Appraisal of skin smear reports of field laboratories

A valuable investigation in leprosy is the examination of skin smears. Being a very simple technique, it can be performed satisfactorily in the field. Unfortunately, it is being given up because the reports from several field laboratories were not found to be dependable, in the sense that they would not match with the clinical diagnosis. There could be many causes for such a mismatching, pertaining to several operational factors and skills of the field staff. This paper restricts itself to the possible defects or deficiencies that could occur in the working of the field laboratories. Such defects could be countered essentially by three steps, (a) training the technician properly, (b) providing minimal facilities, proper reagents and a good microscope, (c) supervision by a periodic cross-checking of the reports. Enough attention has been paid to the first two steps in all the field laboratories of LEPRA-India. Supervision by cross-checking of randomly selected slides is carried by an experienced senior technician in the central laboratory. By these means, a field laboratory is well managed and best utilized. The method of cross-checking and the results of such a procedure are detailed in the paper.