“Sometimes people hold a core belief that is very strong. When they are presented with evidence that works against that belief, the new evidence cannot be accepted. It would create a feeling that is extremely uncomfortable, called cognitive dissonance. And because it is so important to protect the core belief, they will rationalize, ignore and even deny anything that doesn't t in with the core belief.” ― Frantz Fanon (Black Skin, White Masks).

 

The attention of the Association of Medical Laboratory Scientists of Nigeria (AMLSN) has been drawn to the malicious, spurious and unfounded allegation of harassment and assault by the Medical and Dental Consultants Association (MDCAN). In a caption: 'Medical, dental consultants seek streamlining of health sector laws, May reject lab results not endorsed by pathologists' in “The Guardian” newspaper of st Friday, March 21 2014 page 5, as well as “Vanguard” newspaper of Wednesday March 26th, 2014 page 46 captioned: 'Medical consultants allege harassment by hospital laboratory scientists, threaten to withdraw services if government fails to guarantee safety'. 

 

AMLSN has further noted the public notice issued by the Association of Pathologists of Nigeria (ASSOPON) in the Guardian and Daily Trust newspapers of Wednesday, April 2, 2014. AMLSN is compelled to respond to the sentimental falsehood being peddled by MDCAN and ASSOPON so as to put the records straight and avoid a situation where silence is mistaken for acquiescence. 

 

The facts are as follows:

1. Medical laboratory scientists have neither harassed nor assaulted anybody in any Nigerian hospital. It is a well known fact that medical laboratory scientists are about the most patient, rationale and law-abiding group of healthcare professionals in Nigeria. Medical laboratory scientists have always exercised restraint, disciplined conducts, rational discourse and recourse to the law courts for redress whenever they have been denied their rights. The records are there to www.medicalworldnigeria.comprove this assertion: in 1975, our Association won its case with the Federal Ministry of Health over call duty allowance both at the Industrial Arbitration Panel and at the National Industrial Court. It was also the case in 1992 and 1993. The most recent is the landmark judgment of the National Industrial Court of rd Nigeria on the 23 October, 2013 in Suit No. NICN/ABJ/128/2012: Association of Medical Laboratory Scientists of Nigeria vs. Hon. Attorney-General of the Federation, Hon. 

Minister of Health & others in which the honourable court ruled and ordered that medical laboratory science is a distinct healthcare profession by the laws of the Federal Republic of Nigeria deserving to be so recognized and to have its Directorate as enshrined in the statutory scheme of service.

 

2. It is laughable that MDCAN and ASSOPON have resorted to spurious allegations and crying wolf in order to divert the attention of the public from its lawless conduct which is fueling the atmosphere of acrimony and disharmony in the health sector. The Medical and Dental Consultants Association has sort to impose its members to head every imaginable service and activity in the hospital against clear government statutory rules and regulations and even subsisting court judgments. It wants to head Engineering services, Wards and clinics, Security, Energy, and Laboratory services etc. in the name of being the 'only professionals' in the health sector. The Honourable Minister of Health is unfortunately and unwittingly aiding and abetting this clamour by his assertion that the “hospital is totally the doctors' territory” in the interview he granted the Guardian newspaper.

 

3. The public can now appreciate why there has been vehement resistance by other health professionals to Section 1, subsection 1 of the National Health Bill. The subsection seeks to make the bill the omnibus regulator of all health professions by usurping the statutory regulatory mandate of other health laws. It is a concealed tactic by medical and dental practitioners to legitimize their opposition to the regulatory authority of the various health Councils and Boards to regulate and enforce practice standards to protect the public. They claim they can and will practice pharmacy, nursing and midwifery, medical laboratory science, physiotherapy, radiography etc. without the regulatory control of the relevant professional Councils as specied by law. Lawlessness and impunity at its worst display! They need to be reminded that orthodox healthcare practice did not originate from Nigeria. The continued attempt to obstruct nd prevent the Pharmacists' Council, Nursing and Midwifery Council, Medical Laboratory Science Council, Radiographers Registration Board and indeed all other regulatory agencies from enforcing practice standards to protect the public in line with their statutory mandate by MDCAN is an open invitation to anarchy in the health sector.

 

4. The cock and bull story by ASSOPON about the profession of Medical Laboratory Science originating from the United States of America is laughable. It is a fact that, UK colonized Nigeria as well as the USA. That medical laboratory practice had its origin in ancient Europe is well documented; that medical laboratory science has been practiced in Nigeria since 1922 is documented. Standing history on its head to massage bloated ego will serve no useful purpose. Where and how any profession originated is not the real issue. Nigeria is a sovereign country that has subscribed to the rule of law. No matter where and how any profession originated, Nigeria has the right to enact laws, rules and regulations to guide professional services within its borders. The rule of the thumb, arbitrariness and impunity in the health sector which ASSOPON and MDCAN are advocating breed lawlessness. Flouting court judgments and court orders by hospital Managements such as we are witnessing in 

the Jos University Teaching Hospital, Jos is a threat to civilized and orderly conduct which all professionals worth their salt should always condemn.

 

5. Clamoring to countersign laboratory results/reports of investigations performed by licensed medical laboratory scientists will add no value whatsoever to the accuracy or authenticity of the results. Indeed, international best practice in this information age is to send medical laboratory results electronically to the requesting physicians for prompt diagnostic and therapeutic decisions. It is pertinent to remind ASSOPON that its attempt in 1991 to arrest the development and growth of the profession by closing down University degree programmes in Medical Laboratory Science in Nigerian universities failed woefully. Medical Laboratory Science is a distinct healthcare profession with clear legal and professional mandate. 

 

6. Pathologists are licensed physicians trained to attend to and treat patients with abnormalities in their areas of specialization. Parading the corridors in hospitals seeking to countersign laboratory result forms of work performed by medical laboratory scientists or struggling to analyze specimens will in no way improve patient care. License is original 

authority derived from law to perform a specied task. Medical laboratory scientists are highly trained professionals empowered by law to do their job. They are liable under the law for work done by them. It is on record that 

the Medical Defense Union in the UK had advised pathologists against signing forms of work not done by them which equates to 

intellectual theft/plagiarism. 

 

7. ASSOPON is not concerned about the teeming Nigerian patients as it is obsessed with the headship of a sector that is not within its core professional purview. It is so intensely embittered by the successful efforts of the Medical Laboratory Science Council of Nigeria (MLSCN), a government agency, legally mandated to reposition Medical Laboratory Services in the country. A group that pretends to care about the patients ought to place the interest of those patients above pecuniary professional interests, but not so for ASSOPON. 

 

8. The Nigerian High Commissioner to India, Ambassador Ndubisi Amaku revealed recently that it cost Nigerian patients a 

whopping sum of $350million to access various levels and sorts of healthcare in India in 2013. This is an indicting commentary on our healthcare sector, especially the approach to disease diagnosis. Rather than worrying about this unending medical tourism and the efux of scarce foreign exchange from our country, ASSOPON seems preoccupied with puerile polemics about who should head the medical laboratory. 

 

9. ASSOPON's penchant for unprovoked aggression is becoming legendary and it is capable of rubbing negatively on the image of 

the entire medical profession. Anyone whose view on anything is at variance with ASSOPON's own is a potential target. First it was the respected Hon. Ndudi Elumelu, Chairman, House Committee on Health, now it is the US Centres for Disease Prevention www.medicalworldnigeria.comand Control and its implementing partners in Nigeria. Their crime? Supporting MLSCN programmes to build capacity and upgrade 

medical laboratory systems in the country. But stakeholders are urged to treat such as the fury of an unsuccessful suitor or the biblical woman who requested Solomon to cut into two a baby that is not hers rather than allow the rightful mother take custody- a mere licking of wounds. ASSOPON should be reminded that both CDC and other International Partners are supporting MLSCN purely on the merit of its various proposals and mandates. One wonders how ASSOPON leadership could merit such support when it cannot correctly dene SLIPTA and SLMTA even after MLSCN and its partners had trained eight pathologists including 

ASSOPON leadership on the rubrics of these WHO-driven models for quality laboratory services in Africa and beyond. 

 

10. ASSOPON accuses CDC of divide and rule; it attempts to instigate the public and state governments against the MLSCN efforts to improve medical laboratories. The group, driven by pure ignorance or amnesia disregards the fact that Health is in the concurrent legislative list, which both federal and state governments share and in the event of conict, federal laws prevail. ASSOPON is making a mockery of the law and of itself by stating thus: “As it stands today, it is only the MDCN that has the regulatory standards for different levels of laboratory, and operates in collaboration with the State Governments in 

realization of the fact that the ultimate power over facilities in the states (other than Federal Government facilities) resides with the State Governments”. What really is ASSOPON's point here if not to imply that MLSCN is at loggerheads with state agencies? How low can this group condescend? 

 

11. Not satised with previous albeit unsuccessful attempts to be recognized by the MLSCN Law (Cap M25 LFN, 2004) and 

later to get the law amended to suit their purpose; ASSOPON now pretends that the law does not exist or that its provisions are written in language pathologists are incapable of comprehending. The fact remains that the LAW exists and it places the medical laboratory scientists squarely in charge of the medical laboratory. 

 

12. Out of sheer desperation to further denigrate medical laboratory scientists and score acheap point, ASSOPON went as low as to dig up the tragic and highly regrettable HIV case involving Baby Eniola. This is the height of insensitivity towards all those affected by that episode. It is, therefore, pertinent for AMLSN to put the records straight, and members of the public can verify the veracity of the story which is as follows: It was the then HOD Haematology- Dr Okany, a pathologist that was responsible for the procurement of the sub-standard HIV kits used for the ill-fated test in Baby Eniola's HIV saga at LUTH. Other processes and infrastructures such as cold chain and unsuitable laboratory work climate etc. were ignored by the Management. But in the end, four medical laboratory scientists were punished (Mr Ayelari, Mr Adeniyi, Mrs Kazeem (retired compulsorily) while Mr Onifade was demoted for not taking full charge of the Haematology laboratory service in line with the FGN approved Scheme of Service for medical laboratory scientists. The primary assignment of the then HOD, Dr Okany in the College was not affected at all. His appointment as Consultant was not terminated; instead, he was merely removed as HOD and replaced with Dr Akanmu- another pathologist. 

 

13. By legislation, scheme of service, training or cognate knowledge, medical laboratory scientists are the appropriate professionals to head medical laboratory services. For, while the medical laboratory scientist spends his entire six-year period of undergraduate training studying medical laboratory science, the medical doctor uses only four months of his seven years of undergraduate training to undertake introductory courses in Laboratory medicine (equally weighted with M1S1 clinical 

skills and pharmacology over a period of one year) to enable him appreciate what test to request for what disease conditions. This explains why medical doctors cannot be produced without the input of the medical laboratory scientists, while the input of the pathologist is not a prerequisite for the training of medical laboratory scientists (Ref. curricula of BMLS & MBBS programmes).

 

14. Furthermore, for purposes of specialization after NYSC, the MLS takes additional minimum of seven years of full-time studies to obtain professional fellowship, M.Sc and Ph.D before being appointed as a Consultant (Specialist) MLS by health institution Boards. On the other hand, a doctor training to become a consultant pathologist (Specialist) undertakes only four years of part- time training to obtain his professional fellowship diploma since he has to concurrently study, perform routine and on call clinical duties, engage often in private practice and National 

Association of Resident Doctors (NARD) 

activism- equivalent of two years of full time training. A simple comparative analysis of years of cognate knowledge training of basic MLS and Pathologist is at a ratio of 6:2.33 years while that of Consultant MLS and Pathologist is at a ratio of 13:2.33 years in favour of medical laboratory scientists. Given that the generally accepted indices of epistemic professional authority are years of cognate knowledge and training, it goes without saying that the MLS is the appropriate core professional in charge of Medical Laboratory Services at all levels. This is recognized by the approved scheme of service and by the law, a fact ASSOPON's extravagant outpouring of negative emotions cannot obliterate. It is left for the public to then 

judge who the dog is and who the tail is in medical laboratory services delivery. 

 

15. The recognized functions of the medical laboratory scientists as far back as 1972, as republished in the year 2000 and enshrined in the Scheme of Service since 2001, specify that the laboratory scientists are to conduct medical laboratory investigations, interpret, design, modify and take charge of general administration at the various levels of lab services, while in keeping with global practice, autopsy, clinical interpretation of completed laboratory test results to other doctors on specic requests, rendering medical diagnosis or prescribing medical treatment on the basis of such test results are the proper functions for pathologists (Pitt & Cunningham, 2009).

 

16. It is not for the love of the patients that pathologists crave to abandon their primary function as doctors to head the laboratory. The handling of the budget and the procurement of laboratory equipment, kits, reagents and consumables in the lab whether they know which is fake or not is part of the motivation for all this conict (See above again for who procured the HIV kits used in the Baby Eniola test!).

 

17. ASSOPON should be reminded that developments in Medical Science as well as the compelling requirements of the teeming 

patients in Nigeria give no room for clannish mentality or unnecessary obsession with territorial turf or academic reminiscences. No patient ever goes to the medical laboratory merely to inquire about the history of the profession; they go there to deservedly seek reliable and reproducible laboratory test results and reports. They derive no consolation from ASSOPON's polemics or habitual belligerence.

 

18. Moreover, we commend the honourable members of the House of Representatives who, after an instructive debate last year, 

ignored the pecuniary interests of some groups and courageously mandated the House Committee on Health to work with the 

Medical Laboratory Science Council of Nigeria (and no other organization) to improve medical laboratory services in the country. 

 

19. As far back as 2003, AMLSN had acknowledged the chaotic state of medical laboratory services in the country where as 

pathologists, driven by morbid fear of the MLSCN Act as they still are now, had insinuated that all was well within the system. In the Guardian of Monday, November 17, 2003, AMLSN had noted: “Presently over 60% of medical laboratory reagents and chemicals in our markets are faked and often stocked and distributed under unsuitable conditions; over 50% of our laboratories are exclusively and sometimes willfully manned by unqualied personnel... Medical laboratory services in Nigeria are, therefore, far from being smooth running, as pathologists and Medical and Dental Consultants Association of Nigeria would want the public to believe”. Mischievously, pathologists are now insinuating that they told the public so in 2013! 

Yet it was the MDCN that had demanded that the status quo be maintained. The MLSCN simply responded by encapsulating the ramications of the status quo in case MDCN hadn't thought about it.

 

20. That medical practice preceded Medical laboratory Science practice is no justication for the selsh pecuniary quest of pathologists to continue to interfere with the legitimate duties of Medical Laboratory Scientists. Mathematicians, Engineers and Physicists who discovered Computer Science do not crave to boss the later day Computer Scientists. Ditto for the various professional cadres in the building and nance industries etc. The African Charter on Human Rights, Nigerian Constitution and other such instruments meant to protect basic human rights all abhor slave trade, which was also abolished over two hundred years ago as well as apartheid in the eighties; hence the illegitimate ambition of pathologists to lord it over lab services cannot prevail. The FMoH is urged to do the right thing by directing pathologists to hands off interfering with laboratory services and concentrate on their primary duties in specialized clinics, wards and mortuaries in a manner akin to the r e l a t i o n s h i p b e t w e e n C l i n i c a l Pharmacologists and Pharmacists in pharmacy; Trauma/Orthopaedic surgeons and Physiotherapists in physiotherapy etc. Pathologists' quest to head medical laboratory services is as ridiculous as clinical pharmcologists trying to head pharmaceutical services.

 

21. AMLSN would also want to draw the attention of ASSOPON to the “Polio Vaccine Controversy” as captured in the Punch 

newspaper of Monday, March 22, 2004 (pg62) as follows: “AMLSN is happy to note that the Hon. Minister of Health and Nigerians in general have realized that the controversy over the safety and efcacy of polio vaccines was only resolved by laboratory tests conducted in Nigeria, South Africa and Indiaexclusively by Medical Laboratory Scientists and not by pathologists as ASSOPON erroneously tried to claim”. Typically, when things are going well in the laboratory, pathologists want the credit; when they go wrong, they blame it on medical laboratory scientists. 

 

22. In continuation of its ego-trip, ASSOPON st made reference to the 1 international conference of the African Society for 

Laboratory Medicine (ASLM), in Cape town, South Africa in December 2012 where, according to ASSOPON, the South African Health Minister, Dr. Pakishe Aaron Motsoaledi attributed the success of the country's laboratories to the availability of many pathologists. But ASSOPON should have gone further to inform the Nigerian public that the National Health Laboratory 

Service of South Africa, which manages about 300 public medical laboratories in that country has a health scientist as its 

CEO who is NOT a pathologist!. 

 

23. Pathologists and other stakeholders are once again enjoined to join hands with MLSCN to improve medical laboratory services in the country in the interest of the citizens of this country who earnestly desire such.

 

24. AMLSN urges MLSCN not to be distracted by those who value personal quest for leadership above the interest of patients, 

but rather continue to diligently pursue its lawful mandate as enshrined in Cap M24, LFN 2004 without any let or hindrance 

whatsoever so as to sanitize the present chaotic state of medical laboratory services for the good health of Nigerians 

(ASSOPON being the prime driver of mediocrity in the sector).medicalworldnigeria.com 

 

CONCLUSION

AMLSN owes the patient and the public a professional and lawful obligation to vigorously pursue and uphold continuous 

quality improvement of medical laboratory services and indeed healthcare delivery in Nigeria. No amount of posturing or 

grandstanding by any group will deter us. We call on NMA, MDCAN and ASSOPON to bury their hatchet and partner with us in this 

onerous task.

 

Nigeria will be better for it. 

DR GODSWILL C. OKARA

NATIONAL PRESIDENT