By Chioma Obinna
Nigeria has continued to battle misdiagnosis occasioned by poor state of medical laboratories. The problem has not only caused poor healthcare delivery across the nation but also deaths. Meanwhile, medical tourism takes its toll on the system and billions of Naira lost in the process.
And to make matters worse, a battle for supremacy rages among professional bodies in hospital laboratories. While pathologists claim that activities of laboratory scientists fuel misdiagnosis and that they should be in charge of the sector, laboratory scientists argue that the primary cause of misdiagnosis is the pathologist who is not licensed to practice but to interpret results to general practitioners. Wikipedia defines medical diagnosis as the process of determining which disease or condition explains a person’s symptoms and signs.
It notes that, oftentimes, one or more diagnostic procedures, such as diagnostic tests, are done during the process. Sometimes posthumous diagnosis is considered a kind of medical diagnosis. In essence, medical diagnosis is the bedrock of medicine. Sunday Vanguard looks at the reasons for the fight between pathologists and laboratory scientists, implications on healthcare and why government should immediately intervene.
Nigerians, on daily basis, die in the process of seeking quality care which, experts say, starts with information from a laboratory manned by qualified professionals.
Still fresh in mind is the statement credited to the late Chief Gani Fawehinmi when he said: “I was diagnosed of pneumonia and being treated for pneumonia until I got to London where I was told I had cancer of the lungs.”
Fawehinmi, a social critic and human and civil rights lawyer, passed on in 2009 from complications arising from cancer of the lungs. If his illness had been diagnosed correctly at the early stages, he may still be alive today.
Another case of misdiagnosis is Josiah Egbunike, an undergraduate. Josiah was wrongly treated for malaria for months before it was discovered that he had kidney related disease. He died.
The situation has inevitably provoked the question, why is misdiagnosis rampant in Nigeria? A report, in an attempt to provide an answer, says the nation has over 6, 000 registered laboratories but only two, in 2016, met international accreditation as against South Africa which had about 85 per cent of its laboratories internationally accredited.
Echoing the position of the report, a medical laboratory scientist, Mr. Precious Anyiwo, said, “Quality is a measure of excellence or a state of being free from defects, deficiencies and significant variations, brought about by a strict and consistent commitment to certain standards that achieve uniformity of a product in order to satisfy specific or user requirements. In medical diagnostics, quality could be a matter of life and death”.
According to experts, in healthcare delivery, diagnosis is the route that takes the driver (medication/doctor) and the passenger (the patient) to the destination of patient’s recovery. Once the route is wrong, as in cases of misdiagnosis, both the driver and the passenger will never get to their destination. They maintained that misdiagnosis could lead to a number of unpalatable circumstances including death, unnecessary and elongated treatment with the attendant high costs.
This explains why Fawehinmi and thousands of other Nigerians die even after the right diagnosis was made.
And Nigerians have continued to pay with their lives, no thanks to obsolete equipment and the rivalry between key professionals in the system.
At a recent forum of medical doctors, a state Chairman of the Nigeria Medical Association, NMA, narrated the story of how, in a government -owned hospital, a pathologist, who is officially the head of the laboratory department in the institution, gave instruction on a patient and laboratory scientists reversed it.
The NMA Chairman alleged that the activities of laboratory scientists had continued to fuel misdiagnosis in the country.
On his part, the National President of the Nigerian Pathologists, Dr. Kenneth Iregbu, said that over 70 per cent of lab results have no value to healthcare. To him, you cannot have excellence in the midst of anarchy.
Iregbu, who maintained that there is no quality going on in Nigeria laboratories, said many of the test results produced in the laboratories are useless.
“Nigerians are just being killed and injured by people who don’t have regard for life and quality”, he pointed out.
Iregbu, who is also a Consultant Clinical Microbiologist at the National Hospital, Abuja, argued that unless government takes a decisive step to curtail the activities of laboratory scientists, the country is doomed in terms of healthcare.
“There is no country in the world that has ever developed health wise without developing the lab component because that is where diagnosis is made. That is where you have doctors who will tell you ‘this is what your patient is going through’ and unless you keep that area perfectly working, we are wasting our time in this country”, he stressed.
“First and foremost, government has to tell lab scientists enough is enough. You must submit yourself to pathologists and whosoever does not want to do it should get out of the laboratory. These things happen in the public sector but not in the private sector because, when they (laboratory scientists) go to the private sector, they understand the rules there. “Because it is government work, anybody can do whatever he likes. And then, people are playing politics with it.”
Tracing the genesis of the crisis between the two professional bodies, he urged government to implement the report of the committee it sent abroad on a fact-finding mission.
“The report of the committee the government sent abroad is lying there. There has to be an end to it and that is the role of government. “
He regretted that laboratory services in Nigeria are very poor, adding, “Only in few teaching hospitals that you have a semblance of real service. Most state hospitals, most private laboratories are rubbish through and through. I am saying it confidently because I have information.”
Iregbu, who insisted that laboratory practice was a medical specialty, said the department must be directed and controlled by experts in the branch of medicine who are pathologists.
“I am primarily a doctor before I became a pathologist. The advantage I have over the lab scientist is that when you send to me a patient that has chronic renal disease, I already know the kind of patient you are talking about. So when I am looking at the result, I am also looking at the patient. Does this result tally with the patient or is there anything different? I am in a better position to advice on the situation of the patient; the lab scientist does not know what this job is all about because that is why it is medicine”, the pathologist said.
He said the contest between pathologists and lab scientists was absolutely unnecessary as the roles are clearly defined within the setting of the laboratory medicine practice.
Iregbu criticised a 2013 judgement of the National Industrial Court on the issue, saying the court did not understand medicine and had no jurisdiction over medicine, adding that the pronouncement was useless, had no value and detrimental to patients.
Reacting to the claims, the National President of the Association of Medical Laboratory Scientists of Nigeria, Dr. Bassey, said pathologists were the primary cause of the increase in misdiagnosis in Nigeria.
“There are several factors that contribute to misdiagnosis in the country and, for laboratory tests to be right and patients derive all the benefits, there must be the right personnel, equipment and right work environment as well as right administrational structure”, Bassey said.
“Who is responsible for misdiagnosis? Chief medical directors and medical directors in teaching hospitals and federal medical centres, who are doctors, work hand in with pathologists who are also doctors to determine what happens in the laboratory. Eventually the right persons are never hired.
“When was the last time these hospitals recruited medical lab scientists? People retire and go without replacement because they are determined to starve the laboratory of the right personnel. For you to determine that the lab examination I am carrying out is going to give me accurate result, there must be right equipment. Who determines the right equipment to be purchased? Pathologists and doctors who connive to buy all sorts of equipment that are not working. When you visit these hospitals, you will see that what they have are not the right equipment because they were not purchased by the right people.
“The equipment they bought are abandoned in the stores because they were not approved by the right people or inspected by them for the kind of the job they are going to be used for.”
Continuing, he lamented that the work environment is hostile; adding that with over 65 teaching hospitals and federal medical centres, 40,000 medical laboratories, 24,000 medical laboratory technicians, and 12 000 medical laboratory assistants across the country, there is no structure to coordinate their activities in the Federal Ministry of Health.
“It is like a battalion of soldiers going to war without a commander. Who will provide direction? That has been designed by doctors in Nigeria in order for them to remain as leaders they claim in the health sector. And these are the building blocks and ingredients that lead to misdiagnosis. Because you cannot offer what you don’t have.”
He maintained that pathologists are, first and foremost, doctors licensed by the Medical and Dental Council of Nigeria to practice medicine while medical laboratory scientists are licensed by the Medical Laboratory Council of Nigeria to practice medical laboratory science.
Also speaking, Chairman, Lagos State Association of Medical Laboratory Scientists of Nigeria, Mr. Monsuru Adegoke who dismissed the argument of the doctors said “With the position of the law as of today based on the act 11 of 2013 and the judgements of the National Industrial Court since the struggle started, not even one judgement has been in favour of the Doctors/Pathologists.
He accused the Minister of Health whom he described as ‘Minister of Doctors’ with the support of his professional colleague in ministry of Labour to have being prevented the rule of law to prevail in the health Sector in Nigeria , as all of these judgements have ” NO STAY OF EXECUTION ” , hence those judgements.
Describing a medical laboratory scientist as a graduate who has gone through one year of internship & has been licensed to practice the profession said they are not just lab Scientists but medical laboratory Scientists.
He blamed the rivalry in the system on failure of the system to allow the rule of law to prevail.
“Even NMA and all their organs know that medical and dental council act doesn’t give them power to head the Laboratory or even practice medical laboratory, instead their law says they are to regulate practices of resident doctors in pathology training, hence if they are ready to swallow their pride and allow rule of law to stand, there will be peace in the laboratory department in Nigeria.”