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Rising wrong diagnoses in Nigerian hospitals worrisome – Ofungwu, medical equipment supplier

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The Executive Director of ISN Products Nigeria Limited, Felix Ofungwu, speaks to ALEXANDER OKERE about role of medical lab scientists in the health care system as well as the need for better funding of the sector

COVID-19 is currently the world’s biggest challenge and many countries are increasing testing to reduce and manage the spread of the virus. Do you think Nigerian medical lab scientists have been playing their role satisfactorily in the fight against the pandemic?

They are playing the role that they should be playing, which is to run the tests accurately and give accurate results. It introduces this whole idea of quality in medical lab practice, making sure that you are running tests and issuing results that are error-free, that you are not saying something is positive when it is, in fact, negative and vice versa. And in order for you to do that, a lot of things have to happen and studies have shown that in a lot of cases where there are errors in lab practice, it occurs actually in what we call the pre-analytical stage.

So, it is before the tests are actually run that the errors are introduced into the system, through how the specimen is collected – if it is a blood specimen, how the blood is drawn from the patient, how it is handled and how it is stored. So, when there are errors in the system, a lot of them are introduced at that stage. Let’s assume that that goes smoothly, the next questions are: What kind of machine is being used? Are they quality machines? Are they machines that are well-maintained, well-calibrated? Are you running the right quality control processes on the machines? If we assume that that is done correctly, then in the post-analytical stage, how are you getting the results out? How are you managing the results to avoid errors associated with saying that patient A has this result, whereas it belongs to patient B?

Then there are other post-analytical processes that go on, quality assurance and so on and so forth. So, along that value chain, there are numerous possibilities for errors to be introduced and what a good lab scientist should be doing is ensuring that they are following the right quality protocols in running tests from the beginning to the end.

With regards to COVID-19, can you shed some light on the danger inherent in giving out wrong diagnosis?

In general, misdiagnoses can be a matter of life or death. Unfortunately, the situation is that people are treated for the wrong disease or, in some cases, they are not treated at all because the tests don’t reveal anything to be wrong with the patient. So, the disease might continue to fester and develop without any kind of therapy because a patient was misdiagnosed or a patient gets the wrong medications treating the wrong disease.

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But we have some knowledgeable, disciplined and talented medical lab scientists in Nigeria. We recently introduced an initiative called Medical Lab Scientist of the Year (award). The process of actually arriving at the winners was comprehensive. Throughout that process, one thing I came across was that we actually have some very high quality, disciplined and talented medical lab scientists in this country and they can compete with anyone anywhere in the world in their field.

Why does it appear that they don’t get that front-row recognition in Nigeria?

What sometimes hinder their development and progress are environmental factors and the kind of infrastructure they have to work with and the systems in which they work. But in terms of knowledge, yes, they (lab scientists) are very good. So, in addition to continuing training for them and providing them with professional development opportunities, we should ensure that we are fixing the environment in which they operate, by making sure they have the right machines, making sure that proper laboratory practices become the standard.

Many initiatives aimed at rewarding professionalism and excellence among Nigerians usually start with fanfare but soon become moribund because they could not be sustained. How do you plan to sustain yours?

One of the things we hope to achieve with the initiative is recognising the contributions of lab scientists. We call them the unsung heroes – the ones in the background that do what they do to make sure that things happen the way they should happen within the health care system. And very rarely do people recognise the part that they play and the contributions that they make in the entire health care space. So, what we hoped to do was to recognise their contributions more publicly and really celebrate quality in medical laboratory practices. That is why the criteria for selecting the finalists for the award were very comprehensive; we really tested for everything to make sure we got the best. By doing that, inherently, you are celebrating quality.

The plan is to have the event annually and run it for as long as we can run it. We are committed to the cause of recognising laboratory scientists; it is a community that we are very close to. They are essential to what we do as a company. And I think that is going to change as a long as we have the resources, good health and life.

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Do you have any plan to expand the award, in terms of coverage and prize money, to accommodate more recipients?

The planning team talked about this last year (2020) when we did the post-mortem of the event. There is a possibility to expand it. We have operations in Nigeria and Ghana, as ISN, so we talked about a possibility, for example, of making it a West African event, perhaps, even setting up a competition among countries. It is possible. We will definitely look at that. We have quite a few medical lab scientists in government that are working; there is no doubt about that.

In November 2020, the Federal Government raised the alarm over the use of fake COVID-19 test results by some travellers and misdiagnosis has been a challenge in Nigeria’s health sector. What are your thoughts about that?

Am I worried about the trend of misdiagnosis in Nigeria? Absolutely, yes. Do I think there are laboratories operating in Nigeria that don’t have the right credentials and equipment and don’t follow the right protocols? Yes, there are. But there are a host of laboratories that do the right thing, employ the right laboratory scientists, invest in the right equipment and follow the right protocol. I’m quite interested in celebrating those and, perhaps, using that as a way to encourage others to really follow suit.

The Medical Laboratory Science Council of Nigeria has really played a big role in ensuring that their professionals are well-accredited and trained. It is doing a good job in setting the standards and enforcing the standards in medical laboratory practice in Nigeria. I don’t think there is any area where there cannot be improvements anywhere in the world. We are excited about working with them to ensure that those standards are, in some cases, elevated and that the enforcement mechanisms are strengthened.

Can you be specific with what you think can be done to strengthen enforcement?

Some of the things that I think will be helpful are ensuring that more labs become accredited and certified and more labs run external quality assurance programmes that can validate the results that come out of the labs, and more lab scientists pursue medical education and development programmes.

How do you rate government’s investment in laboratory and hospital equipment necessary to fight the scourge?

I will say that some of the very big equipment that we have in the country for testing COVID-19, especially large volumes of test, are housed in government facilities. I think of places like the National Reference Laboratory in Abuja. This is where the government has sophisticated equipment that is designed to run huge volumes of tests for all types of diseases, including COVID-19. So, we cannot deny that there have been some laudable contributions from the government in this area. Could they be more? I guess everybody could always do more. Every government could do more.

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What has been your relationship with government agencies in the supply of modern medical equipment to public health institutions across the country?

A big part of our customer base is made up of either federal or state government hospitals or laboratories. There are a number of them that buy from us and have bought from us over the years. Some of the large and sophisticated equipment that we have distributed over the years usually, the first place that we put them is in a government hospital or facility. And that continues. Some of the most sophisticated equipment that could fill up a whole room are currently located in government facilities. We have had a mutually beneficial relationship with the government over the years.

The dearth of equipment in public hospitals is still a big challenge in Nigeria’s health sector. How do you think public-private partnership can help to solve the problem?

We’ve seen a few successful PPP models and initiatives. I think a big part of it depends on which ‘P’ is involved – who is on the public side and who is on the private side – and whether there is a real commitment to doing things the right way and getting things right. If the commitment is there and strong and protected with the right legal structure, then, yes, it (PPP) can work. Both the public and private sides have a lot to contribute and from different angles as well. If the commitment is there, then that combination of their contributions can be very powerful.

I think that the priority given to research in general, whether it is health care research or research in other areas, can be improved and increased. I also think that investment in health care in general, research inclusive, can be much better. Nigeria is one of the signatories to the Abuja Accord signed in 2001 by members of the African Union. And a big part of it was this commitment of 15 per cent of each member country’s national budget to health care. I thought it was a sincere effort to improve health care across the continent. Unfortunately, our share of the budget that is devoted to health care over the years hovers around three per cent versus the 15 per cent commitment that was required. So, we have a long way to go in terms of ensuring that proper resources are put into health care, including health care research.

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