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02.07.2021 Letter

A Letter To My Lover: Part 2

An Apologetic On Medical Laboratory Science In Ghana
By Pascal Sedor
A Letter To My Lover: Part 2
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I dare say that, as simple as “pushing our machine buttons” may look or seem the lab physicians of the GMA & GCPS cannot quality control & troubleshoot our analytical devices. I therefore found the 4th & 5th recommendations of the GMA to the Prof Ernest Aryeteey committee (on page 15 of committee’s report) very laughable & ridiculous. The recommendations were: “lab physicians to provide supervisory support & the need to rethink the scope of work for lab technologists since major aspect of our work is now automated”. In the logic of the GCPS, “they want to be given oversight responsibilities at the various labs for the training of their lab physicians by medical laboratory scientists (according to bullet 7 on page 11 of committee’s report) to equip them (lab physicians) with the skills needed to supervise us (medical laboratory scientists)”. WHO DOES THAT!!!

In this age of evidence-based medicine, MEDICAL LABORATORY SCIENTISTS play a central & irreplaceable role in confirmative diagnosis. Many conditions share the similar symptoms and can only be differentiated through medical laboratory investigations. For instance, malaria and enteric fever cannot be differentiated by virtue of the signs & symptoms but only through medical laboratory investigations. Diagnosis of megaloblastic anemias, lymphomas, hemolytic anemias, leukemias, sickle cell disease, etc. is conducted is carried out by medical laboratory scientists. Medical laboratory scientists do not only perform testing of patients’ samples but also interpret laboratory reports. For instance, on the face of the medical laboratory scientists can tell as though they are soothsayers: chronic alcoholic patients who don’t even open up on their alcohol consumption habits; patients with hepatobiliary obstruction (blockage of the blood vessels connected to the liver); liver damage of either viral or alcohol associated causes; patients with impaired kidney function; a loss of the liver’s synthetic functions among others – and not merely checking to see which laboratory result parameters are high or low as most physicians do.

In fertility testing, medical laboratory scientists diagnose and interpret results relating among other things to retrograde ejaculation (males discharging semen together with urine at the same time during sexual intercourse), teratozoospermia (structural defects in sperm cells) comprising sperm cells with heads too big or too small, double heads, double tails, etc.), oligospermia (low sperm counts), asthenozoospermia (movement defects including the slow sluggish & zigzag movement of sperm cells), azoospermia (a condition of absence of sperm cells in semen), cryptozoospermia (presence of sperm cells below detectable levels), etc.

In the bacteriology and mycology laboratories, our work includes but is not limited to: media preparation (“cooking food needed to support the growth of bacteria”); growing bacteria and fungi in the laboratory; “segregating microorganisms” into contaminants, commensals (microorganisms that are natural permanent & transient residents on parts of the human body) & pathogens (disease-causing organisms); testing a range of antibiotics on pathogenic bacteria; reporting sensitive (effective against pathogen) & resistant (not effective against pathogen) to the physician.

The physician then chooses from the list of sensitive antibiotics asking patient to “take one in the morning, one in the afternoon & one in the evening”.

The practice of medical laboratory science is neither simple nor about merely “pushing machine buttons” as many have been made to believe. A great deal of mental activity and supervision is performed even in those aspects carried out with the assistance of machines. The practice of medical laboratory science is preceded by a syllabus & course content for instruction in our schools. The subjects studied includes: pathophysiology of diseases, immunology, clinical chemistry (chemical pathology), cytotechnology, molecular biology, hematology, histopathology, parasitology, bacteriology, mycology, virology, anatomy, physiology, forensic science, radiology, biostatistics, pharmacology, health finance & management, laboratory management among others.

Medical laboratory science is recognized by the International Labor Organization (ILO) & the World Health Organization as a profession with its own body of knowledge which is distinct, separate & independent from the practice of medicine, pharmacy, nursing, etc. governed by a code of professional conduct & ethics both locally & internationally. Even a court of competent jurisdiction in Nigeria ruled on the independence and autonomy of medical laboratory science as a distinct profession from medicine and must be practiced, managed & headed by medical laboratory scientists.

The medical laboratory and its services are important for the purposes of health screening, disease diagnosis, prognosis, monitoring the progress of treatment, disease surveillance and public health among others.

Today, not only do we have technological advancements in manufacturing devices of “extreme sophistication and simplicity” to aid disease diagnosis but a sophistication in the training of medical laboratory professionals as well. Gone were the days when: there was training of bench trained laboratory professionals; when the highest academic credential one could acquire in Ghana was a certificate in medical laboratory (some of which were obtained from outside the shores of Ghana).

Today, we have the six-year Doctor of Medical Laboratory Science (MLSD) course offered by the University for Development Studies (UDS) in Tamale based on the recommendation by the West African Health Organization (WAHO) for the training of more sophisticated medical laboratory professionals & accredited by the National Accreditation Board (NAB). The 6-year MLSD program is not a PhD as misconstrued by many but a first degree just like the 6-year programs in: Doctor of Pharmacy (DPharm), Doctor of Optometry (OD), Doctor of Medicine & Surgery (MBChB).

Countless medical laboratory professionals have acquired MSc, MPhil & PhD in specialty areas of both medical laboratory science & other fields.

We produced 88 out of 216 Foundation Fellows of the West African Postgraduate College of Medical Laboratory Science (FWAPCMLS) at the College’s maiden induction & investiture ceremony held on 22nd & 23rd February 2020 in Lagos, Nigeria.

Faculties and specialty areas in the WAPCMLS are:

Medical Bacteriology

Mycology

Medical Virology

Hematology

Medical Parasitology/Entomology

Forensic Science

Clinical Chemistry

Blood Transfusion Science

Cellular Pathology/Cytology

Cytogenetics

Immunology

Molecular Diagnostics/Translational Science

Laboratory Management/Leadership & Biomedical Instrumentation

General Medical Laboratory Practice

Veterinary Laboratory Technology

The practice of medical laboratory in Ghana has come of age but not without its attendant challenges chief among them include the: non-implementation of the National Health Laboratory Policy (NHLP); lack of a line of progression for the profession; neglect and poor recognition of medical laboratory practice by decision and policy makers; very poor remuneration of medical laboratory professionals in spite of our hard work and the highest levels of risk we are exposed to in the hospital environment. Medical laboratory professionals have provided quality diagnostic services in very deplorable working and economic conditions. Medical laboratory scientists have remained the unseen & poorly recognized heroes in our healthcare industry. It is an indelible fact that “until the lion gets its own historian, the tales of hunting will always glorify the hunter” – it is time all Ghanaians got interested in telling the tales, championing & advocating issues of medical laboratory science in Ghana!

The Ghana Association of Medical Laboratory Scientists (GAMLS) has been the nation’s loudest voice advocating to government, policy & decision makers for an improvement of the country’s “medical laboratory architecture”. From 2010 to 2013, the Centre for Disease Control & Prevention (CDC), Atlanta – USA collaborated with the Ministry of Health (MoH), Ghana to develop the National Health Laboratory Policy (NHLP), National Health Laboratory Accreditation Policy (NHLAP) & National Health Laboratory Strategic Plan. This project was sponsored by the government of the United States of America (USA) to the tune of about $1.5 million of the American taxpayer’s money.

Several calls and attempts including industrial actions in 2016 & 2018 by the professional association GAMLS to have the policy implemented unfortunately yielded little to no results. I therefore found it necessary petitioning Dr. Anthony Nsiah-Asare, the presidential advisor on health in publication of May 2020 titled “AN OPEN LETTER TO THE PRESIDENTIAL ADVISOR OF HEALTH” after he professed love for laboratory professionals. That gave many citizens the opportunity to know learn about the main problems confronting the “national laboratory architecture” – that too unfortunately yielded no results. The NHLAP was to aid us a country get more internationally accredited ISO 15189:2012 laboratories in the country. Unfortunately, the number of internationally accredited ISO 15189:2012 laboratories in Ghana today are less than five (5). The international standard for medical laboratories, “ISO 15189:2012 can be used by medical laboratories in developing quality management systems and assessing their own competence.it can be used for confirming or recognizing the competence of medical laboratories by customers, regulating authorities & accreditation bodies”.

Claims by the GMA that the implementation of the NHLP in its current state led by a credible & institution of high repute like the CDC is disastrous to our citizens and health laboratory system is ridiculous. Claims by the Ghana Medical Association (GMA) & Ghana College Physicians Surgeons (GCPS) that they were not consulted for their inputs into the NHLP document is completely false as their views were voted out at stakeholder level. Claims by the Chief Director of the MoH, Mr. Kwabena Boadu Oku-Afari that the NHLP in its current state is draft is VERY FALSE because the Minister of Health (Hon. Hanny Sherry Ayittey) and Director General of the Ghana Health Service (Dr Appiah Denkyira) at the time appended their signatures to the finalized NHLP document in 2013.

PLEASE WATCH OUT FOR PART 3

Written by:

Pascal Sedor

Medical Laboratory Professional

Member, GAMLS National Communications Team

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