REPUBLIC OF CAMEROON REPUBLIQUE DU CAMEROON

*************** ***************
PEAC-WORK-FATHERLAND PAIX-TRAVIAL-PATRIE
*************** ***************
MINISTRY OF HIGHER MINISTERE DE L’ENSEIGNMENT
EDUCATION SUPERIEUR

ST. LOUIS HIGHER INSTITUTE OF MEDICAL

STUDIES, DOUALA
HIGHER NATIONAL DIPLOMA
DEPARTMENT OF MEDICAL LABORATORY SCIENCE

A CLINICAL INTERNSHIP CARRIED OUT AT THE

REGIONL HOSPITAL BUEA FROM THE 9TH OF
JANUARY TO THE 9TH OF FEBRUARY

AN INTERNSHIP REPORT SUBMITTED IN PARTIAL FUFILMENT OF

THE REQUIREMENT FOR THE AWARD OF A HIGHER NATIONAL
DIPLOMA (HND) IN MEDICAL LABORATORY SCIENCE

PRESENTED BY:

NGONG LINETTE NASAH

MLS/21/0005

SUPERVISED BY:

MME YVETTE BENDE

2023/2024
 DEDICATION
This piece of work is dedicated to my family especially to my mother for their unfailing love and

I also dedicate this work to God almighty for His unfailing grace and protection He granted to us

during our internship period.

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 ACKNOWLEDGEMENT

My Gratitude to The Ministry of Public Health and St. Louis University Institute Douala for

giving me the opportunity to study in the faculty of Health.

I also want to thank the Director and the General Supervisor of the Nylon district hospital for

allowing me practice in their institution.

I am not living out the Staffs of Nylon district hospital for their unfailing collaboration and

toleration during my stay at their hospital most especially the staffs of the Laboratory.

I also thank my family for their unfailing love and financial, physical, moral and spiritual support

throughout this year.

To my friends who stood by me during the writing of this work and their countless support in the

typing of my work.

Above all I want to thank the almighty God for his wonderful grace, peace and good health upon

my life throughout this internship period.

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 LIST OF FIGURE

Figure 1: Map................................................................................................................................13

Figure 2: Picture of Hospital.........................................................................................................14

Figure 3: Organigram....................................................................................................................15

Figure 4: Patient flow...................................................................................................................17

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 CHAPTER ONE

INTRODUCTION TO INTERNSHIP

1.1 Internship

To begin with , i had the privilege me as a medical

practionnal to observe and participate in many different activities of

the internship program. This internship was an initiative to bridge the

gap between knowledge and its application through a series of

interventions that enabled us students to gain insight. My clinical

internship took place at NYLON DISTRICT HOSPITAL which is a

public hospital and equipped with qualified medical doctors and

nurses. There are types of internship

Paid, which is most common in professional fields including medicine, business and technology

and work experience usually occurs during the second or third year of schooling which aims at

expanding the student knowledge theoretically and practically. The intern is expected to bring

ideas and knowledge from school into the institution.

Work research, which is mostly done by students who are in their final year of studies.

With this kind of internship, the student dose research on a particular topic or concept in

which they feel the need to improve on the practice and the results of the research study

will be put in a report and its often presented and graded.

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Unpaid, are typically called voluntary service and entails little to no payment. However,

within the Cameroon public health system, the government is struggling to crop out this

form of internship.

Partially paid internship is when students are paid in form of motivation that is a fixed

amount of money for the services they provide on a regular basis.

1.2 Internship period

The internship lasted for four weeks that is from the 9 th of January 2024 to the 9th of February
2024.

1.3 internship objectives

1.3.1 General objectives

The goal of this internship is to give the students the opportunity to put into practice the

knowledge and skill acquired in class under supervision without supervision in order to reach the

competence level required at the end of their study in ST. Louis University Institute of Health

and Biomedical Sciences.

1.3.2 Specific objectives.

This clinical internship session is slated for a period of six weeks and the students is required to

be versed with each unit for this number of weeks.

OBJECTIVES FOR PHLEBOTOMY (BONUS)

At the end of the internship, the student should be able;

1. To disinfect the blood collection site with appropriate disinfectant.

2. To know how to apply a tourniquet and for desirable time.

3. To detect the preferred venous access sites.

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 4. To have a broad knowledge about the various anticoagulants and when to put them in use.

5. To insert the needle properly for blood withdrawal.

6. To take care of the patient to avoid complications during and after blood collection

process.

7. To sort out collected blood properly, label and distribute to the various units.

OBJECTIVES FOR MICROBIOLOGY (BACTERIOLOGY AND

PARASITOLOGY)

{TWO WEEKS}

At the end of the internship, the student should be able to;

1. Collect specimens from various anatomical sites for examination of bacteria and fungi

2. To know which samples are acceptable for analysis and which to reject while

explaining to the patient the reasons for rejection.

3. Prepare smears from specimen for microscopic examination

4. Stain smears with basic stains including gram, giemsa, ziehl nelseen, etc and know how

to prepare the stains where applicable.

5. Identify bacteria and fungi from stained smears.

6. Prepare culture media

7. Transfer specimen on culture media, streak, incubate and interpret the growth of fungi

and bacteria on culture plates.

8. Evaluate bacteria count and run antibiotic sensitivity testing.

9. Collect specimen from various anatomic sites for examination of parasites including skin

snips.

10. Identify parasites from stained smears and wet mounts.

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 11. Be familiar with techniques for identification of intestinal parasites.

12. Be familiar with the routine procedures in the sero-diagnosis for parasites such as malaria

rapid diagnostic kits and others.

OBJECTIVES FOR HAEMATOLOGY AND BLOOD BANKING

{TWO WEEKS}

At the end of the internship, the student should be able to;

1. Wash red cells and prepare different concentrations of red cell suspensions.

2. Be familiar with the methods of detecting immune red cells anti-bodies

= Indirect antiglobulin test (Coombs’ test)

= Direct antiglobulin test

3. Matching test

= One – tube match: Immediate spin and indirect antiglobulin test.

= Matching using an albumin addition and saline roam temperature test.

= Emergency matching

4. Perform leukocyte differential counts/ blood picture, erythrocyte sedimentation rate

(ESR), hemoglobin (Hb)/ packed cell volume (PCV) estimation.

5. Perform RBC, WBC and platelet counts.

6. Prepare different red cell concentrates and be able to conduct HB electrophoresis and

interpret the results

7. Perform bleeding and clothing time test

8. Be familiar with the use of modern hematological analyzers.

9. Be familiar with prothrombin and activated partial prothrombin time, fibrinogen

measurement with manual and automated analyzers.

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 10. Be familiar with the organization and management of a blood bank.

11. Differentiate between the different types of blood donors.

12. Access all accepted and projectable criteria for blood donation.

13. Have a wide knowledge on the different tests used to prescreen a donated blood sample.

14. Know the procedures used for labelling blood bags.

15. Differentiate types of blood bags.

16. The types and principles for each type of blood bag anticoagulant.

17. Procedure for bleeding a patient.

18. Differentiate between the types and samples needed for transfusion.

19. Cross match blood samples, ABO and Rhesus.

20. Know the different storage conditions of blood samples.

21. Learn and understand the procedures on how to give out a donor’s result if needed.

22. Know the exact method of dispatching blood samples.

OBJECTIVES FOR CLINICAL BIOCHEMISTRY (CHEMICAL

PATHOLOGY)

{ONE WEEK}

At the end of the internship, the student should be able;

1. To learn different techniques in clinical biochemistry.

2. To learn special techniques applied in clinical biochemistry.

3. To interpret biochemical values for healthy and disease conditions.

4. To understand the principle and instrumentation of the spectrophotometer.

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 5. To identify and practice calibration procedures and quality control for various tests and

criteria for calibration acceptance or rejection.

6. To identify specimen type (e.g., whole blood, serum, plasma, body fluids etc.), container

appropriateness, quantity required and pre-analytical preparation of sample.

7. To Sort specimens according to test turnaround time, apply proper storage of specimens

for later testing.

OBJECTIVES FOR IMMUNOLOGY AND SEROLOGY

{ONE WEEK}

At the end of the internship, the student should be able to;

1. Differentiate the type of specimen used in this unit.

2. Reject sample samples and fill records for nonconformist.

3. Centrifuge samples and separate serum / plasma from cellular components.

4. Identify and practice on all serological assays such as CRP, ASO etc.

5. Hormone quantification using serological markers.

6. Understand the basic principles and functioning of ELIZA, hem agglutination, etc.

7. Carryout standard titration and dilution procedures.

8. Plot standard curves and interpret serology and immunology results.

1.4 Significance of internship

To the student

The internship will give the student-medical personnel the opportunity to experience

realistic working environment, situations and equipment’s as a medical personnel, to

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provide insight into the practice of a professional health personnel, to give the student on

intern an opportunity to gain experience in an employment situation in health care

settings, the internship exposes the students to real world experiences that is by gaining

(visualizing and practicing) actual work experiences, it gave the students the opportunity

to put into practice knowledge and skills acquired in class (theoretically), the internship

will enhance student communication skill as I took part in events that required

communication and gained new communication and time management skills. The

internship was important because I learned how to manage time effectively that is

finishing delegated task on time, attending to emergency situations promptly and

working under pressure which acts as a building block to one’s career (that is used to

build up CV or résumé), leads to a transition into job depending on student nurse known

capabilities, it helps develop, refine, and learn new skills, acts as networking with

professionals in the field as students build contacts in their field that is a stepping stone to

additional opportunities within the same organization, the internship gave the student the

opportunity to correct their mistakes and gaps concepts which were not understood

theoretically, the internship will be significant to the student because it allows them to

know their strengths and weaknesses, it’s important in that I will learn to conduct myself

in a professional manner that is respecting all ethical principles and following the code

of ethics.

To Health workers

Reduces work burden as employers take maximum advantage of the short-term support,

improves on the body of knowledge as medicine is dynamic and new ideas are brought

into the field, be on the on the look for future employees, health workers can evaluate

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themselves from the interns in the course of explaining procedures and rational, health

workers can learn from student’s fresh perspectives.

CHAPTER 2

I . DESCRIPTION OF NYLON DISTRICT HOSPITAL

2.1History of the hospital

NYLON DISTRICT HOSPITAL is among the 1 8 health

entities in the littoral region. It was created from the progressive

transformation of the former PMI TERGAL in maternity, then in an

integrated health center. The current structure was inaugurated on

SEPTEMBER 24,1 999 by professor MONEKOSSO minister of public

health. This achievement is as a result of cooperation between the

Cameroon state and SWISS state for the development of the nylon

area.

The hospital has a status of a public health facility.

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2.2 Geographical location of the hospital

Figure 1: Map

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NYLON DISTRICT HOSPITAL is located at tergal in the area
of health Barcelona whose population is estimated to 1 61 389
inhabitants, at the east of the heavy St Michele College, Douala
international airport axis and to the west of Madagascar market
2. Physical description of the hospital
It is located in the heart of tergal and build on a
marshy land . The total area of the site is 09 to 63. The
surface occupied is estimated to 2/3. The entrance of the hospital
premisses of the 8th division police station located at the entrance to
the Madagascar market. The hospital premises are inside an
enclosure bounded by a fence built. All the services and functional
care units at the hospital opens on the premises which are housed by
six buildings. Clinical services ( medicine and maternity) are initially
housed together in the large buildings and intended for the games
and shows of a previous health center .

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Figure 2: Picture of Hospital

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2.4 Hospital mission
As wanted by the gold of its creation in 1 999, the
main mission of NYLON DISTRICT HOSPITAL is to provide prodigy
care, allowing the rehabilitation of the population at the lowest cost
through its humanitarian action and taking into consideration these
realities from society the hospital pass, they put patient care as a
priority.
II . ORGANIZATIONAL CHART
-The director
- The physician
-The general supervisor
-The bursar
-The accounter
- The majors
-The team leader

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-Other staff

Figure 3: Organigram

Preentation Of Services Offered By Nylon

District Hospital
The various services that nylon offers are ;
- 01 Maternity unit
-01 Medical laboratory

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-01 Emergency unit
-01 Dental unit
-01 Medical unit
-01 Physiotherapy unit
-01 PEC unit
-01 CDTA unit
-01 Prenatal and vaccination unit
-01 Pharmacy
-01 Surgical unit
-06 Consultation offices
Nylon District Hospital is made up 90 BEDSAND 45 hospitalization beds

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Figure 4: Patient flow

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 CHAPTER THREE

DESCRIPTION OF THE VARIOUS ACTIVITIES CARRIED OUT

3.1Hematology unit

The following tests were performed in the hematology bench;

ESR, Hb electrophoresis, hematocrit, FBC, WBC count, WBC differential

count, CD4 count, Hb measurement (using hemiglobinometer).

a. Erythrocyte Sedimentation Rate

Principle: when blood in a vertically positioned westergren pipette is left

undisturbed, red cells aggregate, stick together to form a rouleaux and

sediment through plasma. ESR is the rate at which the sedimentation occurs

in one hour and indicated by the length of the column of clear plasma above

the red cell measured in mm.

Materials and reagent

 Westergreen ESR pipette

 Westergreen stand

 EDTA anticoagulant blood

Procedure

The westergren pipette was filled with EDTA anticoagulant blood and was

kept on the ESR stand.

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The timer was set at 60minutes and the starting time recorded on a piece of

paper together with the stand number and the stop time. After one-hour

interval, the ESR was read as the length of the clear plasma above the red

cells in millimeter per hour (mm/hr). The blood was then discarded into the

sink and the tube was washed and kept in a stand to air dry.

Interpretation of ESR test results

Normal values:

 Men: up to 10mm/hr

 Women: up to 15mm/hr

 Elderly: up to 20mm/hr.

b) Hb Electrophoresis.

Principle: This test is used as a screening test to screen for and identify variant

and abnormal hemoglobin. The various hemoglobin separates at different

rates due to differences in their surface electrical charges as determined by

their amino acid structure.

Materials and reagent:

Distilled water, EDTA anticoagulant blood, control samples (HbAA, HbAS,

HbSS), a pair of glove, cellulose acetate paper, electrophoresis chamber.

Procedure:

 The work station was set and gloves done.

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  The blood was lysed in distilled water.

 The buffer was placed into the two opposite spaces of the

electrophoresis chamber.

 The samples that is the controls; HbAA, HbAS, HbSS, and the patient’s

sample (lysed blood) were applied at one end of the cellulose acetate

paper respectively at the same distant.

 The cellulose paper was then transferred into the electrophoresis

chamber with its two ends immersed into the buffer.

 The chamber was then closed and the power was switch on and the

setup was left undisturbed for 20minutes for the various samples to

migrate in the cellulose paper due to electric current.

 After 20minutes the power was switched off and the distance moved by

the various bands and the number of bands in the patient’s sample was

observed and compared with control samples to give the final results.

 The buffer and the nitrocellulose paper were then removed and stored

back in the fridge.

Hematocrit:

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Principle: Anticoagulated blood in a glass capillary of specified bore size, and

wall thickness is centrifuged in a micro hematocrit centrifuge at 12000-

15000xg for 3-5 minutes to obtain constant packing of the red cells. The PCV

value is read from the scale of a micro hematocrit reader or calculated by

dividing the height of the red cell column by the height of the total column of

blood.

Materials and reagents:

Heparinized capillary tube, capillary blood, micro hematocrit centrifuge,

sealant and micro hematocrit reader, a pair of glove.

Procedure:

 The work station was set and gloves done.

 A finger prick was done to collect capillary blood.

 A heparinized capillary tube was three quarter filled with capillary

blood.

 The unfilled end of the capillary tube was sealed with a sealant (soap).

 The sealed capillary tube was placed in one of the numbered slots of the

micro hematocrit rotor with the rim end against the rim gasket

corresponding to the lab number and was balanced with another tube.

 The sample was centrifuged for 5 minutes at 12000 xg.

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  After centrifugation, the tube was checked for any leakage and the PCV

was read using a hand held hematocrit reader by placing the base of the

red cell column (above the sealant) on the zero mark and the top of the

plasma column on the 100-line mark.

 The capillary tube was then discarded into the infectious waste

container.

D) WBC count:

Principle: whole blood is diluted 1 in 20dilution in an acid reagent which

hemolysis the red cells, leaving the white cells to be counted microscopically

using an improved Neubauer counting chamber and the number of WBC per

micro liter calculated.

Materials and reagents:

EDTA anticoagulant blood, improved Neubauer counting chamber, cover slip,

Pasteur pipette, light microscope, Turk’s fluid, and glove.

Procedure:

 The work station was set and gloves done.

 380ul of Turks fluid was transferred into a clean tube and 20ul of whole

blood was added onto it and mixed.

 After a few minute, a clean dropper was used to charge the Neubauer

counting chamber with the diluted blood.

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  The chamber was mounted on the microscope and was focused with 10x

objective and the cells were counted in the four corner squares and the

number of WBC per micro liter was calculated and reported.

 The counting chamber was then removed and wiped with a clean tissue

paper and was stored in it box while the tissue paper was discarded in to

infectious waste container.

E) WBC differential count:

Principle: A well-made thin blood film, fixed with 95% alcohol and stained

with the appropriate Romanowsky stain was allowed to air dry and observed

under 100x objective using immersion oil to count the different types of white

blood cells present in the peripheral blood of the individual. The percentage of

each white cell counted in 100WBCs was reported.

Materials and reagents:

A pair of glove, a clean glass slide, blood sample, 95% alcohol, spreader, field

stains, A and B, microscope.

Procedure:

 A well-made thin film was made and kept in to a hot air oven to dry.

 The dried film was fixed with 95% alcohol and was kept to air dry.

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  The dried thin film was stained with field stain (the film was put in to

field stain A for about one minute, rinsed and deep in to field stain B

and washed immediately).

 The stained film was put in to a hot air oven to dry.

 Immersion oil was put on the dried film and was focused using 100x

objective to count the different type of white blood cells present and

were reported in percentage.

F) Hemoglobin measurement using the hemoglobin meter:

The measurement of total Hb concentrations is defined as the sum total of

oxygenated hemoglobin, deoxygenated hemoglobin, carboxyhaemoglobin and

methaemoglobin. It is done to detect anemia and its severity.

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3.2 Parasitology unit

Thick film for malaria parasite, urine analysis, stool analysis, skin scrapping,

RDT for Plasmodium falciparum were carried out.

Malaria testing:

RDT for plasmodium falciparum: 5 microliter of whole blood was placed on

the new cassette using a dropper from the cassette and three drops of the

buffer solution added. The results were observed for 20 minutes and reported,

positive when the control and the patient line appeared, negative when only

the control line appeared and invalid when no line appeared or line on patient

and not on control.

Malaria parasite

Procedure;

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  A clean grease-free slide was taken and a drop of blood was placed on it

and smeared, then dried in the hot air oven.

 Stained with field stain A for 5 seconds and wash with tap water, then

field stain B for one 1 second and wash again with tap water, dry and

observed microscopically.

 It was observed with 100X objectives, for the presence of malaria

parasite.

 Results were recorded as (+), (++), (+++) depending on the number of

parasites present per field.

Urine analysis

 The sample was collected and was centrifuged, the supernatant was

removed and the sediment was placed on labelled clean grease –free

slide and cover slipped.

 The slide was mounted on the microscope and was focused with 10X

objective.

 The 40X objectives was used to confirm for the presence of epithelial

cells, blood cells, spermatozoa, yeast cells, Trichomonas vaginalis.

Stool analysis

 The stool sample was prepared on a labelled clean glass slide using one

drop each of both normal saline and lugol’s iodine on the same slide.

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  Using a spoon found in the stool container stool was emulsified on the

different reagent and cover slip starting from the saline to iodine.

Then was observed microscopically for the presence of any parasites such as

yeast cells, Giardialamblia, Entamoeba coli, motile bacteria

3.3 Serology unit

H. pylori, ASLO, RF, ABO blood group test, HIV test, HCV test, HBsAg test, Widal, C-Reactive

Protein (CRP), PSA test, TPHA, PT, VDRL, test, T3, T4, TSH, HbA1C.

H. pylori test
Principle; This is a rapid test that employs gene recombination. H. pylori antigen together with

the principle of gold immune filtration assay to indirectly detect antibody in human serum. The

nitro-cellular membrane is immobilized with H. pylori antigen and H. Pylori antigen is

conjugated to colloidal gold particles at the test region. The conjugated particle then migrates

chromatographically to react at the test region.

Procedure

 After blood was centrifuged, plasma from wet tube was obtained and serum from dry

tube was also used in place of plasma.

 The test was removed from the sealed pouch and placed on a clean, level surface and the

patient’s identity was labeled on it.

 One drop of serum or plasma was pipetted using the pipette coming directly from the

pouch and was inserted in the well of the test and one drop of buffer placed in the test

well.

 The serum or plasma migrated till the end of the test line.

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  The test was left for 20 minutes and if a red line appeared on the Test region, therefore

the test was reported as Positive and if no line appeared on Test region, therefore the test

was reported as Negative.

ASLO

Principle; The ASLO reagent is a suspension of polystyrene latex particles coated with

stabilized Streptolysin O. The reagent has been adjusted in the way that the presence of an Anti-

Streptolysin O titre of IU/mL or higher in the serum gives a visible agglutination of Latex

particles without previous sample dilution.

Procedure

 Reagent and the specimen were bought at room temperature.

 A drop of test reagent was place on the dark side of a clean dry tile.

 Equal drops of serum were added on the same spot of the reagent.

 A sticker was used to mix the two drops well.

 The tile was placed on the oscillator for two minutes

 ASLO was reported as negative when no observable agglutination was seen.

Rheumatoid Factor

Principle; The Rheumatoid Factor latex particles are coated with specifically purified human

gamma globulin. When the latex suspension is mixed with serum containing elevated rheumatoid

Factor levels on the tile, clear agglutination is seen within two minutes.

Procedure

 Reagent and the specimen were brought at room temperature.

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  A drop of test reagent was placed on the dark side of a clean dry tile.

 Equal drops of serum were added on the same spot of the reagent.

 A sticker was used to mix the two drops well.

 The tile was placed on the oscillator for two minutes.

 Rheumatoid Factor was reported as positive when any observable agglutination was seen.

 Rheumatoid Factor was reported as negative when no observable agglutination was seen.

ABO grouping

Principle; It is based on specific agglutination reaction between Antigen on red cell and IgM

antibodies in the patient’s serum.

Procedure

 The reagents were removed from the fridge and were placed on a clean table for it to

reach the room temperature for 20-30 minutes.

 The reagents were mixed well before use.

 A clean dry tile was taken and a drop of each anti-serum; Anti-A, Anti-B, Anti-AB and

Anti-D was dropped on it.

 A drop of patient’s whole blood was placed onto each reagent.

 Applicator sticks were used to mix well the blood and the Ant-sera.

 Tile was rugged for two minutes and scored for agglutination.

HIV Test

Principle; Determine TM HIV-1/2 is an immuno chromatographic test for the qualitative detection

of antibodies to HIV-1 and HIV-2 sample is added to the sample pad. As the sample migrates

through the conjugate pad, it reconstitutes and mixes with the selenium colloid-Antigen

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conjugate. This mixture continues to migrate through the solid phase to the immobilized

recombinant antigen and synthetic peptides at the patient window site.

Procedure

 A strip test of HIV-1/2 was placed on a clean, level surface and the patient’s identity was

labeled on it.

 Two drops of the patient’s serum were dropped on the determine TM

HIV-1/2 and two

drops of buffer solution of HIV was added too.

 The sample migrated till the end of the strip and a red line appeared on the Control line.

The strip was left undisturbed for 15 minutes and read.

 If a red line appeared on the Test region, therefore the test was reported as Positive and if

no line appeared on Test region, therefore the test was reported as Negative.

HCV Test

Principle; The one step HCV test strip is a qualitative membrane based immunoassay for the

detection of antibodies to HCV in serum or plasma. The test line of the membrane is coated with

recombinant HCV antigens. When the specimen is applied, it migrates upward by capillary

action and combines with the antigens to generate a red line.

Procedure

 The strip was remove from the pouch and placed on a clean, level surface and the

patient’s identity was labeled on it.

 Three drops of patient’s serum were dropped on the strip.

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  The serum migrated crossing the Test and Control regions.

 A redline appeared on the Control region and the strip was left for 15 minutes, after

which result was observed.

 If a red line appeared on the Test region, therefore the test was reported as Positive and if

no line appeared on Test region, therefore the test was reported as Negative.

HBsAg Test

Principle; The HBsAg rapid test strip is a qualitative immunoassay for the detection of HBsAg.

The membrane is pre-coated with anti HBsAg antibodies on the test line region on the strip.

When specimen is applied on the specimen pad, the specimen reacts with the anti HBsAg

antibodies conjugate particles. The mixture migrates upward on the membrane by capillary

action and reacts with anti HBsAg antibodies on the membrane and generates a colored line.

Procedure

 The test strip was removed from a sealed pouch, placed on a peeled test card

 1 to 2 drops of patient’s serum were dropped on the specimen pad on the strip

 The timer was set for 10 to 15 minutes and read.

 Presence of two colored lines in the test and control indicative of the presence of HBsAg

antibodies in patient’s serum or plasma.

 Presence of only one line at the control region indicates the absence of HBsAg antibodies

in patient’s serum or plasma.

Syphilis test (TPHA)

Principle; The syphilis ultra-rapid test strip is a qualitative membrane based immunoassay for

the detection of Treponema pallidum antibodies in plasma or serum. When the sample is applied

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on the sample pad, it reacts with the pre-coated syphilis antigens on the sample pad. The mixture

migrates by capillary action and interacts with the immobilized syphilis antigens on the test line

producing a colored line.

Procedure

 The test strip was removed from a sealed pouch, placed on a peeled test card

 1 to 2 drops of patient’s serum were dropped on the specimen pad on the strip

 The timer was set for 10 to 15 minutes and read

 Presence of two colored lines on the control and test band indicates the presence of

antibodies to Treponema pallidumin patient’s plasma or serum.

 Presence of one colored line on the control band indicates the absence of antibodies to

Treponema pallidum in patient’s plasma or serum

Pregnancy test

Principle; It is based on the identification of HCG (Human Chorionic Gonadotropin) in urine

with the use of a strip incorporated with anti- HCG.

Procedure

 The strip was removed from the pack and labeled

 The strip was then dipped in the urine container containing urine.

 The presence of a double line indicated the presence of the HCG in the urine for a

positive test.

 The presence of a single line indicated the absence of the HCG hormone for a negative

test.

Widal test
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Principle; The bacterial antigen test is a slide and tube agglutination test for the quantitative and

the semi-quantitative detection of antibodies: anti salmonella, in human serum. The reagents,

standardized suspensions of killed and stained bacteria agglutinate when mixed with samples

containing homologous antibody.

Procedure

 Reagents were brought to room temperature and suspended

 The reagents were then respectively dropped on a tile with eight circles with the O, AO,

BO, CO, H, AH, BH, CH antigens.

 Patient’s serum was dropped on to each of the circles

 This was then mixed using an applicator stick to fill the entire circle

 The mixture was then rocked for 2 minutes using a rotator and observed for agglutination

 Agglutination indicates the presence of antibodies to salmonella in patient’s serum. 1/80

= insignificant, 1/160 = mild, 1/320 = moderate, 1/640 = severe.

 No agglutination indicates absence of antibodies to salmonella in patient’s serum.

CRP

Principle; The C - reactive protein latex is a slide agglutination test for the quality and semi-

quantitative detection of C - reactive protein in human serum. Latex particles coated with goat

anti-human CRP are agglutinated when mixed with samples containing CRP.

Procedure

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  Reagent and the specimen were bought at room temperature.

 A drop of test reagent was place on the dark side of a clean dry tile.

 Equal drop of serum was added on the same spot of the reagent.

 A sticker was used to mix the two drops well.

 The tile was placed on the oscillator for two minutes.

 CRP was reported as positive when any observable agglutination was seen.

 CRP was reported as negative when no observable agglutination was seen.

T3 Test

Principle; Uses a competitive immuno-detection method. In this method, the target material in

the sample binds to the fluorescent labeled detecting antibody in detection buffer, to form the

complex as sample mixture. The complex is loaded to migrate onto the Nitro-cellulose matrix,

where the covalent couple of T3and Bovine Serum Albumin is immobilized on a test strip and

interferes with binding of target material exists in blood; the less detecting antibody is

accumulated, resulting in the less fluorescence signal.

Procedure

 75 micro liters of the sample was transferred in to the tube containing solution A.

 It was well mixed by pipetting the solution up to 10 times.

 75 microliters of solution B was added to the tube containing the sample and solution.

 The two solutions and the sample were well mixed with the lid well closed.

 The tube was incubated after mixing at room temperature for 08 minutes.

 75 microliters of the mixture form the tube and loaded in the sample well on the

cartridge.

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  The cartridge was inserted into the slot of the chamber.

 The cartridge was seen immediately after the 08 minutes and the results were displayed

on the screen of the ichroma machine and was recorded and printed.

T4 Test

Principle; Uses a competitive immuno-detection method. In this method, the target material in

the sample binds to the fluorescent labeled detecting antibody in detection buffer, to form the

complex as sample mixture. The complex is loaded to migrate onto the Nitro-cellulose matrix,

where the covalent couple of T4 and Bovine Serum Albumin is immobilized on a test strip and

interferes with binding of target material exists in blood; the less detecting antibody is

accumulated, resulting in the less fluorescence signal.

Procedure

 75 microliters of the sample were transferred in to the tube containing solution A.

 It was well mixed by pipetting the solution up to 10 times.

 75 microliters of solution B was added to the tube containing the sample and solution.

 The two solutions and the sample were well mixed with the lid well closed.

 The tube was incubated after mixing at room temperature for 08 minutes.

 75 microliters of the mixture form the tube and loaded in the sample well on the

cartridge.

 The cartridge was inserted into the slot of the chamber.

 The cartridge was seen immediately after the 08 minutes and the results were displayed

on the screen of the Ichroma machine and was recorded and printed.

TSH

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Principle; It is a FIA (Fluorescent Immuno-Assay) for the quantitative determination of TSH in

serum or plasma. The test is a Sandwich Immuno-detection method; the detector antibody in

buffer binds to antigen in the sample, forming antibody-antigen complex and migrate onto the

nitro-cellulose matrix to be captured by the other immobilized antibody on the test strip. The

greater in quantity of antigens in the sample, the more anti body-antigen complex and leads to

stronger intensity of fluorescence signal on detector antibody which is processed by instrument

for Ichroma test to show TSH concentration in sample.

Procedure

 150 microliters of sample to a mixing tube.

 The lid was closed and the mixture well shaken 10 times.

 75microliters of the solution was pipetted and loaded in the cartridge.

 The cartridge was incubated at room temperature for 12 minutes.

 After incubation, the cartridge was inserted in the chip that was inserted in the machine.

PSA (Prostate Specific Antigen) Test

Principle; It is a FIA (Fluorescent Immuno-Assay) for the quantitative detection of PSA in

serum, plasma or whole blood. The test is a Sandwich Immuno-detection method; the detector

antibody in buffer binds to antigen in the sample, forming antibody-antigen complex and migrate

onto the nitro-cellulose matrix to be captured by the other immobilized antibody on the test strip.

The greater in quantity of antigens in the sample, the more anti body-antigen complex and leads

to stronger intensity of fluorescence signal on detector antibody which is processed by

instrument for Ichroma test to show PSA concentration in sample.

Procedure

37
 75 microliters of the sample were transferred in to the tube containing solution A.

 It was well mixed by pipetting the solution up to 10 times.

 75 microliters of solution B was added to the tube containing the sample and solution.

 The two solutions and the sample were well mixed with the lid well closed.

 The tube was incubated after mixing at room temperature for 15 minutes before scanning.

 After scanning, results appeared on the screen and was recorded by printing the results

from the machine

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 CHAPTER FOUR

4.1 CONCLUSION

To conclude this internship was a great opportunity for me to develop my skills and

competence in my future carrier.

However, there were some goals which could not have been met due to the crises in the

area as was the case with Mondays and the numerous gunshots that brought tremble.

Above all the internship was a great experience.

4.2 RECOMENDATIONS

Short term recommendations

Patients comfort should be considered as nurses don’t give the patents all the attention

they need.

The ministry of public health should should re-innovate the hospital in other to make it

comfortable for their clients.

They should also increase the number of doctors as one doctor entitled with more than

100 patients that leads to fatigue and inefficiency.

The ministry should increase the number of security workers due to the insecurity in the

region swot analysis

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4.3 SWOT ANALYSIS

Strengths: Proper management of waste, Proper time management, Confidentiality is

highly respected by staffs, Presence of many staffs, have competent workers, Team work

and relation between staffs is efficient.

Weaknesses Workers work without considering protective measures putting gloves, poor

transportation of patients from one part of the hospital to another especial to the theatre

because of rough ground surfaces causing vibrating and shaking of patients, space and

shelter for care takers and clients is poor, generator don’t supply electricity to entire

hospital, some staffs don’t explain things to student

Opportunities Presence of many patients which as a result gives us students the

opportunity to come across different kind of cases, Opportunity to meet competent

workers

Threats Malfunctioning of some machines which can lead to faulty results and as a result a

threat to patients’ life, Lack of protective measures by workers like wearing of gloves

during work and is life threatening to staffs because they can contract nosocomial

infections.

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