MODERN medical laboratories are crammed with high-tech, sleek machines, automatic analysers replacing technicians. The doctor decides which tests are indicated by choosing from column after column of possibilities. Not infrequently an alarmed medical refugee from elsewhere will appear, clutching lab reports and asking for a second opinion. By then, they will have googled the diseases mentioned on the reports. I explain that the more tests done, including CT scans and MRIs in normal people, the more likely that abnormalities will be spotted, even if they have no bearing on the current illness.

As students, our pathology lecturer tooks us round the hospital labs. One proferred a specimen container of urine.

“Right, chaps, this is from a diabetic patient and I want you to test it for sugar.” He dipped his own finger in the urine and tasted it. “Yes, quite obvious.”

Each of us neophytes in turn did the same with distaste – until a lab technician revealed our lecturer had changed fingers without us noticing. “That’ll teach you to use your bloody eyes, lads.”

This is not about the shining citadels mentioned above whose influence on real health and happiness is negligible even if its cost are not, but of lab facilities in our parts of rural Africa. Many have no technicians. The good news is that many tests are available and affordable using disposable kits and sticks which do not need power or technical expertise.

Anaemia is common and often difficult to detect without the help of a simple measuring device called a haemoglobinometer. It is not a diagnosis in itself as there are many causes – heavy menstruation, poor diets lacking iron, malaria, longstanding infections – but it is a great relief to have objective evidence rather than a suspicion or gut feeling. The only time I assaulted a colleague was after finding he had guesstimated a patient’s haemoglobin. She was bleeding internally and the correct result would determine whether she needed an operation or not.

The dipstick to test urine is cheap and detects many abnormalites, and ot long ago it would have occupied a technician for the best part of an hour to perform each individual calculation. Virtually every adult and child attending the clinic has what is probably the most cost-effective test there is for preventive and curative health as it also screens indirectly for liver disease, several infections, kidney failure, sexually-transmitted diseases and binge drinking.

Testing for HIV and malaria is essential. The advent of inexpensive tests where a drop of blood from a finger is put on the strip has been a godsend. The accuracy is very high, and false negatives or positives are now rare.

Intestinal bilharzia is common and damaging at all ages. When suspected, we do a rectal snip, the delicate ‘“nipper” pinching a minute piece of soft mucosa from inside the rectum, usually painlessly. The fragment is squashed between two glass slides and viewed through a microscope. The bilharzia show as dense black elliptical bodies, scores of them in clusters, against a white background – the patient is invited to peer down the lens, and as a rule they do so with interest.

The dirtiest lab I saw was shared by a few doctors in Khartoum. Everything was layered with fine sand from the Sahara outside but this did not prevent my medical relative from insisting I look down the microscope at the blood slide he was very proud of.

“And this ..?”

Time passed. “Daud, I have no idea what it shows. Sorry.”

He looked rather pleased. “That little thing is a trypanosome, the cause of sleeping sickness. The patient was from southern Sudan’s border with Uganda.”

Every lab needs specimen containers, test tubes and pipettes, not always for clinical reasons. I recently tested the first batch of my homemade liqueur brandy, pouring a tot into each sterile green-capped urine container then distributing to fellow health workers. Only George, the head of our very modern lab, hesitated when he recognised the container – but his smile showed the ingredients – raisins, unrefined sugar, yeast, and tangerines – had hit the button.

Dr David Vost studied medicine at Glasgow University and works at a hospital in Swaziland. He and his family live on a farm in Northern Uganda near the Albert