The National President of the Association of Medical Laboratory Scientists of Nigeria (AMLSN) Mr Toyosi Raheem, a medical laboratory scientist, in this interview throws more light on why misdiagnosis still exists in medical laboratory practice, and how some unscrupulous healthcare professionals are killing public health laboratories for their selfish interests.
How will you assess the development of medical laboratory practice in Nigeria?
As background information, medical laboratory science is the science that deals with investigation of body fluids and tissues for the purpose of ascertaining the state of health or otherwise of an individual. Sometimes, samples can also be taken from animals. But the overall objective is to ascertain the state of that individual or animal whose sample has been collected by using scientific knowledge, skill and proficiency that have been gained through years of training in the university and license, which has been given by the Medical Laboratory Science Council of Nigeria (MLSN).
This means that if one has gone through this level of training in the university but is not licensed to practice, one cannot claim to be a medical laboratory scientist. It is a professional service that is acquired through a period of training in the university and with license to practice.
For instance, if someone complained of malfunction in his system in form of headache and pain, it could be called a number of ailments. When the person presents himself in the clinic, there will be a temporary assessment, and sometimes, the sample will be collected and sent to the laboratory. A thorough laboratory investigation will reveal the actual state of the individual’s health. When the results are out, treatment will be instituted. At times, even when treatment is ongoing, we need to monitor the patient’s level of response to the treatment. And if there is no need for treatment, the patient will be counseled.
The British introduced medical laboratory science in Nigeria in Nigeria around 1920. Before then, diseases were diagnosed based on assumptions. When the profession was introduced, a formal training was instituted in its rudimentary state though. Between then and now, we have a well-structured form of training in universities and some approved training institutions. The profession has really metamorphosed into a well-structured and complex one. And with the advent of automation, it is now well scientifically advanced.
There is a law that gives full professional autonomy to the medical laboratory science practice in which case the former Institute of Medical Laboratory Technology Degree was repealed. That empowers the regulatory body, MLSN, to have full professional regulatory power to regulate the practice in teaching hospitals, state hospitals, in public and private hospitals, and regulate the distribution, sales and marketing of laboratory equipment and reagents, because we observe that there are so many sub-standard reagents and equipment that can affect our practice. No matter how well trained one is, if one has fake reagents and equipment, one will have erroneous results.
If there have been advancements, how come misdiagnosis among medical laboratory operators is still rampant in Nigeria?
It has been of concern to us too. Globally, it is a concern to all medical laboratory scientists. We have observed that a number of errors have compromised the safety of patients when they attend various medical facilities. Aside the laboratory, when patients go for surgery, there could be errors that might cause harm to them. The same thing is applicable to laboratory. If there are errors in the laboratory, it is not what the patient presented that would be treated. Eventually, there would be delays and complications. So, errors are of concern to us. And we the medical laboratory scientists are trying very much to ensure that this is minimised.
We have identified the few causes of errors. Most times, the errors are not because of lack of professional competence; errors are due to lack of standard reagents. Like I said earlier, Nigeria market is flooded with substandard and fake reagents; people just import anything without going through the normal procedure. Moreover, we have quite a number of equipment that are substandard.
We also have a lot of quacks that are impersonating as medical laboratory scientists. Just as we have fake lawyers, doctors and journalists, we have quite a number of quacks practicing as medical laboratory scientists. That is why we always tell the patients in both public and private hospitals that they have the right to know whether the person they are patronising is a licensed medical laboratory professional. A number of times, people graduate from biological sciences -even if one has a PhD in any of the biological science fields like chemistry, biology, physiology among others, once one is not licensed and trained to be a medical laboratory scientist, one cannot be. It is like one has a PhD in anatomy but then claims to be a surgeon. It is not possible. But a lot of quacks are parading themselves as medical laboratory scientists.
When you enter most private and public laboratory centres, you see people that are employed as medical laboratory scientists. But they are not qualified medical laboratory scientists.
These are some of the factors that are responsible for the release of erroneous results in hospitals. But we expect our colleagues that are in the health profession to assist us in curbing this development, because if we all work together to fight quackery, the health system will be better for it. For instance, if a medical doctor knows someone who is not a qualified nurse, that doctor is not supposed to employ that person as a nurse, or train such person as auxiliary nurse. The same thing goes for medical laboratory services; a medical doctor is not supposed to recruit someone who is not a licensed medical laboratory professional. We should all go for qualified and licensed medical professionals.
I am sad to say that most health facilities, even government-owned health facilities, instead of employing qualified professionals, they go on to recruit people who are not qualified to work in such facilities. And when you tell them that this person is not supposed to work in such facilities, they will tell you that the person is the son of the chairman, in-law of the governor, or that the board chairman sent him across to be employed. It is a professional work that is not supposed to be treated politically.
We need to understand the difference between a medical laboratory scientist and graduate of biological sciences. The two are not the same. When this is done, these errors in the various medical laboratories will be reduced to the barest minimum.
As for the errors that require capacity building of colleagues, we know that things are changing for the better. That is why we are very much concerned with continuous professional education, which we call continuous professional development (CPD) programme, in case there are new trends that have to do with analysis of results among others. So, we periodically update the knowledge of our colleagues.
Some of your colleagues have alleged that there is a deliberate effort to starve medical laboratory services funds in government hospitals of funds and that such services are being increasingly but unofficially privatised by investors who are increasingly siting their medical diagnostic facilities in and around the premises of government –owned hospitals. Please, kindly throw more light how this is happening.
It is happening in Nigeria, and the trend is worrisome. I do not want to mention names. But practically, every health institution in Nigeria, whether officially and unofficially, engages in this act.
Some health professionals are even adversely contributing to the trend. What do I mean? Most of these private investors that have come to site their facilities in government –owned health institutions have callously connived with some healthcare providers to be sending patients to them. Of course, to whom much is given, much is expected. The more patients these healthcare providers send to these private centres, the more commission the healthcare providers get, to the extent that some of the healthcare providers do not want to send samples to their own hospital laboratories again because they feel the hospital medical laboratory facility is owned by the government and nobody will give them commission. These are issues we have being trying to avoid so that they will not say we are blackmailing them. But they are killing the health system, and we cannot continue to keep quite.
If you look at the people who are clamouring for public-private partnership (PPP), it is not that they know we cannot manage the laboratories or that government cannot provide the needed human resources and materials, but because they know that something is coming back to their pockets in form of commission at the end of the month or year. And they will not disclose this.
We should not kill our public health laboratories. If government is allowed to fund public health laboratories, and motivate medical laboratory scientists and others working there, quality medical laboratory services will be given to the public at cheaper rate.
Published: May 2, 2015. By Guardian
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