| In medical practice and medical research undertakings, | | | | to be addressed as a Ward Orderly. A doctor would |
| the laboratory has played and still plays a vital role, | | | | not like it if a medical assistant was labelling himself as |
| one which has sadly not been acknowledged by the | | | | a medical doctor. Not to say that the latter |
| masses, especially, here in Ghana. Laboratory tests | | | | professions are less significant but, rankings and |
| have however become very vital in diagnosis. Many | | | | nomenclature of office is vital to any profession. T. H. |
| people are not informed of the incalculable inputs of | | | | Huxley (1825 - 1895) a biologist said, "One of the |
| the laboratory in diagnosis and treatment. | | | | unpardonable sins, in the eyes of most people, is for |
| Measurement of hormone levels ascertains endocrine | | | | a man to go about unlabelled. The world regards such |
| diseases. Enumeration of different kinds of cells in the | | | | a person as the police do an unmuzzled dog, not |
| blood, called a differential count, helps pinpoint | | | | under proper control."The question now is; who then |
| anaemia and some kinds of malignancies. The culturing | | | | is qualified to work in the medical laboratory? |
| of body fluids or tissues to show the presence of | | | | Anybody! This is because; there is no council that |
| specific microorganisms is essential to rational | | | | regulates the practice of this ‘profession'. There |
| treatment of infections with antibiotics. There are | | | | is the need for a legislative instrument that would |
| numerous patients that are be that as it may being | | | | empower the Ghana Association of Biomedical |
| misdiagnosed in this scientific age of evidence-based | | | | Scientists to discharge its duty as a professional |
| medicine. A number of individuals have been | | | | association. |
| repeatedly misdiagnosed of having malaria rather than | | | | The Ghana Association of Biomedical Scientists has |
| other relatively more life-threatening ailments like | | | | been in a limbo with reference to the passage of a |
| leukaemia and typhoid fever. | | | | legislative instrument by parliament. The influx of |
| Certain tests considered routine tests are not | | | | second-rate auto analysers and laboratory equipment |
| requested for and many other definitive tests or | | | | into the laboratory is one abhorring factor that places |
| specialised tests are not even explored, because of | | | | a dent on service quality. There have been occasions |
| lack of education with respect to those specialised | | | | where analysers have broken down because of how |
| tests. Biomedical Scientists should not hesitate to | | | | they are either overworked or their bad quality. Most |
| recommend for such specialised tests to be | | | | of these automated systems and equipment have |
| conducted when the need arises. Seminars should be | | | | been dumped by some so-called foreign suppliers. |
| organised to educate health workers who are | | | | These second-hand machines have probably failed |
| concerned, in order for the right tests to be | | | | proficiency analyses so it is not surprising that |
| requested and the right thing to be done. The patient | | | | erroneous results are yielded. Moreover, most of |
| would thus, leave the consulting room, theatre or the | | | | these analysers already have a bad reputation when |
| ward realising the contributions made to his or her | | | | it comes to proficiency assessments, I wouldn't like |
| recuperation. | | | | to mention brand names nor their distributors but as |
| There are many reasons why laboratory practice has | | | | the aphorism goes "garbage in, garbage out", and |
| not been able to "put on its good cloth." However, it | | | | who is blamed for this? |
| would be expedient to make mention of some of | | | | I was filled with a blend of surprise and |
| the ‘insignificant' ways laboratory medicine has | | | | disappointment when I entered the store room for |
| contributed and is still contributing to medical | | | | lab supplies in one of our health facilities and noticed |
| diagnostics and research, particularly here in Ghana. | | | | that most of the reagents which were to be stored |
| The medical laboratory profession is not as limited as | | | | at temperatures between 2-8°C were left to the |
| the masses have estimated. It is not surprising to | | | | mercy of the room's temperature which was well |
| hear someone say in Twi, "mo na mo hwe ebine ne | | | | above 18°C. I would not like to go into the details |
| dwonso no", meaning," you are the ones that just | | | | of how they were shelved if at all they were. The |
| examine urine and stool". The ‘urine-stool | | | | supply chain or cold chain for these reagents is not |
| syndrome' is not however, too far from the truth; | | | | even conformed to. Reagents are being transported |
| diagnosis is achieved by documenting the presence in | | | | in the luggage compartments of coaches and cars. |
| the patient or client of an agent known to cause the | | | | Some if not most laboratories in the country are not |
| disease, either by visualising the agent directly in | | | | endowed with the savoir-faire in laboratory supply |
| clinical material (urine, stool, tissue, aspirates, | | | | chain, not to talk of modern internal and external |
| effusions, sputum, CSF, whole blood, serum etc.) | | | | quality assessment procedures. It not expected in |
| obtained from the patient, or by cultivating the agent | | | | the face of these flaws to gain the dignity deserved |
| in the laboratory. Also, by detecting a specific | | | | from the ordinary Ghanaian not to talk of other |
| product of the infectious agent in clinical material | | | | health professionals. This has led many Biomedical |
| obtained from the patient, a product that could not | | | | Scientists to pursue greener pastures outside where |
| have been produced without the agent's presence or | | | | the profession is better appreciated. |
| by detecting an immunological response specific to | | | | There is this axiom which states, "The lab man is the |
| the infecting agent in the patient's serum. | | | | eye of the medical profession". He or she captures |
| Contributions have been made in such fields as | | | | more than what is seen macroscopically and |
| Bacteriology, Clinical Endocrinology, Molecular Medicine | | | | compliments this by giving his microscopic view of |
| and Genetics, Transfusion medicine, Oncology, Clinical | | | | the clinical diagnosis. It is only the lab medic that can |
| Biochemistry, Virology, Clinical Pathology and | | | | give at almost all times a definite diagnosis, provided |
| Histopathology, Immunology, Pharmacology, | | | | the correct laboratory analysis is requested by the |
| Biomedical Engineering, Drug monitoring, Forensic | | | | doctor or consultant, or is recommended by the |
| Science and many other related field. I do not think it | | | | Biomedical Scientist. Without the laboratory, the |
| expedient for any lab medic who shares in these | | | | patient becomes more or less a guinea pig. As a |
| sentiments, to allow this noble profession to be | | | | result, there are a lot of sicknesses, especially in our |
| driven through "the mud of limitation." | | | | country which are actually iatrogenic. I however, |
| Laboratory medicine in Ghana by rigid definition is not | | | | agree with the sceptics to a certain extent. What |
| yet a profession. It could be termed as just a | | | | shows that the results being churned out by the |
| ‘job' like any other. One of the requirements of | | | | laboratory is accurate enough and could be |
| profession is to have a professional association or | | | | incorporated into the diagnostic process? Let us |
| council which regulates entry and practice of the | | | | consider the following scenario: Lab A reports the |
| profession. Anybody could just acquire a | | | | fasting blood glucose level of a suspected diabetic |
| ‘container' and claim to run any of the basic | | | | patient to be 3.6mmol/L whilst another, lab B is |
| laboratory tests and even sometimes claim ability to | | | | reporting 9.8mmol/L for the same patient. Such an |
| conduct certain specialised tests. One-room or | | | | enormous disparity is completely unacceptable. The |
| mushroom laboratories have become a normal | | | | former result is indicative of a normal patient, |
| spectacle these days. Yes, there are no grounds for | | | | whereas the latter could be indicative of a diabetic |
| a complaint because; there are no standards, | | | | patient. Assuming the former or the latter is right, |
| specifications or regulations against the sprouting of | | | | which in this case is not known, what happens to the |
| these mushroom laboratories. The ideal size of a | | | | patient? That is a question for all stakeholders to |
| laboratory and the tests such a laboratory could run | | | | answer. The presence of a regulatory body would |
| has not been defined. Nobody even cares about the | | | | check if not remedy the occurrence of such |
| results these mushroom laboratories are churning out. | | | | defaming and degrading occurrences which tarnish |
| The results being issued out by the laboratories of | | | | the image laboratory medicine is carving or itself. |
| our teaching hospitals are sometimes given to slight | | | | Almost every scientific finding traces its roots from |
| drifts and shift from the ideal, how much more these | | | | the laboratory; from the germ theory of Louis |
| mushroom laboratories? There is no credible external | | | | Pasteur through the discovery of Penicillin by Sir |
| quality assurance to check these errors. To further | | | | Alexander Fleming down to DNA by Crick and |
| worsen matters, most of these laboratories are the | | | | Watson, and now new areas being explored such as, |
| preferred stops for patients who need quick results | | | | genomics and proteomics. One could now even know |
| because of the hustle and bustle at the district and | | | | his lifetime predisposition to certain diseases such as |
| regional hospital laboratories. But, who regulates | | | | (age-related macular degeneration, CHD, Cohn's |
| them? Who gives accreditation for these laboratories | | | | disease, multiple sclerosis and many others) via gene |
| to operate? Who gives accreditation to the staff to | | | | technology. The uncovering of the Ebola virus, HIV |
| practise? Proactive measures must be taken to | | | | virus, H5N1 (SARS) virus and many others are |
| arrest the spate of these mushroom laboratories. | | | | contributions of the medical laboratory to medical |
| The office of Biomedical Scientist in the hospital's | | | | research. Medical laboratory has a bright future in the |
| organisational ladder has not been well defined and I | | | | health delivery system of this country. It takes a bit |
| beg to complain. The Lab medic over the years has | | | | of pro-activeness on the part of our leadership, |
| been denied such extra important benefits such as | | | | particularly those concerned with the health sector. |
| hazard allowance, disdaining his or her direct exposure | | | | This could be done by improving the facilities in our |
| to pathogens. The poisonous notion which puts the | | | | district and regional laboratories. This would involve |
| lab medic on the lowest point of the health | | | | upgrading instrumentation as well as personnel. This |
| profession is most unhealthy. This is the time for | | | | would go a long way to compliment the delivery of |
| change and I challenge for the formation of a "Ghana | | | | quality laboratory services as well as proper diagnosis |
| Biomedical Council". "Laboratory tests are requested | | | | of the patient. One of the best ways to assess any |
| and not demanded". Samples sent to the laboratory | | | | health facility is to examine critically their procedure |
| could be returned to whoever sent it, provided the | | | | of diagnosis, patients' care and treatment. Are tests |
| sample is deemed inappropriate. Ideally, every | | | | considered as routine conducted? Is the patient |
| laboratory request form should have a slot for a brief | | | | monitored for any iatrogenic manifestations during |
| clinical summary of the patient, this helps to | | | | treatment? Are pre-surgery tests conducted properly |
| recommend the right tests as well as acts as a guide | | | | and accurately? Are internal and external quality |
| in conducting the requested tests. The lab has over | | | | assurance measures in place? These and many |
| the years been known to lack the confidence to | | | | others are questions that require answers. |
| speak its mind although what is being ‘demanded' | | | | There is thus, an urgent need for a legislative |
| is not in the interest of the patient or the health | | | | instrument similar to the 1960 Professions |
| personnel. The lab medic has the right to know | | | | Supplementary to the Medicine Act in the U.K which |
| where, from whom and how each sample brought to | | | | would enable the establishment of a council to |
| the lab was taken, but there is no legal and binding | | | | provide for the registration of qualified lab medics, for |
| document that affirms all these ideals here in Ghana. | | | | regulating professional education and professional |
| The Lab Medic has faced much discrimination and | | | | conduct as well as cancelling registration in cases of |
| misnomer right from our institutions of learning right | | | | misconduct. Mention can be made of the Ghana |
| up to the professional level for far too long. Some of | | | | Nurses and Midwives Council, the Ghana Pharmacy |
| the people working in and operating the laboratories | | | | Council and the Ghana Medical Council, why not a |
| are not qualified and do not possess the analytical | | | | "Ghana Biomedical Council?" All stakeholders in this |
| know-how required on the bench. Another setback is | | | | profession are to rise up and join in this age-long fight |
| that, they go by the official titles one could only use | | | | for the passage of a legislative instrument which |
| if he or she had an HND (i.e. Medical Lab Technician), | | | | would aid in regulating laboratory practice in Ghana, |
| Degree or its equivalent (Biomedical Scientist/Medical | | | | for the good of the nation as a whole. The quality of |
| Lab Technologist). A Pharmacist would not like to be | | | | health delivery and the nation's human resource base |
| addressed as a Dispenser or a Drug Counter | | | | depends on it. |
| attendant. In the same vein, a Nurse would not like | | | | |