IT solutions, the automated laboratory will have the opportunity to provide value in the diagnosis, treatment and monitoring of the patients, while simultaneously helping their institution to operate more efficiently.

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Beatriz Varela, Gonzalo Pacheco, Bernard Gouget and Ana Mendez

The afternoon session was in Spanish on viral haemorrhagic fevers, focussing on the diagnosis and the development of immunologic and molecular tools for more rapid disease diagnosis, and how the viruses are transmitted, and exactly how the disease affects the body.

On the second day, in the morning, with Beatriz and Stella, we drove through Avenida 18 de Julio downtown, admiring the diverse architecture and the glorious façades. We crossed Plaza Independencia, with its bronze statue of Uruguay’s founding father, José Gervasio Artigas before stopping at the Faculty of Chemistry of the University of the Republic. There we visited the office of the Standardization Committee and External Quality Control Scheme program (EQAS), with the presence of Marisa Viera, Scientific assessor in Clinical Biochemistry, Ana Maria Piana, and Stella Raymondo from the Uruguayan Association Committee Board.

The EQAS is a non-profit organization with a specific aim to maintain the EQAS programme running at national level. It has 150 laboratories participating out of a total of 200.The Executive Board is formed by clinical biochemists, clinical pathologies and a representative of the national society board, ABU and from the clinical pathology Uruguayan Society Board. The programmes and delivery schedules are as follows:

  • Biochemistry, hormones, tumor markers, therapeutic drugs, and immunology (10 series per year)
  • Bacteriology (6 series per year)
  • Hematology (4 series per year)
  • Urine, haematimetry, and HbA1c (3 series per year)
  • Haematology, instrumentation, microalbuminuria, parasitology, mycology, and molecular biology (2 series per year)

EQAS started in 1979, but it was only in 1987 that it formed the first commission board, and in 2009, the status was incorporated in the Ministry of Education, and Culture.

Another very important role that the EQAS program has is education, having annual meetings with participant laboratories and coordinators of the sub-programs, where questions are raised and results are discussed.

In 1998, the Analytical Quality committee /EMD/IFCC organized a serum donation project, where the Uruguay EQAS was invited to participate representing Uruguay, in conjunction with Argentina, Bolivia and Dominical Republic. The serum materials were sent to each country and donated by Bayer Laboratories, the coordinator being Daniel Mazziotta from FABA, in La Plata, Argentina. An article was published in the European Committee for External Quality Assurance Programme Laboratory, where Uruguay was mentioned as an efficient country in EQAS according to the donation serum programme done by IFCC (EQANews 12 no 1. 9-10, 2001.

In a meeting of the Renal Health Honorary Commission (CHSR in Spanish), integrated by nephrologists, we initiated the creatinine standardization project in 2006. This involved sustained work by different clinical institutions, and lately, by the ANII as a part of the financial support of the EQAS programme. In 2008, the EQAS presented a project to the ANII (national agency for research and innovation) being ours one of the winner projects. Thanks to this program, EQAS was reinforced and vitalized. In addition, it provided economical support to the standardization creatinine program, to the point to where the inter-laboratory variability decreased from 15% to 7%, contributing to the improvement of diagnosis of chronic renal disease.

As a resolution of the Executive power on May 5th, 2008, such project was declared to be of national interest, having the auspices of the Minister of Public Health (MSP in Spanish) under decree no 594 of the MSP of the 22nd September 2008. This activity opened an international agreement with the Reference Laboratory of the Argentine Biochemistry Foundation (LARESBIC) in order to obtain the accurate values of creatinine concentration in the serum pool used for the experiments.

In 2010, owing to the impact of the NII Project and the sources obtained, the EQAS received an important number of instruments, such as lyophilyzers, ultra-freezers, immunofluorescent microscopies with chambers, freezer (-20oC, -80oC), refrigerators, refrigerated ultracentrifuge, analytical digital balances, last generation spectrophotometry, laminar hoods, renovated software, all adapted to the needs of the EQAS programs, for standardization and quality improvement  of the laboratories of the country.

As far as EQAS is based in the university environment, it is easy to collaborate with the education of future professionals, allowing students who would like to do their laboratory stays at the EQAS site, which once approved are part of the evaluation of the department of Clinical Biochemistry, and serve as credits for optative subjects under the career of Clinical Biochemist. This plan was adapted in 2000, and since then dozen of students have participated and some of them have very important positions in the quality sector. At the end of the meeting, it was decide to reinforce collaborations between ABU and IFCC and different experts involved in external quality control.

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from left to right:
Ana Piana, Graciela Queiruga, Bernard Gouget,
Stella Raymondo, Beatriz Varela and Laura Yametti

from left to right:
Ana Piana, Graciela Queiruga, Bernard Gouget,
and Stella Raymondo

For lunch, we  decided to  search for traditional asados, or barbecues, and we stopped at the Mercado del Puerto, a busy old market packed with steakhouses ; a fabulous place for a tourist ! Thanks Stella for this friendly meal period in a typical place. Before we went to the gala party  at the complejo Punta Pocitos, Rambla Mahatma Gandhi, we discovered the intriguing Ciudad Vieja (Old Town), the formely walled colonial grid stradling the western tip of a peninsula between the sheltered port and the wide open river.

The following morning, I printed with nostalgia, my boarding pass. I was thinking again of José Mujica stated that he was « passionate about bringing Latin Americans together, about what defines us as belonging to a great nation that is to be created ». He pointed out another element that unites the countries in Latin America: "There are many young people; as an old man a little advice... Life can set us a lot of snares, a lot of bumps, we can fail a thousand times, in life, in love, in the social struggle, but if we search for it we'll have the strength to get up again and start over. The most beautiful thing about the day is that it dawns. There is always a dawn after the night has passed. Don't forget it, kids. The only losers are the ones who stop fighting."

Thanks to everyone, and especially to Stella, Graciela, and my guide Beatriz who welcomed me in the city designed with such Parisian influence! See you in Punta del Este, Uruguay, for COLABIOCLI 2017.

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