How misdiagnosis, quackery affect healthcare delivery

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At the heart of misdiagnosis crisis bedeviling the country’s healthcare delivery system are problems of quackery and lack of recognition for laboratory science professionals that should handle the diagnostic arm of medical practice, reports OLUWANDE DARE

It was one destructive surgery too many. Unlike many medical misdiagnoses that went unreported, the one that recently attracted the retributory justice of the Medical and Dental Council of Nigeria (MDCN) proved fatal for the patient as well as her doctor. At last, the tribunal set up by MDCN found Dr. Jamilu Muhammad guilty of gross negligence and incompetence, wielding the big stick in a celebrated trial that also put the medical profession on trial throughout the proceedings.

Muhammad, a doctor employee of the Martha Bamaiyi General Hospital in Zuru, Kebbi State, stood trial for mismanaging the case of a pregnant woman, Fatima Danjuma. Perhaps so as not to prolong the bad case, the doctor pleaded guilty to the one-count charge when it was read to him. Delivering ruling, the chairman of the tribunal, Abba Hassan, ordered the suspension of Dr. Muhammad for six months, stressing that a prima faciecase had been established against the respondent. He was suspended for six months.

According to the charge sheet (No MDODT/4/2018), Dr. Muhammad wrongly diagnosed that the baby in the womb of the victim was dead. On this erroneous premise, he went ahead to carry out a destructive surgery to evacuate the assumed dead baby before realising that the baby was alive after amputating the baby’s upper limb. “That you, Dr. Jamilu Muhammad, registered medical practitioner, practising as such on April 19, 2017 at the Martha Bamaiyi General Hospital, Zuru, Kebbi State, while managing one Malama Fatima Danjuma (F) as a pregnant woman under your care, were grossly negligent in her management when you assessed her in a manifestly incompetent manner, erroneously diagnosed her to have intrauterine foetal death, and proceeded to carry out a destructive surgery, only to realise that the baby was alive after amputating the prolapsed upper limb, thereby conducted yourself infamously in a professional respect contrary to rules,” the charge read. The charge was based on the affidavit issued by Elisha Nona Ajoyi dated and filed on May 8, 2017, alleging unethical behaviour against the respondent.

But Dr. Muhammad was not alone in the recurrent crisis of medical misdiagnosis; he was one of the 14 doctors arraigned for trial this year by the MDCN for similar offences of negligence and wrong diagnosis. Indeed, the country’s medical sector is replete with cases of misdiagnosis of ailments and attendant wrong treatments and avoidable loss of lives. Besides Dr. Muhammad’s travails, there was also a report of a couple who have been married for about 25 years, who went for check-ups and were given two conflicting test results. The man who said he knew his genotype to be AA was said to be AS while the wife was said to be AA. Not satisfied with the result, the couple went to another laboratory and this time, the wife was said to be AS and the husband AA. So in this case, their genotype fluctuated.

There was also a case of a lady simply known as R.A Aminu who narrated how she escaped being damaged through wrong diagnosis. According to Miss Aminu, it started with severe stomach pain towards the end of March this year and she proceeded to the hospital, but was treated for malaria and typhoid at Kubwa General Hospital in Abuja. However, after a week of being placed on medication, there was no sign of improvement. Rather, the pain became more so excruciating that she was forced to go back to the hospital to complain. She was asked to go for an abdominopelvic scan (which helps a doctor to see the organs, blood vessels and bones in the abdominal cavity). The scan “showed that I had umbilical hernia,” she said.

She was booked to see a doctor the following week because her diagnosis report came out during the weekend. “I was examined the following week by the consultant in charge of SOPD at the general hospital in Kubwa and he said it was indeed hernia and said the cost of operation alone is 170k,” she added. Again, she felt unsatisfied with the outcome of the medical laboratory test, and heeded the advice of her parents who asked that she should be brought to Lagos. It was a moment of relief when another round of test at the Lagos State University Teaching Hospital (LASUTH) in Ikeja, Lagos, showed that there was no sign of hernia. After doctors in LASUTH placed her on strong medications two days, she was fine again.

The list of victims of wrong diagnosis is endlessly long, which seems to be a pointer to the fact that quacks now run many of the country’s medical laboratories. Laboratory scientists say even public-owned health facilities are not exempted. Nigeria loses about $1.35 billion (359.2 billion) to medical tourism annually, which is in the region of the country’s annual budget for the health sector. Nigeria’s health budget for 2018 is about N350 billion, which represents 3.9 percent of the N8.6 trillion expenditure plan. It is also estimated that an average of 9,000 medical tours occur monthly from Nigeria to other countries, with India being the major beneficiary of 500 visits monthly. Sadly, many Nigerians who travel out of the country for their medical needs often go for medical laboratory tests as a result of low confidence in the outcomes (results) of tests carried out in medical laboratory facilities in the country.

Despite frequent shutdowns of laboratory facilities, it has not curbed the flooding of the profession by quacks who continue to churn out inaccurate results to the detriment of innocent patients. Findings also revealed that, in some cases, most of the equipment being in medical laboratories are obsolete and malfunctioning; yet because of economic gains, the laboratories still put them to use. This also suggests that the blames public always heap on doctors should actually go to the professionals manning the diagnostic arm of medical practice since doctors always rely on test results to administer treatment.

Speaking recently at the 50th anniversary celebration of MLSCN, former military Head of State, Gen Yakubu Gowon, identified quackery as a major threat to credibility of medical laboratory science practice in the country. An obviously saddened elder statesman said activities of quacks and unregistered medical laboratory scientists have eroded the public trust and confidence in the medical profession. The octogenarian, who bared his mind at an event to mark the 50th anniversary of the Medical Laboratory Science Council of Nigeria (MLSCN), which took place in Abuja, concluded that such nefarious practices have forced the people to resort to the option of self-help.

After congratulating MLSCN for its five decades of accomplishments in the medical service, the former Nigerian leader challenged its leadership to strengthen its systems so it could easily identify and punish people who fall short of minimum standards. While describing the influx of quacks into the health sector as disturbing, he urged the Federal Government to evolve policy initiatives that can eliminate quackery, reduce brain drain in the sector and discourage the growing trend of medical tourism, which he said, is drastically depleting the nation’s economic resources.

“It’s disturbing that with degree programmes in laboratory science in 25 universities, over 30, 000 medical lab scientists, 23.000 lab technicians and over 15,000 assistants, there are still growing incidences of quackery in the profession. Regrettably, it has been promoted by unqualified persons and a handful of qualified practitioners.

“Nigeria may not have met the ratio of medical laboratory scientists to the general population as recommended by the World Health Organisation (WHO), but there is no argument that great progress has been made. However, it’s time to step up policing and regulation activities to stamp out the activities of unregistered and quacks to minimise compromise in the quality of healthcare delivery in Nigeria,” he said.

The former head of state also called for alignment of all medical and regulatory councils under one umbrella to reduce rivalry among health professionals. Also at the event, former chairman of the governing board of MLSCN, Prof. Dennis Agbonlahor, equally decried the rivalry between pathologists and medical laboratory scientists. According to him, such issues would not arise if pathologists stuck to their functions and not trying to take over the functions of medical laboratory scientists. He enjoined both professionals to work together on diagnostic research to improve results for patients, adding that doing so would reduce medical tourism for diagnosis outside the country.

According to the national president of the Association of Medical Laboratory Scientists of  Nigeria (AMLSN), Dr. Bassey Enya Bassey, the crisis posed by quackery in the medical profession is even worse at the federal health institutions where there is an unwritten rule that favours micro biologists over and above professional medical laboratory scientists when recruiting workforce. He noted that no teaching hospital or any federal health institution has engaged or recruited medical laboratory scientists in the last 15 years, stressing that it is only micro biologists that are always favoured.

Bassey noted that the Federal Government does not care about the medical laboratory scientists. He buttressed his allegation by saying the way the Federal Government values laboratory scientists is reflected in the fact  that there is no coordinating point or department for medical laboratory services in the Federal Ministry of Health. “No coordinating point-department for the medical laboratory services. So nobody coordinating the activities of the over 65 tertiary centres in the country,” he added.  Bassey, who is obviously bitter with the system, also alleged that though laboratory scientists “generate a lot of funds from the laboratories; most of the fund does not even go into government coffers.”

But if claims about lack of official recognition for laboratory scientists and other issues are disputable, what is however not unclear is that the country is not battling with paucity of manpower in its diagnostic aspect of healthcare system. Records show that there are over 40,000 medical laboratory scientists, 24,000 medical laboratory technicians and 12,000 medical laboratory assistants in the country, even though the vast majority of these professionals are not found in government hospitals. According to medical professionals, the problem bedeviling Nigeria’s healthcare delivery is not just about quacks operating in the privately-owned laboratories all over the country, but also in public health institutions where they have refused to engage qualified hands

Attempts to address the situation have always been frustrated by the same hands managing the sector, Bassey said, stressing that the hospital environments are not conducive for medical laboratory scientist to function properly. In a recent presentation at the 13th annual public health lecture series, he highlighted the critical contributions of medical laboratory testing in disease surveillance and outbreaks response, clinical management and patient’s care as well as programme management of outbreaks, which he said are key to healthcare delivery.

“The problem in the Nigeria healthcare system is the way it is being run by the people running it. They are not health managers. Hospital administrators and managers have been pushed away by the doctors and that has done a lot of damage to the system,” he said. He also went ahead to accuse those managing public health facilities in the country of over-experimentation. “If you go to the hospital stores, you will see state of the art facilities purchased but not functional. The facilities are dead on arrival because hospital managers did not seek the input of laboratory scientists (before embarking on the purchase), but for economic opportunities and not healthcare reasons,” he said.

The consequence of all of these, Bassey concluded, is that the country may never achieve its dream of universal health coverage (UHC) for its citizens. While explaining the nexus between laboratory services and UHC, he said the work of a laboratory scientist is based on scientific evidence. “It has been shown that over 70 per cent of the data required for efficient patient management comes from medical laboratory.

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