As Nigeria turns 50, most analysts agree that the country’s healthcare sector is comatose and needs a major surgical procedure if it must meet the people’s expectations. Many however proffer complex solutions which tend to further complicate the problem. But a medical expert believes that strengthening the nation’s medical laboratory sub-sector would save the health sector. Steve Dada writes
A major hurdle stakeholders are struggling to cross in the country’s health sector is the incidence of drug counterfeiting and faking, which most people believe has killed more Nigerians than accidents and armed robbery. Many Nigerians have paid the supreme price for using adulterated drug to treat debilitating ailments at critical periods of need for survival.
Indeed, this is a major problem the country has been contending with. But there is another major phenomenon staring the country in the face. This is the issue of misdiagnosis on the part of medical laboratory personnel operating within the hospital environment. Due to lack of infrastructure/equipment to carry out accurate laboratory diagnosis, doctors have been misled into committing errors while administering treatment for some health complications.
Likewise, because of inadequate laboratory reagents to investigate specimens to find the exact cause or causes of illness, wrong results have come out of laboratory investigations and since doctors rely on the outcome of such investigations, a lot of havoc has been committed, some leading to the death of patients.
Diagnosis is very important if doctor’s prescription of treatment must be accurate. As the country marks its 50th independence anniversary, THISDAY sought to know what the state of diagnosis or laboratory investigation is in the country’s healthcare delivery sector.
Before defining laboratory diagnosis, Dr. Pamela Ajayi, the Managing Director of a notable pathology laboratory, PathCare Nigeria , explained that people must first understand what laboratory tests are. She noted that for doctors to effectively treat an individual, they need to understand the cause or causes of the illness. “History taking, physical examination, and where necessary, requesting for laboratory tests can help doctors deduce the cause of an illness”, she explained.
Laboratory tests, she noted, are medical procedures carried out to evaluate, diagnose and determine disease, confirming diagnosis, ultimately directing the course of treatment. She said, “Laboratory tests are valuable tools in deducing definite diagnosis, or a screening tool for detecting hidden disease in asymptomatic patients. It is essential that Laboratory tests done are accurate and reliable to ensure that correct diagnosis is made.”
Talking about the importance of diagnosis in the treatment, Ajayi said laboratory tests serve to support or refute a doctor’s clinical suspicion. “It helps ascertain the clinical status of the patient, ensuring it justifies the clinician line of management. It can also assist in identifying individuals that are susceptible to diseases or infection and can help determine if their status warrants clinical intervention.
“If the tests done are inaccurate, the doctor can end up making the wrong diagnosis; mistreat the patient which can result in death. It is imperative that tests are done in a laboratory that guarantees accurate results to avoid this. In the past, people who could afford it would always travel abroad for testing but now that PathCare with its ISO 15189 accreditation can provide the same international standards, people trust its results and no longer fly out for every single test.”
She expressed her view about diagnosis in the country saying, in developed countries, an estimated two-thirds of clinical diagnosis is achieved through laboratory testing. “Though the situation in Nigeria has improved compared to about a decade ago, a lot more still needs to be done as regards utilising laboratory tests in achieving a diagnosis. In present day Nigeria , clinicians are now able to access rare investigations that were not previously available.”
She said she can authoritatively assert that many tests were not in existence in Nigeria before PathCare’s emergence in 2004. “We have also expanded our reach and can provide access in multiple locations in Lagos , Abuja , Port Harcourt , Warri, Ibadan and will soon be in Kaduna . In spite of this success made over the last couple of years, a lot more ground need be covered.” She said there are many areas that still need to be developed but which need to be driven by doctors who must demand for more sophisticated testing and do more research to ensure that the development of the country’s healthcare system catches up with efforts in industrialised nations.
On whether Nigeria is making any appreciable impact in medical development vis-à-vis the global community, Ajayi said no, saying in the 1970’s, LUTH and UCH were at the cutting edge and ranked among the best tertiary health institutions in the world. “There has been a severe decline and we must now work a lot harder to get back to where we belong.”
She said Nigerians are still seeking foreign medical treatment in the United States , the United Kingdom , India , Singapore and South Africa , among many other countries. “Medical tourism is a multi-billion dollar industry and a lot of privileged Nigerians seek medical help outside the shores of the country. Improvements in the medical industry have certainly started, in particular, in the private sector. However, we need to work at raising standards in all our institutions, providing international standards of care in all our hospitals to ensure that the downward trend is totally reversed and Nigeria benefits rather than lose this income to other countries.”
On what she feels Nigeria needs to do for improvement, she said she doesn’t believe in chastising the government or blaming all woes in all spheres of the economy entirely on the government. “There is a lot that the private sector can achieve. All we require is an enabling environment with sound, stable enforceable policies. Nigerians are extremely entrepreneurial, creative and capable of achieving a lot. But we need to have a more positive attitude and be prepared to work harder, focussing on long term gains. Small and Medium Enterprises (SMEs) are the engines for economic growth and development. I believe that the development of the private healthcare sector is the future for healthcare in Nigeria .”
According to her, the country’s disease patterns are changing with our more urban lifestyles. This, she insists, makes a strong role for preventive medicine imperative. She therefore noted that, “Health education (amongst others) is important and as individuals, we all need to take responsibility for our health, adopting healthier lifestyles and avoiding harmful practices such as self medication.”
As Nigeria attains 50 years of independence, Ajayi is of the view that the country’s healthcare system is not where it should be but is certainly on the way up. “There is hope but it will require strong commitment from all sides. Reforming a health system is a cumbersome process but it can be done as has been demonstrated in developed countries like the United States , Holland and Germany amongst other countries. We need to re-evaluate our heath system with emphasis on primary care and health education, which will significantly reduce disease burden. There is no single panacea to Nigeria ’s health system. But the concerted efforts of individuals, doctors, government and the society would go a long way in tackling these issues.
Ajayi expressed the opinion that laboratory diagnosis has a major role to play in making healthcare better now and in the future. She however noted that there are challenges even in this sub-sector, saying the greatest challenge to laboratory practice is lack of standards. She stressed that internationally, the ISO 15189 was created specifically by the International Standards Organisation to ensure Medical Laboratories produce accurate, reliable and reproducible results, because of the importance of laboratory results and their impact on human lives.
She described it as the standard being adopted in many developed countries and is now being written into law. “This means that in some countries, laboratories cannot practice without achieving this accreditation standard. These are the countries with the highest standards of medical care and longest life expectancy.”
According to her, Nigeria needs to adopt the ISO 15189 standard as a minimum standard in Laboratory care. This, she said, will ensure that all Nigerians get international-standard results and doctors will get the support they need for improved patient management. It needs to be brought into the curriculum and enforced by law,
Ajayi said, noting that there are a lot of challenges affecting the industry. “For example, epileptic power supply affects quality of reagents utilised, it also increases basic operational costs that can damage a lot of the automated equipments used.”
She also noted that sourcing for local supplies, retrieving imported supplies from the ports, maintenance of equipments, sourcing manpower and transportation costs are major sources of headache in the medical laboratory sub sector.
Talking about the role government can play to alleviate some of these problems, she said government can create good basic infrastructure and provide good policies that allow for long term development in healthcare as well as ensure effective regulation of standards.
Ajayi mentioned some of the achievements of PathCare as a company that has made an indelible impact on laboratory practice in Nigeria , saying the company has raised the standards and introduced the widest range of testing in Nigeria today. “Many people who had to travel abroad no longer do so as our results are accurate and reliable and accepted anywhere in the world. Since our conferment with the ISO 15189 accreditation by SANAS (South African National Accreditation Systems) in 2006, our processes have become so standardised that they are now comparable with laboratories in developed countries.”
This, according to her, ensures the highest quality of testing and both patients and doctors have “implicit trust in results from our laboratories nationwide.” Among other awards, in 2010, PathCare was named West Africa ’s World Class Medical Diagnostic Laboratory and DNA Services of the year by West African Corporate Achievement Awards 2010.
“We strongly believe in our responsibility as corporate citizens and provide free screening (testing) and health checks for the underprivileged in Ajegunle, Makoko, Ikorodu and various locations around the country. We also participate actively in developing continuous medical education programmes for doctors with our Doctors Forums and the distribution of Pathology Newsletters. We also created and still sponsor a radio show, ‘Doctor’s on Air’ which provides basic health education to listeners every Wednesday at 8am on Classic FM 97.3.”
Ajayi said PathCare was established to improve healthcare in Nigeria through the provision of international standard medical laboratory testing. “Simply put, PathCare provides precision testing that doctors and patients can trust. PathCare has brought so many innovations in pathology testing to Nigeria , providing specialised investigations, thereby improving doctors’ ability to treat their patients. We were established to be the bench mark of laboratory testing in Nigeria and we will continue our quest for excellence, without compromising our standards.”
As far as Ajayi is concerned, bringing all medical laboratories up to these high standards would do the magic in the health sector. She insists that if laboratories operate such standards, they would churn out accurate results which would in turn improve diagnosis and treatment. And, with improved treatment, the health sector would be on its feet once again.