THE PRACTICE OF MEDICAL LABORATORY SCIENCE AND PATHOLOGY IN NIGERIA: MY TAKE AND MY PLEA!

Lately, there has been so much ado about nothing concerning the practice of Medical Laboratory Sciences in Nigeria.

In the past, the battle line was drawn strictly between a section of Medical doctors who had specialized in Laboratory Medicine at the postgraduate level – the pathologists and the core practitioners of Clinical/Medical Laboratory Science called Medical Laboratory Scientists.

Recently however, on seeing the unfolding events in the health sector; realizing that it is working against the pathologists and surmising that there is a likelihood of such “ills” eroding on the larger spectrum of doctors in Nigeria; the Nigeria Medical Association (NMA) decided to champion the cause of her child, ASSOPON (Association of Pathologists of Nigeria).

Earlier this month, I read the NMA’s submission on the matter; where she castigated the judiciary and the legislative arm of government for their ‘connivance’ with the Medical Laboratory Scientists in Nigeria to deprive doctors, especially the pathologists their rightful place of headship by making and pronouncing ‘obtrusive’ laws and judgements respectively in favour of the Medical Laboratory Scientists. I was aghast! Then, I became amused even though I was seriously taken aback by the effrontery of the NMA; throwing away the baby with the bath water and unjustly indicting these noble, learned and distinguished men of the bench and the hallowed chambers. But, since AMLSN (Association of Medical Laboratory Scientist of Nigeria) and certain individuals have responded to that, I will not prolong this discourse by giving another response.

As background information, it will be interesting for us to know that all Doctors, Nurses, Pharmacists, Medical laboratory scientists etc; in fact, every professional in the health sector at one time or the other actually got their training in the same environment. What makes this worthy of mention is the fact that one would expect people of same or similar environmental and intellectual backgrounds; who shared virtually everything together as undergraduates, participated in the same social activities, attended the same religious institutions and programmes, confessed love one to another, befriended themselves and/or helped one another one way or the other to attain their professional pursuits to actually grow to become best of friends and work together to promote the health of the nation. Alas! The reverse is the case in the Nigerian health sector! As working professionals after school, the battles seem unending!

Perhaps, it would have been a different story if all the professions emanated from same source and grew at the same time and rate but nay, that is never possible! It is just natural for one of the professions to father or be the elder to the others and in the case of the health sector – Medicine and surgery played that role! This naturally gave doctors a lot of edge and advantages. This also naturally placed them at the helm of affairs in virtually all health and health-related institutions and policymaking bodies. Being the core decision makers equally gave them the privilege of taking the lead in everything. Hence, this allowed them to not only formulate policies in their favour but also twisted policies to suit themselves! A Yoruba proverb says “even a mad man would plough to his own advantage if given the hoe to plough!” So for me, it is just understandable why doctors would make sure that virtually all the policies made in the health sector in Nigeria favours them! But, I think it is most unfair when a man seek to advance his own cause to the detriment of others or seek to deliberately subjugate, oppress and/or annihilate the others while pursuing his own convenience and advancement! Apartheid!

This headship privilege, coupled with the fact that most of the other professions in the health sector like the Pharmacy, Medical Laboratory Science, Nursing, Medical records, Optometry, Imaging science etc started and stagnated for many years as middle manpower ( though not without the complicity of the doctors at the helm of affairs of the health sector) actually gave the doctors the room of not only taking advantage of them but also subjecting them to varying intimidations and harassments. They freely and completely look down on these professions which ought to be seen as sister professions and nurtured as siblings! But, what the NMA has refused to realise and admit is the fact that despite the humble beginnings of these professions, their stagnation at mediocrity for many years and the willfully deliberate opposition of NMA to their advancements; they have since metamorphosed, upgraded and have long gone beyond where they used to be. Moreover, they can now boast of many geniuses, standardised programmes, medically competitive syllabuses/curriculum with excellent first-class training and exposure.

NMA, after her unsuccesful bid at impoverishing the training of these health workers; at the expense of the entire nation, but in pursuit of their agenda of remaining the head at all cost, is now refusing to accord these other health workers their rightful place as colleagues but would prefer to still treat them draconically as subjects!

No man loves to be ruled forever, at least not by his equal! The other health workers, including the Medical Laboratory Scientists have since refused to be ruled draconically! Most of the ripples in the health sector today are direct result of this little misunderstanding; because, it is not only sickening but also deadly for a professional group to try to lord it over the other in a jurisdiction where the perceived lesser – e.g. the Medical Laboratory Scientist; is more competent than the pretentious Leader (the Pathologists)!

For years, Pathologists held to ransom the less privileged Medical Laboratory technologists (the progenitors of today’s Medical Laboratory Scientists), when the training of Medical Laboratory Sciences in Nigeria was at the Middle manpower level. But not anymore! The present crop of Scientists, who were adequately trained and are cerebrally competent and their progenitors, who despite the tight ropes and unfavourable, forcibly imposed stringent, pauperized training and practicing conditions went ahead to use the very scarce resources to improve themselves and carve niches for themselves; would not tolerate any more subjugation! Today, they are authorities in the world of Laboratory Medicine globally and you want to insist that in Nigeria, they must remain under you?

No, it is not possible anymore! Not after the programme has been upgraded and training of Medical Laboratory Scientists standardized with the curriculum made robust, medically-competitive and administratively efficient and the profession itself has gone world-class!!

Not anymore!!! Not after clear, concise, distinguishing, and distinguishable laws were made to clarify the distinctions between the two professions and professionals.

Not anymore! Not when the profession of Medical Laboratory Sciences is no more a middle level manpower!

Not anymore! Not when all Medical Laboratory Scientists in Nigeria have the requisite knowledge, exposure and training to discharge their duties medically, technically and administratively to maximum capacity!

Not anymore! Not when the pathologist does nothing in the laboratory but simply sits down in his office to sign completed laboratory investigations that he has contributed nothing to and for which he does not want to be held responsible if anything goes wrong!

Not anymore! Not when the pathologists do not understand the art of laboratory medicine as much as the core professional, the Medical laboratory Scientist.

Not anymore! Not when we need every profession and professional to aspire to reach the zenith of their callings and be capable of giving their best!

Oh, not Anymore! The list of why we can no longer retrogress is endless!

To make matters interesting, the laws governing the practice of Medicine and surgery in Nigeria (MDP Act 2004 ), which is also the law regulating the activities of the pathologists; and the laws governing the practice of Medical Laboratory Science in Nigeria (MLSCN Act 2003) are distinct and unambiguous!

The relevant sections of the laws for this discourse are sections 1 of MDP Act and section 4 of MLSCN Act as set out below:

Section 1. MDP Act 2004: Establishment and functions of the Medical and Dental Council of Nigeria.

(1) There is hereby established a body to be known as the Medical and Dental Council of Nigeria (hereafter in this Act referred to as *the Council) which shall be a body corporate with perpetual succession and a common seal and may sue or be sued in its corporate name.
(2) The Council shall have responsibility for :-

(a) Determining the standards of knowledge and skill to be attained by persons seeking to become members of the medical or dental profession and reviewing those standards from time to time as circumstances may permit;
(b) Securing in accordance with the provisions of this Act, the establishment and maintenance of registers of persons entitled to practice as members of the medical or dental profession and the publication from time to time of lists of those persons;
(c) Reviewing and preparing from time to time, a statement as to the code of conduct which the Council considers desirable for the practice of the professions in Nigeria;
(d) Supervising and controlling the practice of homeopathy and other forms of alternative medicine;
(e) making regulations for the operation of clinical laboratory PRACTICAL 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, and
(f) Performing the other functions conferred on the Council by this Act.

Section 4. MLSCN Act 2003:

4. The functions of the Board are to:-

The Board:

(a) Determines from time to time, the standard of knowledge and skill to be attained by persons seeking to become Medical Laboratory Scientists, Medical Laboratory Technicians and Medical Laboratory Assistants (in this Act referred to as “Scientists”, “Technicians” and “Assistants” respectively);

(b) Regulate the PRACTICE of Medical Laboratory Science in Nigeria;

(c) Regulate the training of scientists, technicians and assistants in any institution in Nigeria and give periodic accreditation to institutions;

(d) Provide and maintain separate register for scientists, technicians and assistants;

(e) Regulate the production, importation, sales and stocking of diagnostic laboratory reagents and chemicals;

(f) Assess, evaluate and register foreign graduates of Medical Laboratory Science;

(g) Conduct examinations for technicians and assistants;

(h) Inspect, regulate and accredit medical laboratories; and

(i) Perform such other functions as may be conferred on it by this Act.

However, the crucial subsections are subsection (2) (e) MDP Act and subsections (4) (b) above of the MLSCN Act.

It must be noted by every observant reader that while the MDP Act that guides the activities of the Pathologists gives them the power to regulate PRACTICALS in the above stated specialties of pathology which incidentally are specialties common to both the Pathologists and Medical Laboratory Scientists, the act regulating the activities of the Medical Laboratory Scientists(MLSCN Act) gave them power to regulate the PRACTICE of these specialties! Gaskia!
It then goes to show that while the doctors in the laboratories (Pathologists) are free to organize, moderate, supervise and/or regulate laboratory PRACTICALS for both undergraduate and postgraduate medical students offering courses in the pathology sub-specialties in the laboratories, Medical Laboratory Scientists are empowered to regulate the PRACTICE of the certified professionals!

So, while the pathologists can be involved in the training of laboratory personnel and are allowed to supervise and regulate the PRACTICALS of the undergraduates and post-graduate students passing through the laboratory; Medical Laboratory Scientists are to supervise and regulate the activities of anyone, be it doctors, medical scientists, biochemists etc that may want to practice Medical laboratory science in any clinical laboratory in Nigeria!

The justification for this is simple! While a doctor, or any other professional spent their days in the University pursuing their respective callings, a Medical Laboratory Scientist spent his seven years(5-year as undergraduate, 1-year internship and 1-year as corp member) learning the art, act, science and management of laboratory medicine! And while a doctor or any other professional may afterwards go back to study laboratory medicine at postgraduate level, a Medical Laboratory Scientist would most likely continue his postgraduate studies in the same field. So, who please should head the laboratory?

Is it someone that had his basics (undergraduate) and advanced (postgraduate) studies in laboratory medicine or someone that suddenly woke up to realise that he has some chances in laboratory medicine and hence come as a postgraduate student?

From the foregoing, it becomes obvious that there should be no reason for in fighting and strife amongst the doctors (Pathologists) and Medical laboratory scientists that work in the laboratories as their laws and trainings have succinctly prescribed their jurisdictions and degree of expertise.

I hereby appeal to the two groups of professionals to please – learn to stay within the ambit of their prescribed professional and judicial jurisdictions and stop raising dust in our perpetually turbulent health sector. Nigeria deserves peaceful and loving co-existing health sector professionals!

As good people of Nigeria, we should please live at peace one with the other for the betterment of our nation and the healing of our people. We should learn to be law abiding and carve a niche for ourselves within the allowance of the law! We must learn to LIVE AND LET OTHERS LIVE. Thanks.

God bless AMLSN
God bless ASSOPON
God bless MLSCN
God bless MDCN
God bless the Health sector
God bless Nigeria
God bless you.

Ojerinde A. Olakunle
B.MLS, M.Sc (Clinical Chemistry), PCM, AMLSCN.