Some may dismiss the lingering crises in the health sector, especially the one in laboratory medicine as some “professional” rivalry but a closer look will see the grave danger posed to public health by unchecked rascality which has become a reflection of the larger society. If we just take a look at the downstream, the mortuary, it may bring home some point. I participate in investigating many deaths traceable to some disconnect between the medical laboratory and clinical practice. Our people have walked into many of these "medical" laboratories to undertake "tests" without physician's consult, and to proceed to chemist shops for "prescription" based on the usual "test" diagnosis of combined "typhoid and malaria” and eventually ended up at autopsy tables following sudden death. Findings at autopsy have varied from complicated appendicitis to advanced cancers. These people depended on test results that were recommended and evaluated by non physicians and the accompanying medications prescribed by people unqualified to make clinical diagnosis and consider differentials based on overall clinical features of the patients. These needless deaths occurred because of failure of regulation of medical practice. Most unfortunate aspect of this malady is that usually no one is held to account.
We can't possibly move ahead without a clear understanding of the past, our roots. From the ancient time to the modern era, physicians have trained certain categories of workers to assist them in the overall management of the patient. Every profession, from law to engineering, has allied workers who assist in ensuring the respective mandates of such professions are actualized in the interest of the public and these allied workers in these professions have remained within their bounds of practice. In Nigeria, anarchy reigns in medicine especially in laboratory medicine. The radiographer challenges the authority of the radiologist; the optician that of the ophthalmologist; the pharmacist that of the clinical pharmacologist, and the laboratory technologist that of the pathologist. There is constant agitation by unions which have turned unionism into some lucrative business and “legalized” truancy. Outside the shores of Nigeria you can't buy certain drugs at the pharmacy without a physician’s prescription. Here in Nigeria, any drugs could be purchased over the counter freely. In a recent meeting of the association of medical laboratory technologist in the Ibadan, members of the public were advised they could simply walk into a medical laboratory and procure medical tests without prior physician’s consult. It is not surprising that patients present so late and too late to the hospital.
The system is broken and has betrayed the public, and concerned authorities appear impotent in tackling this quackery. Unfortunately, issues in Nigeria often get decided by the amount of violence and disregard to civility displayed by individuals and groups championing such cause, and our hospitals are now held hostage at will by unions to the detriment of patient care and public health. Conflicting and confusing laws are in place and implementation has been left to the jungle mentality of "survival of the fistful" while our health indices continue to plummet. Where else on this planet has the place of orthodox medicine practice been distorted and redefined than in Nigeria? Our leaders know the rot, which they have entrenched in the health sector as in other sectors of our national life. They and their families do not utilize public hospitals, and at huge public expense hop into the next flight abroad for treatment of even the simplest of illness. They profit from the present crises as they justify their proclivity for mismanagement of public fund on the unreliability of medical laboratory tests and lack of modern facilities in Nigeria’s public hospitals. And hapless Nigerians continue to experience needless deaths.
There are no inquests on many Coroners’ cases we conduct autopsies on. Perhaps, the general public may have been better informed about such fatalities related to misplaced agitations in the health sector. The concern is where all this will end. Will there ever be a restoration of the normal relationship between physicians and allied health workers in line with global best practice? How many captains can there possibly be in the hospital boat? When will parochial mentality give way to collaborative effort for the sake of the patient and public health? When will concerned authorities enforce regulations and restore sanity in the health sector in Nigeria. In the meantime, patients continue to come to the hospital to "see their doctor" but even that traditional quest has also been confused. It's a Red Alert!
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