RAISING MEDICAL LABORATORY SCIENCE FROM DEATH IN NIGERIA

MEDICAL LABORATORY SCIENTISTS: A CLEAR CASE OF ANACHRONISTIC PROFESSIONAL INTRUSION INTO MEDICAL PRACTICE IN THE HISTORY OF NIGERIA HOSPITAL SETTINGS; A CLARION CALL TO PURGE THE SYSTEM, AND RAISE MEDICAL LABORATORY SCIENCE PROFESSION FROM DEATH

The relevant laws that will apply to the above subject matter include :
a.  The Medical and Dental Practitioners Act No 23 of 1988 (MDPA)
b.  Medical Laboratory Science Council of Nigeria Act No 11 of 2003 (MLSCNA)
c. The Teaching Hospital Act/Laws of different Teaching Hospitals in Nigeria

ISSUE FOR DETERMINATION
Whether Medical Laboratory Science is a hospital-based profession

ARGUMENT
The issue of laboratories in hospitals has generated controversies. However, the name of the laboratory practised in a hospital determines who operates the laboratory. Is it a pathology laboratory or medical laboratory?  These are two different types of laboratories created for purposes exclusive to them. While some of the laws establishing a Teaching Hospital may specifically call it pathology laboratories, others just call it laboratory. No Teaching Hospital Law or Act creates medical laboratories because medical laboratories are not meant for hospital patient management. This shall be seen shortly when the clear provisions of the MLSCNA will be reproduced for emphasis and clarity, where it defined medical laboratory science profession.

Teaching Hospital Act/Laws, the establishing laws of Teaching Hospitals, stipulated the name of the laboratory to be operated in the hospital as just laboratories. This now casts doubt on the type of laboratory referred to. However, this doubt appears to have been removed by the mentioned categories of workers obtainable in Teaching Hospitals, namely MEDICAL PRACTITIONERS, PHARMACISTS, MIDWIVES, NURSES and Members of other professions and calling. See section 8(6) of the Act.

The medical laboratory science profession is clearly not included. In fact, in the whole length and breath of these establishing laws, there is no mention of medical laboratory science or medical laboratory. Expressio unius est exclusio alterius.

Going still further, section 3 of ESUT Teaching Hospital Law (a state Teaching Hospital) established the hospital as " a Specialist Hospital to be known as the University College Teaching Hospital Parklane Enugu, which shall be capable of providing such facilities usually provided in medical schools forming part of a university for the instruction of medical students in such subjects as are usually taught in such schools".

This provision is as crystal as clear. ESUT Teaching Hospital Parklane (like other Teaching Hospitals in Nigeria) is established to teach medical students. Medical students according to this same law means undergraduate medical students and postgraduate medical students. It does not include medical laboratory scientists. In the course of the training of the medical student, he is taught pathology in Teaching Hospital Pathology laboratories in his 3rd MBBS medical undergraduate year. For those doctors that go ahead to specialize in pathology at the postgraduate level, they are also taught pathology in Teaching Hospital Pathology laboratories in their Part1 and Part2 programs after which they become consultants in the field of Pathology. No medical student undergoes training in medical laboratory science. This field is not part of the medical training.

Therefore, it is obvious the laboratories referred to are pathology laboratories manned by medical practitioners, and not medical laboratory science laboratories manned by medical laboratory scientists. These two laboratories are not the same thing.

The laws/Act also gave Teaching Hospital Boards the function and authority to manage the Hospital. See section 11of ESUTTH Law and section 7 of Teaching Hospital Act which provide for the functions of the Boards:
(a)  to equip, maintain and operate the Hospital so as to provide facilities for diagnostic, curative, promotive and rehabilitative services in MEDICAL TREATMENT;
(b)  to construct, equip, maintain and operate such training schools and similar institutions as the Board considers necessary for providing the Hospital at all times with proper staff of hospital TECHNICIANS and NURSES.
(c)  to construct, equip, maintain and operate such clinics,  out-patient departments, laboratories, research or experimental stations and other like institutions as the Board considers necessary for efficient functioning of the Hospital.

An obvious emphasis in (a) above is on medical treatment. As we shall see later, in the law creating medical laboratory science, the emphasis in medical laboratory science profession is in medical laboratory treatment. Medical treatment and medical laboratory treatment are two different entities wide apart. While medical treatment involves treatment of the patients, medical laboratory treatment involves treatment of samples and equipment used and analyzed in the medical laboratory. Medical treatment involves the treatment of a whole human being by giving medications or operating on the person, while medical laboratory treatment involves the treatment of samples like blood or urine by adding chemicals to them in a sample bottle to preserve them for analysis. Samples taken from humans deteriorate unless they are treated immediately after collection. The samples are mixed with chemicals and reagents which preserve them in a particular state till they are analyzed. This is called medical laboratory treatment.

The import of (b) above is that the Board can operate training schools for nurses and technicians. Technicians are a group of hospital staff that can be trained within the hospital setting to help with the analysis of specimens. They also include Orderlies, Messengers etc. Some technicians who work in pathology laboratories, are thus trained within the hospital setting, according to (b)  provision above, and they help out with sample analysis.
As regards training of nurses within the Teaching Hospital setting, some Teaching Hospitals already have Nursing Schools where nurses are churned out for the Hospital activities and functions. Some Teaching Hospitals at the moment have not started running a school for the technicians, rather, medical laboratory scientists/technicians/technologists are employed to fill in that gap, pending the time the Hospital Management Boards decide to expand and operate the school by virtue of section 20(1) of the ESUT Teaching Hospital Parklane Enugu Law 2006. It is because the medical laboratory scientists can do the analysis part of medical laboratory technicians' job, as the scientists undergo some training in sample analysis, albeit for a different purpose from the purpose of the pathologists. For that end, their work stops at the analysis section of the pathology laboratories.

The Act creating medical laboratory science came into force in 2003. The law creating ESUT Teaching Hospital Parklane came into force on 20th April, 2006. No mention was made in ESUT Teaching Hospital Parklane Enugu Law of the profession of medical laboratory science that was already in existence before the ESUT Law. That was not an oversight. It was a calculated decision of Legislature not to include an irrelevant profession in ESUT Teaching Hospital Parklane. Rather, Board was empowered by law to establish schools, to train sample analysts (technicians) that would assist pathologists in pathology laboratories at the analysis section of Pathology laboratories. This same group of staff now want to head the pathology departments.

The import of (c) above is also very clear. It states : "to construct, equip, maintain and operate such clinics,  out-patient departments, laboratories, research or experimental stations and other like institutions as the Board considers necessary for efficient functioning of the Hospital."

Arranging it for easier and better understanding, the Board has the power "to construct, equip, maintain and operate such clinics,  out-patient (departments, laboratories, research or experimental stations) and other like institutions as the Board considers necessary for efficient functioning of the Hospital. In other words, such outpatient departments, out-patient laboratories, out-patient research station or out-patient experimental stations, are to be established according as the Board considers. Note the disjunctive in RESEARCH OR EXPERIMENTAL STATIONS. This is in direct contradiction to the conjunctive used in Medical Laboratory Science Council of Nigeria Act No 11 of 2003 (MLSCNA). Therefore, the hospital management Board could run out-patient laboratories, not medical laboratories. This is the killer. Out-patient laboratory, as the name implies, is operated for patients. It is not a place for production, design or fabrication of equipment, as is the case with medical laboratory science. Out-patient laboratory is a Pathology laboratory. It is specifically created for medical treatment of patients.

Section 20(1) of ESUT Teaching Hospital Law also states that "The Board shall be responsible for laying down general policies and guidelines relating to major expansion programs of the Hospital and the provision of facilities for the training of medical students of the University and it shall be the duty of Board to execute such policies and to keep within such guidelines ". This statutory duty has been diligently followed by the Board. At no point in the history of ESUT Teaching Hospital Parklane Enugu, did the Board expand the hospital to include a medical laboratory science laboratories. The hospital Organogram only has pathology laboratories in it; there is no space for medical laboratory science which is involved with design and fabrication of equipment.

Section 5(5) of Teaching Hospital Act and section 9 of ESUTTH Law state that, Subject to this Act/law, the Board shall have power to appoint (including power to appoint on promotion and transfer and of confirmation of appointments) , advance, terminate or discipline employees (including consultants) holding or acting in any office in the Hospital; and any such appointment shall be made having due regard to any personnel establishment approved for the Hospital. The Teaching Hospital Management Boards have never created any medical laboratory science departments. In fact, it is not in the contemplation of the Management Boards of Teaching Hospitals to create departments that have no legal basis or use for the Hospitals.

For the avoidance of doubt, the meaning of pathology and medical laboratory science are covered by law with that of medical laboratory science being comprehensive and circumscribed.

Pathology as a field is provided for in Medical and Dental Practitioners Act (MDPA) . Section 1(2)(e) MDPA states the functions of Medical and Dental Council of Nigeria (MDCN) as: "making regulations for the operation of CLINICAL laboratory practice in the field of PATHOLOGY which includes Histopathology, Forensic Pathology, Autopsy and Cytology, Clinical Cytogenetics, Haematology, Medical Micro-biology and Medical Parasitology, Chemical Pathology, Clinical Chemistry, Immunology and Medical Virology". The emphasis here is on CLINICAL laboratory. It shall be seen that in this Act, legislature used clinical laboratory, and not medical laboratory, a clear indication that clinical laboratory (not medical laboratory)  is the laboratory meant for the Hospitals.

The definition of medical laboratory science is provided in Medical Laboratory Science Council of Nigeria Act (MLSNCA). In the paragraph in section 29 Medical Laboratory Science Council of Nigeria Act No 11 of 2003 (MLSCNA) :

“Medical Laboratory Science”- "Means the practice involving the analysis of human or animal tissues, body fluids, excretions, production of biologicals, design and fabrication of equipment for the purpose of MEDICAL LABORATORY diagnosis, treatment and research; and includes medical microbiology, clinical chemistry, chemical pathology, haematology, blood transfusion science, virology, histopathology, histochemistry, immunology, cytogenetic, exfoliative cytology parasitology, forensic science, molecular biology, laboratory management; or any other related subject as may be approved by the Council".

The emphasis here is on medical laboratory diagnosis, treatment and research. It clearly did not use the qualifier CLINICAL, because this type of laboratory is not for clinical purposes.
The difference between pathology and medical laboratory science is clear,calculated and intentional, wrought by Legislature to avoid ambiguity. Hence it is settled principle of law that Legislature does not employ words in vain. The use of CLINICAL LABORATORY in section 1(2)(e) of the Medical and Dental Practitioners Act (MDPA) and then MEDICAL LABORATORY in section 29 of Medical Laboratory Science Council of Nigeria Act No 11 of 2003 (MLSCNA) is a clear indication of divergent legislative intendment for the two professions.

While the analysis done in medical laboratories under MEDICAL LABORATORY SCIENCE is on HUMAN OR ANIMAL SPECIMENS,  the only specimens handled under CLINICAL LABORATORY in the field of Pathology is HUMAN SPECIMEN. The reason is simple : the pathologist is only concerned with the analysis of the sample of an identifiable and identified patient whose PARTICULAR disease and health or otherwise is his primary concern, and not diseases generally ; while on the other hand, the laboratory scientist is concerned with diseases generally and not that attached to a PARTICULARLY patient. He is also concerned with both human and animal analysis results of the samples got from ANIMALS or HUMANS. Thus, while the latter result may be very important to the CLINICAL LABORATORY DOCTOR who is called a PATHOLOGIST (as opposed to a medical laboratory scientist as the case may be, who uses the results for entirely different purpose of general nature) , results from the former are a nonstarter in a hospital setting and thus unimportant, not needed and therefore dispensed with in all its entirety.

The scope of MEDICAL LABORATORY PRACTICE include : (a) analysis of HUMAN or ANIMAL specimens (b) production of biologicals (c) design of equipment (d) and fabrication of those designed equipment for the PURPOSES of medical laboratory diagnosis, treatment and research.

Therefore, while the field of pathology is involved with taking history of specific patients, collection of samples from specific patients, analysis of those specific samples, interpretation of the specific report, approval of those reports, sending the results with the interpretation to the clinician, advising the clinician based on the result, the advice having been adequately effected from the postgraduate training of the pathologists which crystallizes in the admix of his training in human medicine and laboratory medicine. The field of medical laboratory science, on the other hand involved analysis, production, design and fabrication. Note the conjuntive. The four go together, and they are for a particular purpose of medical laboratory diagnosis, treatment and research, and nothing more.
Secondly, while the purpose of pathology is for medical treatment (see section 11 of ESUT Teaching Hospital Law),  the purpose of medical laboratory science is for medical laboratory diagnosis, treatment and research. Thus the purposes are not the same at all. The only meeting point of both professions is at ANALYSIS section. However, the purpose of the analysis is different for both professions. Because of the training a medical laboratory technician / technologist/ scientist has in analysis, he finds himself a ready tool in the pathology laboratories working in place of the statutory technician (see section 11(1)(b)  of ESUT Teaching Hospital Parklane Law) because there are scanty number of pathologists to perform all the analysis in that laboratory; hence, his employment in Pathology laboratories for assistance at the section for sample analysis. In addition, because the training of a medical laboratory scientist in sample analysis is not targeted at medical treatment but at medical laboratory diagnosis, treatment and research, he hands over the report of the analysis to the pathologists who are trained in medical treatment to continue subsequent work on the analysis reports in the direction of medical treatment of the patients.

Each pathology form is made up of different parts, namely, the heading of the laboratory, the identity of the Hospital, the biodata, the sending clinician, the clinical summary and clinical diagnosis, materials to me tested, report, the laboratory technician's signature, the comments from the pathologist in charge, and finally, the signature of the pathologist in charge. The laboratory request is thus made to the pathologist. He looks at the referring department, looks at the biodata of the patient, looks at the suspected disease and the sample to be tested, he also looks at the date and signature of the referring doctor. His job is to match all these parameters with the content of the sample as a doctor who has had adequate medical training as well as postgraduate medical training in the field of Pathology. The technician looks at the sample in a microscope or uses reagents to analyze the sample. He documents the findings in his column on the form, and presents it to the pathologist. The pathologist then interprets the report using the biodata of the patient as supplied, the demographics, the provisional diagnosis of the referring clinician, and the technician's report on the sample, to reach a conclusion. The pathologist has been properly and adequately trained for this. The medical laboratory technician/scientist did not receive that kind of training of reconciling of the different patient's parameters. He is trained in analysis only. The pathologist thereafter makes his comments and recommendations to the referring clinician who makes use of the results for medical treatment of the patient. The pathologist ultimately endorses the results and sends to the clinician. If he is not convinced with the reconciled outcome, he instructs the technician to repeat the analysis. He could even order that a new sample is collected or that the reagent or equipment be changed, or that another technician should do the analysis. As a final measure, he could do the analysis himself. This is the superintendent role of the pathologists who are trained to identify faulty analysis report, and interpret (as a trained medical doctor) based on the available information on the patient.

The wordings of the section 29 Medical Laboratory Science Council of Nigeria Act No 11 of 2003 (MLSCNA) is deductibly categorical as it is impudent when it brought to the fore that while clinical laboratory in the field of pathology is an end in itself, medical laboratory practice is a means to an end; all of its purpose are geared towards production of biologicals and design of equipment for research, identification and discovery of the best ways that would ensure that METHODS of analysis of specimens are sensitive, specific, accurate,  error-free and of the optimal predictive values. These, the laboratory scientist, does and discovers, and sends same across to the pathologist who uses them in pathology laboratories, as well as to the vetenery doctor working within the animal clinics for reliable confident application of the findings and discoveries to identified human and animal patients in the care of the clinicians and the vetenary doctors. This is because the laboratory scientists are at the center, producing and manufacturing reagents, equipment and biologicals used for both human and animal clinics.

There is no hospital in the whole world that has this kind of reagent manufacturing and biomedical production laboratory within the hospital setting. It is a science center with egregious mandate. Medical laboratory is not hospital based; it is a production, fabrication, design and research center. It is not for patients treatment, rather, the products of this laboratory are made use of in laboratories in veterinary medicine clinics and pathology laboratories in human medicine hospitals.

In continuation of the construction of the definition of medical laboratory science according to the establishing Act, a more detailed analysis of the section 29 of MLSCNA is pertinent.
“Medical Laboratory Science”- "Means the practice involving the analysis of human or animal tissues, body fluids, excretions, production of biologicals, design and fabrication of equipment for the purpose of MEDICAL LABORATORY diagnosis, treatment and research; and includes medical microbiology, clinical chemistry, chemical pathology, haematology, blood transfusion science, virology, histopathology, histochemistry, immunology, cytogenetic, exfoliative cytology parasitology, forensic science, molecular biology, laboratory management; or any other related subject as may be approved by the Council".
That means that for a use of human or animal sample to fall within the ambits of medical laboratory practice, it must be for medical laboratory diagnosis ; not medical diagnosis. The analysis, production, design and fabrication are for the purpose of medical laboratory diagnosis, treatment and research. The three purposes are NOT for medical diagnosis, treatment and research. No. The purposes are rather for medical laboratory purposes, not MEDICAL purposes. That is the difference.

Diagnosis is restricted to medical laboratory diagnosis. Medical laboratory diagnosis, according to section 29 MLSCNA is a diagnosis of samples analysis reports, biologicals and equipment , that is to say,  the diagnosis of the problems in the sample analysis, the reagents (ie biologicals)  and the equipment being used in the medical laboratory. This is not patient diagnosis. That is also the reason MLSCNA did not mention patient or hospital in all its length and breath.

Medical laboratory sample diagnosis is different from patient diagnosis. Sample diagnosis, treatment and research are not the same thing as patient diagnosis, treatment and research. Patient diagnosis is the job of the clinicians with the pathologists. The terms diagnosis and treatment are generic and not proprietary. So, the term diagnosis does not mean exactly the same thing to a medical laboratory scientist as it means to a medical doctor. Diagnosis depends on the subject matter of diagnosis. To the doctor, the subject matter is the patient. For the medical laboratory scientist, the subject matter is the sample. Same goes for treatment : for the doctor, the subject matter of the treatment is the patient, and for the medical laboratory scientist the subject matter of treatment is the sample and equipment.

The law establishing medical laboratory science did not even empower the medical laboratory scientist to come in contact with the patient. He can only analyze samples. The job of performing invasive procedure to collect samples from a patient is not part of the training of the medical laboratory scientist.

Patient treatment is not medical laboratory treatment. Patient treatment involves patient history taking, physical examination, provisional diagnosis, (treatment in some cases), investigations (which may include clinical laboratory testing ), (definitive diagnosis in some cases), treatment and follow up.

Research as used in the Act is also confined to medical laboratory science research and not research generally. Thus the research contemplated by the Act does not include research in history, anatomy, political science, law, treaties etc.

The pertinent question is : how many medical laboratory scientists or medical laboratories in Nigeria have advanced in giving real life to the clear provisions and mandates exclusively granted medical laboratory science, vide (a) analysis of human and animal specimens (b) production of biologicals (c) design of equipment (d) fabrication of those designed equipment for the PURPOSES of medical laboratory diagnosis, treatment and research.

Could it be a result of pretentious or sheer lack of enterprise and entrepreneurship, intuition, sense of purpose, priority and direction, commonsense and intelligence, professional compos mentes; and then the overwhelming magnitude of greed, jealousy, professional complex and interprofessional hatred and unprovoked rivalry between parties that are not equally professionally yoked, garnished with a dense quantum of ignorance of professional competences and societal expectations from a professional grouping who have chosen to abandon their primary areas of laudable assignment, to perennially dabble into another, and consistently and cantankerously engage in professional pageantry with another profession which has always accommodated them? Could it be an uninformed and unnecessary professional beauty contest that has been ongoing in this country for too long a time, to the detriment of the paying public who albeit could be said to be equally uninformed?

Medical laboratory scientists work in pathology laboratories. This is because their training at one point involves human sample analysis and not because the profession has a department or directorate in a hospital. They work under and help pathologists with analysis as technicians because of the dearth of pathologists. After the analysis, the pathologists carry on with other pathologists' duties to the clinician.

It is hereby submitted that there is no conflict between the two Acts. While MDPA provided for the field of Pathology as a branch of medicine, MLSCNA provided for an entirely different profession which is Medical Laboratory Science.

Now, medical laboratory science is a science and not an art. On the other hand, pathology is both science and arts. While medical laboratory science is involved with the production of biologicals, design of equipment using human and animal samples as the basis for those functions, pathology on the other hand, is the application of those biologicals and equipment in the hospitals by the pathologists. Pathologists do not produce reagents or design equipment. It is the job of the medical laboratory scientists.

Reagents and equipment are not produced in hospital laboratories. They are produced in medical laboratories ,which are essentially independent private outfits that can at best be adjoined to Health facility, and never part and parcel of a hospital like pathology laboratories are.  This position is made clear at section 19(1)(d)  of the MLSCNA where it stated on its Rules as to practice of Medical Laboratory Science : "the maintenance of good standard of medical laboratory practice and services with respect to regulation and control of private practice including statutory inspection, approval and monitoring of all medical laboratories including those adjoined to clinics, private and public health institutions". Therefore, medical laboratories can best be adjoined to clinics, not part and parcel of clinic. The importance of the clinics is to supply them with samples for their scientific research and experiment if permitted by the patients.

Medical laboratory science is a vehicle. It is to pathology what English Language is to law. This is apparent when an English professor is compared to a judge. Laws are written in English language yet the interpretation of laws is not done by English professors. This is because laws go beyond English syntactic arrangements. For an English professor to be able to interpret the law, he has to go ahead to read law first and foremost; just as the interpretation of the results of human sample analysis is done by the pathologists, and not laboratory scientists. Law is the bedrock of any attempt to understand and interpret legal documents. If not, the interpretation of any documents written in English language, including engineering and architecture, would be left for English professors. We all know that this is not the case. English language is only the medium of communication.

The same applies to medical laboratory science and pathology. While a medical laboratory scientist is responsible for the production of materials used in the clinical setting by being allowed by its enabling law to make use of human and animal samples, he is not a pathologist. For him to practice as a pathologist, he has to first go ahead and read medicine. Medicine is the bedrock of any attempt to investigate patients in the clinical setting.

This position is reinforced by the provisions of the same MLSCNA at section 4 (e), to the effect that the Medical Laboratory Science Council of Nigeria (MLSCN) shall: "regulate the production, importation, sales and STOCKING of diagnostic laboratory REAGENTS and CHEMICALS".

And this is specifically true especially when it concerns those reagents and chemicals that are products of applied biology ie the BIOLOGICALS as used in the MLSCN Act. The medical laboratory scientist can also use animal or human samples, biologicals and equipment to research into better ways of diagnosis, treatment and research.

Medical laboratory science does not only feed medical practice,  it also feeds veterinary medicine. Yet in veterinary medicine, laboratory scientists are not part of their investigative processes unless they are employed to help with the analysis of samples for the veterinary surgeons who it is their sole duty to conduct tests in the animals.

A better statutory appreciation of the duty of a medical doctor (clinicians and pathologists) can be found in a corollary provisions of section 20 of the Veterinary Surgeons Act 1969. This Act, unlike Medical and Dental Practitioners Act (MDPA), BUT like Medical Laboratory Science Council of Nigeria Act No 11 of 2003 (MLSCNA), circumscribed veterinary surgery practice in Nigeria. It states thus:

"Veterinary Surgery" means:
"The art and science of veterinary surgery and medicine and, without prejudice to the generality of the foregoing, shall be taken to include-
(a) The diagnosis of diseases in, and injuries to, animals, INCLUDING TESTS PERFORMED ON ANIMALS for diagnostic purposes;
b. The giving of advice based upon such diagnosis;
c. The medical or surgical treatment of animals; and
d. The performance of surgical operations on animals".

Note (a) above. Those are the corollary of the jobs of pathologists in medical practice. The veterinary surgeons use biologicals and equipment produced by the medical laboratory scientists in the medical laboratories, to now do the tests by themselves (ie by the veterinary surgeons themselves) on the animals in their veterinary institutions. For a medical laboratory scientist to do this job,  he has to go ahead and read veterinary medicine and become a veterinary surgeon.

Medicine is so wide and the establishing Act did not define the profession nor did it circumscribe its scope. Pathology was not also circumscribed in definitions. But a critical look at the corollary Veterinary Medicine Act will help in the appreciation of the intendments of legislature in the creation of medical laboratory science profession (now wrongly applied by those that should know better), not for hospitals and veterinary clinics, but for the scientific production of materials (biologicals and equipment) used by pathologists and veterinary surgeons in the hospital pathology laboratories and veterinary medicine laboratories.

The only reason for allowing the medical laboratory scientists by law to analyze human or animal samples is because those biologicals and equipment that the medical laboratory science profession is created to design and fabricate, are going to be used for the analysis of human or animal specimens. How then could they know the effect of those equipment and reagents on human and animal samples if the scientists are not permitted by law to analyze them.

Translocating this on the doctor and his patients, it just strengthens the universal proclivity of medical practice that it is the doctor who sees the patient, its is the doctor who does all the tests on the patient, it is the doctor who makes the diagnosis, determines what should be done to the patient on admission on day to day basis, and it is the doctor who determines the drugs to be administered to the patient, not the pharmacist, who only dispenses the drugs according to doctor's prescriptions. This is the case no matter what the pharmacist has read about medicament; the pharmacist is not a doctor and thus cannot prescribe drugs for hospital patient. No other paramedical personnel does those functions for the doctor, and the doctor has not ceded those duties to any usurper of functions whatsoever. No persons can thus create a strange profession in the Teaching Hospitals, or get an existing profession transmogrified .

In conclusion, Medical laboratory science is not a department in our Teaching Hospitals. A medical laboratory scientist in a Teaching Hospital is only found in pathology laboratories by virtue of the need for him to function at the sample analysis section of pathology, which is just a small section in the myriad of activities of the pathologists. The medical  laboratory scientist is employed in the pathologists office just like any other support staff.

The hospital management Board has the sole responsibility of operating the hospital. The Association of Medical laboratory scientists or any other association or persons cannot usurp that power. No persons can create a strange profession in our Teaching Hospitals, or get an existing profession transmogrified. Whenever there is a need for creation of other professions or department, the Teaching Hospital Board would be called upon, or call upon itself, to do the needful.

The problem now is that a person employed as technician or as messenger as the case may be wishes to head the department, just as a court clerk wishes to head the court. This can only be conceived and attempt made at its execution only in a backward society where anything can be allowed to flourish.

Medical laboratory science profession in Nigeria has remained essentially dead and dormant these years because the medical laboratory scientists have mostly abandoned their patriotic and statutory duties of design, fabrication and production of biomedicals and reagents for pathology and veterinary medicine clinics, to degrade into technicians' status. Nigeria spends billions on importation of what can be manufactured in Nigeria by our teeming number of medical laboratory scientists churned out from our universities every year. These new graduates come out of the University thinking that their primary place of employment is in the hospitals. This wrong notion is exploited by the politicians in their midst who egg them on to fall consistently in heated confrontation with the owner-professionals of hospital laboratories, the Pathologists.

The solution to these unnecessary problems lies with the proper directive, encouragement, instigation or compulsion of the various Teaching Hospital Management Boards to give holistic effect to the statutory mandate of establishing schools for technicians to supply needed technical staff strength to the Teaching Hospitals. These technicians will adequately replace the laboratory scientists, so as to release the laboratory scientists from hospital engagements to enable them do the arduous statutory task they were created for, in their non-hospital-based medical laboratories. This is the major way to change the face of laboratory practice in Nigeria and save Nigeria billions in foreign exchange.

©Awkadigwe Fredrick Ikenna 2017 (MBBS, LLB, MWACOG, DSC)
awkadigweikenna@yahoo.com

This article can be read and shared purely for enlightenment and education of the people of Nigeria. The reader can also freely comment and argue with the thoughts of this author using chrome or web browser preferably, as opera mini does not readily open the comments area. 

© Copyright 2017 Ikenna Fredrick Awkadigwe. All rights reserved. No part of this publication is permitted to be used in any way, copied, photocopied printed, reproduced, transferred, adapted, argued in any fora, used in Court or recreated in any form or resemblance whatsoever, without the written approval and license of the author, Ikenna Fredrick Awkadigwe.