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Laboratory practice in Ghana: The Good, The Bad and The Ugly

In medical practice and medical research undertakings, the laboratory has played and still plays a vital role, one which has sadly not been acknowledged by the masses, especially, here in Ghana. Laboratory tests have however become very vital in diagnosis. Many people are not informed of the incalculable inputs of the laboratory in diagnosis and treatment. Measurement of hormone levels ascertains endocrine diseases. Enumeration of different kinds of cells in the blood, called a differential count, helps pinpoint anaemia and some kinds of malignancies. The culturing of body fluids or tissues to show the presence of specific microorganisms is essential to rational treatment of infections with antibiotics. There are numerous patients that are be that as it may being misdiagnosed in this scientific age of evidence-based medicine. A number of individuals have been repeatedly misdiagnosed of having malaria rather than other relatively more life-threatening ailments like leukaemia and typhoid fever.

Certain tests considered routine tests are not requested for and many other definitive tests or specialised tests are not even explored, because of lack of education with respect to those specialised tests. Biomedical Scientists should not hesitate to recommend for such specialised tests to be conducted when the need arises. Seminars should be organised to educate health workers who are concerned, in order for the right tests to be requested and the right thing to be done. The patient would thus, leave the consulting room, theatre or the ward realising the contributions made to his or her recuperation.

There are many reasons why laboratory practice has not been able to "put on its good cloth." However, it would be expedient to make mention of some of the ‘insignificant' ways laboratory medicine has contributed and is still contributing to medical diagnostics and research, particularly here in Ghana. The medical laboratory profession is not as limited as the masses have estimated. It is not surprising to hear someone say in Twi, "mo na mo hwe ebine ne dwonso no", meaning," you are the ones that just examine urine and stool". The ‘urine-stool syndrome' is not however, too far from the truth; diagnosis is achieved by documenting the presence in the patient or client of an agent known to cause the disease, either by visualising the agent directly in clinical material (urine, stool, tissue, aspirates, effusions, sputum, CSF, whole blood, serum etc.) obtained from the patient, or by cultivating the agent in the laboratory. Also, by detecting a specific product of the infectious agent in clinical material obtained from the patient, a product that could not have been produced without the agent's presence or by detecting an immunological response specific to the infecting agent in the patient's serum. Contributions have been made in such fields as Bacteriology, Clinical Endocrinology, Molecular Medicine and Genetics, Transfusion medicine, Oncology, Clinical Biochemistry, Virology, Clinical Pathology and Histopathology, Immunology, Pharmacology, Biomedical Engineering, Drug monitoring, Forensic Science and many other related field. I do not think it expedient for any lab medic who shares in these sentiments, to allow this noble profession to be driven through "the mud of limitation."

Laboratory medicine in Ghana by rigid definition is not yet a profession. It could be termed as just a ‘job' like any other. One of the requirements of profession is to have a professional association or council which regulates entry and practice of the profession. Anybody could just acquire a ‘container' and claim to run any of the basic laboratory tests and even sometimes claim ability to conduct certain specialised tests. One-room or mushroom laboratories have become a normal spectacle these days. Yes, there are no grounds for a complaint because; there are no standards, specifications or regulations against the sprouting of these mushroom laboratories. The ideal size of a laboratory and the tests such a laboratory could run has not been defined. Nobody even cares about the results these mushroom laboratories are churning out. The results being issued out by the laboratories of our teaching hospitals are sometimes given to slight drifts and shift from the ideal, how much more these mushroom laboratories? There is no credible external quality assurance to check these errors. To further worsen matters, most of these laboratories are the preferred stops for patients who need quick results because of the hustle and bustle at the district and regional hospital laboratories. But, who regulates them? Who gives accreditation for these laboratories to operate? Who gives accreditation to the staff to practise?  Proactive measures must be taken to arrest the spate of these mushroom laboratories.

The office of Biomedical Scientist in the hospital's organisational ladder has not been well defined and I beg to complain. The Lab medic over the years has been denied such extra important benefits such as hazard allowance, disdaining his or her direct exposure to pathogens. The poisonous notion which puts the lab medic on the lowest point of the health profession is most unhealthy. This is the time for change and I challenge for the formation of a "Ghana Biomedical Council". "Laboratory tests are requested and not demanded". Samples sent to the laboratory could be returned to whoever sent it, provided the sample is deemed inappropriate.  Ideally, every laboratory request form should have a slot for a brief clinical summary of the patient, this helps to recommend the right tests as well as acts as a guide in conducting the requested tests. The lab has over the years been known to lack the confidence to speak its mind although what is being ‘demanded' is not in the interest of the patient or the health personnel. The lab medic has the right to know where, from whom and how each sample brought to the lab was taken, but there is no legal and binding document that affirms all these ideals here in Ghana.

The Lab Medic has faced much discrimination and misnomer right from our institutions of learning right up to the professional level for far too long. Some of the people working in and operating the laboratories are not qualified and do not possess the analytical know-how required on the bench. Another setback is that, they go by the official titles one could only use if he or she had an HND (i.e. Medical Lab Technician), Degree or its equivalent (Biomedical Scientist/Medical Lab Technologist). A Pharmacist would not like to be addressed as a Dispenser or a Drug Counter attendant. In the same vein, a Nurse would not like to be addressed as a Ward Orderly. A doctor would not like it if a medical assistant was labelling himself as a medical doctor.  Not to say that the latter professions are less significant but, rankings and nomenclature of office is vital to any profession. T. H. Huxley (1825 - 1895) a biologist said, "One of the unpardonable sins, in the eyes of most people, is for a man to go about unlabelled. The world regards such a person as the police do an unmuzzled dog, not under proper control."The question now is; who then is qualified to work in the medical laboratory? Anybody! This is because; there is no council that regulates the practice of this ‘profession'. There is the need for a legislative instrument that would empower the Ghana Association of Biomedical Scientists to discharge its duty as a professional association.

The Ghana Association of Biomedical Scientists has been in a limbo with reference to the passage of a legislative instrument by parliament. The influx of second-rate auto analysers and laboratory equipment into the laboratory is one abhorring factor that places a dent on service quality. There have been occasions where analysers have broken down because of how they are either overworked or their bad quality. Most of these automated systems and equipment have been dumped by some so-called foreign suppliers. These second-hand machines have probably failed proficiency analyses so it is not surprising that erroneous results are yielded. Moreover, most of these analysers already have a bad reputation when it comes to proficiency assessments, I wouldn't like to mention brand names nor their distributors but as the aphorism goes "garbage in, garbage out", and who is blamed for this?

I was filled with a blend of surprise and disappointment when I entered the store room for lab supplies in one of our health facilities and noticed that most of the reagents which were to be stored at temperatures between 2-8°C were left to the mercy of the room's temperature which was well above 18°C. I would not like to go into the details of how they were shelved if at all they were.  The supply chain or cold chain for these reagents is not even conformed to. Reagents are being transported in the luggage compartments of coaches and cars. Some if not most laboratories in the country are not endowed with the savoir-faire in laboratory supply chain, not to talk of modern internal and external quality assessment procedures. It not expected in the face of these flaws to gain the dignity deserved from the ordinary Ghanaian not to talk of other health professionals. This has led many Biomedical Scientists to pursue greener pastures outside where the profession is better appreciated.

There is this axiom which states, "The lab man is the eye of the medical profession". He or she captures more than what is seen macroscopically and compliments this by giving his microscopic view of the clinical diagnosis. It is only the lab medic that can give at almost all times a definite diagnosis, provided the correct laboratory analysis is requested by the doctor or consultant, or is recommended by the Biomedical Scientist. Without the laboratory, the patient becomes more or less a guinea pig. As a result, there are a lot of sicknesses, especially in our country which are actually iatrogenic. I however, agree with the sceptics to a certain extent. What shows that the results being churned out by the laboratory is accurate enough and could be incorporated into the diagnostic process? Let us consider the following scenario: Lab A reports the fasting blood glucose level of a suspected diabetic patient to be 3.6mmol/L whilst another, lab B is reporting 9.8mmol/L for the same patient. Such an enormous disparity is completely unacceptable. The former result is indicative of a normal patient, whereas the latter could be indicative of a diabetic patient.  Assuming the former or the latter is right, which in this case is not known, what happens to the patient? That is a question for all stakeholders to answer. The presence of a regulatory body would check if not remedy the occurrence of such defaming and degrading occurrences which tarnish the image laboratory medicine is carving or itself.

Almost every scientific finding traces its roots from the laboratory; from the germ theory of Louis Pasteur through the discovery of Penicillin by Sir Alexander Fleming down to DNA by Crick and Watson, and now new areas being explored such as, genomics and proteomics. One could now even know his lifetime predisposition to certain diseases such as (age-related macular degeneration, CHD, Cohn's disease, multiple sclerosis and many others) via gene technology. The uncovering of the Ebola virus, HIV virus, H5N1 (SARS) virus and many others are contributions of the medical laboratory to medical research. Medical laboratory has a bright future in the health delivery system of this country. It takes a bit of pro-activeness on the part of our leadership, particularly those concerned with the health sector. This could be done by improving the facilities in our district and regional laboratories. This would involve upgrading instrumentation as well as personnel. This would go a long way to compliment the delivery of quality laboratory services as well as proper diagnosis of the patient. One of the best ways to assess any health facility is to examine critically their procedure of diagnosis, patients' care and treatment. Are tests considered as routine conducted? Is the patient monitored for any iatrogenic manifestations during treatment? Are pre-surgery tests conducted properly and accurately? Are internal and external quality assurance measures in place? These and many others are questions that require answers.

There is thus, an urgent need for a legislative instrument similar to the 1960 Professions Supplementary to the Medicine Act in the U.K which would enable the establishment of a council to provide for the registration of qualified lab medics, for regulating professional education and professional conduct as well as cancelling registration in cases of misconduct. Mention can be made of the Ghana Nurses and Midwives Council, the Ghana Pharmacy Council and the Ghana Medical Council, why not a "Ghana Biomedical Council?"  All stakeholders in this profession are to rise up and join in this age-long fight for the passage of a legislative instrument which would aid in regulating laboratory practice in Ghana, for the good of the nation as a whole. The quality of health delivery and the nation's human resource base depends on it.

About the Author

Emmanuel Kwame Teye, Age 22, Graduate Student( Ms.Cellular/Molecular Biology,Post Grad Cert. Biotechnology, Ball State University, Indiana, U.S.A

Is clinical laboratory science a good pre med degree?

Is clinical laboratory science a good pre med degree? I am a freshman in college trying to pick a major and I think that I want to become a doctor, but i realize that I may change my mind or that I may not be able to get into med school so I want an undergrad degree that will land me a good job and give me knowledge and skills that will easily translate in to other science and occupational fields. Also I loved playing with microscopes, bacteria and pipettes in my intro to bio lab class and would like a degree that involved a lot of lab classes.

Why sure it is. With enough science & lab education, you could eventually become a...

toxicologist
pathologist
medical examiner..I think there may be one or two more. I'm in the field of pathology (pathology assistant) and I love it. The pay is GRAND!

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