A letter to my lover: an apologetic on medical laboratory science in Ghana - Part 3

……. Claims by the Ghana Medical Association (GMA) & Ghana College Physicians Surgeons (GCPS) that they were not consulted for their inputs into the National Health Laboratory Policy (NHLP) document is completely false as their views were voted out at the stakeholder level.

Claims by the Chief Director of the MoH, Mr. Kwabena Boadu Oku-Afari that the NHLP in its current state as a draft is VERY FALSE because the Minister of Health (Hon. Hanny Sherry Ayittey) and Director-General of the Ghana Health Service (Dr. Appiah Denkyira) at the time appended their signatures to the finalized NHLP document in 2013.

The NHLP which was due for implementation in September 2013 was aborted due to a letter from Prof. Dr. Sir George Wireko Brobby (president of the GCPS at the time) written in the name of the GCPS asking for a halting of the process.

It is unfathomable that supposed collaborators in the healthcare industry will work against the implementation of this document that will to a large extent perfect the medical laboratory architecture & services delivery in Ghana.

The Ghana Association of Medical Laboratory Scientists (GAMLS) undertook an industrial action in 2016 asking government to come out with a roadmap leading to the implementation of the NHLP. The Minister of Health at the time, Mr. Alex Segbefia on 26th October 2016 constituted a three-member committee made of Dr. Abdul Baasit Aziz Bamba, Prof. Adjei Nsiah & Prof. Ernest Aryeetey as its chairman in response to protests by some groups who were not in support of the policy’s implementation.

The recommendations of the GCPS to the Prof. Ernest Aryeetey committee as captured on page 11 of the committee’s report included: “a request to supervise our work & append their signatures to our laboratory results in endorsement of our laboratory reports”; a request for the amendment of Act 857 of 2013 to allow lab physicians to practice in the lab as they weren’t permitted to do so by law; most annoyingly a request that headship of laboratories at the various levels should be open to only lab physicians because they thought the very competent laboratory scientists in Ghana couldn’t interpret some laboratory reports.”

The reasons why I think Laboratory Physicians (LPs) should neither work nor head our laboratories include:
I. Firstly, the presence of MORE THAN ENOUGH QUALIFIED MEDICAL LABORATORY SCIENTISTS IN GHANA.

The earth is known to be oval in shape against the belief of the days of old that the earth was flat. Gordon Guggisberg was the governor of the then Gold Coast when we were under the British’s colonial rule, this will not however give him the right to contest an election to become Ghana’s president.
A “child” who grows to become of age doesn’t need his parents to manage his affairs and his home. Teachers who taught students in primary, junior high, Senior high schools, etc. aren’t brought to become heads of companies because they taught the individuals who work in those companies.

Before the coming into force of the Health Professions Regulatory Bodies Act (Act 857 of 2013), medical laboratory practice was in a mess with numerous substandard laboratories & unlicensed professionals of the trade springing up like mushrooms. People with qualifications in soil science, zoology, botany, oceanography, biological science, etc. could practice medical laboratory science as there was no regulation for the trade.

To add up to the level of training of medical laboratory professionals in the country, the Kwame Nkrumah University of Science & Technology (KNUST) introduced a Bachelor of Science (BSc) in Medical Laboratory Science/Technology in November 1998 followed by the University of Ghana (UG) that started same in September 2001. In the presence of all these programs in the natural sciences & the doctor of medicine & surgery (MBChB) already running or administered in our universities, our institutions of higher learning (universities) found it WISE & PRUDENT to introduce the BSc in Medical Laboratory Science & the Doctor of Medical Laboratory Science (MLSD).

Individuals with varied university degrees have taken up courses in nursing, pharmacy, medical laboratory science, etc., and subsequently gone through the licensing process to practice these professions as stipulated by law. Many have also undertaken the popular Graduate Entry Medical Program (GEMP) in order to qualify to practice as medical officers. Why should the case be different for the practice of medical laboratory science? Should the standards for practicing medical laboratory science in Ghana be lowered? Why are some individuals unwilling to take up the relevant training in medical laboratory science/technology agitating to be licensed to work in the medical laboratory?

Interestingly, people pursue other courses ignoring medical laboratory science in the same universities that offer both courses only to later agitate to be licensed to practice the profession after graduation. So many graduates in the natural sciences (zoology, botany, oceanography, biological sciences, soil science, etc.) who subsequently studied medical laboratory science have admitted there is a very vast difference between the natural sciences & medical laboratory science in terms of course content.

Many of these people have subsequently gone through the licensing process to practice medical laboratory science in Ghana and have been gainfully employed in various laboratories both in Ghana & abroad. I think career guidance in our schools must be taken seriously! Does the practice of medical laboratory science in Ghana not deserve high quality in the training of its professionals too? Or “anything goes” for the practice of medical laboratory science?

Is the introduction of the BSc & MLSD (Bachelor of Science & Doctor of Medical Laboratory Science) needless? Arguments by some sections of people (GMA of GCPS & MSSG) that were involved in the practice & training laboratory professionals in the past and so the status quo be maintained doesn’t make sense.

Julius Wagner-Jauregg discovered the curative value of transfusing malaria-infected blood to induce fever in syphilis patients around 1917 - this treatment method was widely admired and extensively used till the 1950s.

Quinine was administered to treat malaria as soon as syphilis was cured. In 1927, Wagner-Jauregg received a Nobel prize in medicine for this discovery. The introduction of penicillin in treating syphilis ended the method of treatment discovered and introduced by Wagner-Jauregg.

The implementation of Act 857 of 2013 took a prospective effect and not a retrospective effect – people who were practicing medical laboratory science prior to Act 857 without the appropriate qualifications were not sacked from practicing in the laboratory – it is therefore not true that GAMLS sacked or prevented people from working in medical laboratories.

As I earlier explained, “there is sophistication in the training & caliber of medical laboratory professionals we have today.” In our dynamic society, change must regularly be embraced as THE ONLY CONSTANT IS CHANGE.

The MLSD (Doctor of Medical Laboratory Science) program was introduced “to further close the gap between diagnostic testing, clinicians and patients” and is comparable to a program administered in the USA as the DCLS (Doctorate in Clinical Laboratory Science).

Brandy Gunsolus, the first graduate of the DCLS currently works at the Augusta University Medical Centre as a: pathology utilization manager; immunology laboratory manager, and toxicology laboratory manager providing consultation services to physicians on the appropriate tests to be done and interpretation of test results.

Unfortunately, in Ghana, most of our physicians do not want to tap into the expertise and great worth of knowledge of our Doctors of Medical Laboratory Science. Prof. Agyemang Badu Akosa in his letter of 12th March 2018 to the NAB (National Accreditation Board) questioned why they had accredited UDS (University for Development Studies) to run the MLSD program since in his estimation the UDS lacked the needed resources to administer the program.

A specialist parasitologist in one of Ghana’s tertiary healthcare facilities & currently a fellow of the West African Postgraduate College of Medical Laboratory Science, WAPCMLS habitually wrote comments of his suspected confirmative diagnosis in his laboratory reports or results. He also suggested other laboratory investigations (tests) in his lab reports to assist physicians to better diagnose & treat patients.

History has it that the medical director in his health facility at the time sent him a stern warning to stop writing these comments. Medical laboratory scientists should be allowed the freedom to practice their profession and do their work.

II. Secondly, medical laboratory scientists should take fiduciary duty for their work.

There have been a number of reported cases of alleged and legally decided cases of medical negligence both in Ghana and abroad. The British Broadcasting Cooperation (BBC) once reported that “Kenya doctors ‘perform surgery on the wrong patient’” due to a horrifying mix-up of identification tags.

Myjoyonline.com once reported that “Director of Institute of Languages alleges medical negligence at Ridge Hospital led to the death of his wife”.

Thefourthestategh.com also reported “Medical negligence: “My brother bloated to death” – Man sues 37 Military Hospital.” Citinewsroom.com reported a legal suit and damages awarded for the death of a 27-year-old woman during childbirth in November 2015 in a publication “37 Military Hospital slapped with over GH¢1M for woman’s death in childbirth.”

I once heard of a seamstress who went to a health facility to deliver a baby but allegedly returned from the health facility an amputee and subsequently sued for damages. Fiduciary duty is the responsibility to act in the best interest of a person or organization.

MEDICAL LABORATORY SCIENTISTS SHOULD BE ALLOWED TO EXERCISE FIDUCIARY DUTY OVER THEIR OWN WORK AND BE IN CHARGE OF HEADSHIPS ROLES OF MEDICAL LABORATORIES AT ALL LEVELS and not the recommendations of the GMA & GCPS to allow them to work or head a space not meant for them.

III. Thirdly, the quality of medical laboratory service will be negatively affected.

Arguments that there are medical officers already in laboratories of research institutions like the Noguchi Memorial Institute of Medical Research (NMIMR) do not fit into this conversation. A distinction should be made between clinical (hospital) laboratories & research laboratories.

One doesn’t require licensing to conduct research or work in a research laboratory like the NMIMR. However, one would require licensing to practice medical laboratory science, pharmacy, nursing, medicine, physiotherapy, radiography, etc. as stipulated by the Health Professions Regulatory Bodies Act (HPRBA), Act 857 of 2013.

Sections 6 to 11 of the HPRBA (on pages 9 to 11) states the requirements for who qualifies to practice as a medical laboratory professional (page 57 of the Act).

Page 23 of the HPRBA defines medicine to “include surgery, anesthesia, obstetrics & gynecology, pediatrics, psychiatry, public health, internal medicine, radiology, and radiotherapy.” The GMA & GCPS now find the need to insert laboratory medicine into the definition.

It is therefore not surprising that the GMA & GCPS recommended to the Prof. Ernest Aryeteey committee in November 2016 that “the laws of medical and dental practice be amended to reflect the role of laboratory physicians” as captured on page 11 of the committee’s report. This is a very clear admission by the GMA & GCPS of the fact that the term “laboratory physicians” is alien to our laws and has no locus to practice in the laboratory. There have however been several rumours of attempts by the GCPS & GMA to have “laboratory physicians” smuggled into the HPRBA.

They also recommended to the committee that “headships of laboratories at the various levels should be opened to only laboratory physicians” (on page 11 of the committee’s report).

Why should more competently trained medical laboratory professionals be denied headship of labs only to be assigned to laboratory physicians who are not even recognized by law?

The GMA through their links have stifled the professional progression of medical laboratory professionals over the years in the GMA’s quest to manage the medical laboratory space.

Calls by GAMLS for regulation of the profession and the establishment of a medical laboratory science council date as far back as 1973.
This call for regulation was also presented by the Head of Civil Service in the scheme of service developed for the health laboratory services in 1989.

Calls for a medical laboratory directorate also date as far back as the same period. Unfortunately, we haven’t made much progress as a profession as compared to other parts of the world.

This point of profession suppression is also evidently clear in the proposed organogram for medical laboratories by the GMA & GCPS, in which their entry point (residents in laboratory medicine) is equal to (or at par with) the current highest grade for medical laboratory professionals (Chief Medical Laboratory Scientist). Very selfish, disrespecting, and insulting from the GMA & GCPS, isn’t it?

Other instances of professional suppression include:
1. The request for the removal & replacement of Prof Clement Opoku Okrah with a medical officer.

2. The refusal to make Dr. David Sackey (medical laboratory scientist, specialist laboratory hematologist & a fellow of the West African Postgraduate College of Medical Laboratory Science, WAPCMLS) a substantive head for some years now.

3. The refusal of headship to the only person in Ghana with a Ph.D. in transfusion medicine (a medical laboratory scientist and fellow of the WAPCMLS) because he is not a medic.

4. A medical laboratory scientist and a fellow of the WAPCMLS with a Ph.D. in microbiology was not even invited for an interview for headship only to bring a medic who allegedly didn’t even apply for the position.

5. In a related issue, the request for the removal from office of the immediate past CEO of HeFRA (Health Facilities Regulatory Agency), Mr. Matthew Yaw Kyeremeh because he wasn’t a medical professional by three medical officers (see ghanaweb.com publication "President petitioned to remove Registrar").

Fast forward, the new and current CEO of HeFRA Dr. Philip A. Bannor, abused his office when he wrote a letter dated May 31, 2021, stating that “primary, secondary and tertiary laboratories are headed by laboratory physicians” to support the claims of the GMA his professional association.

This is in clear contravention & violation of Article 296 of the 1992 constitution on the exercise of discretionary power. According to the specific requirements for a clinical and biomedical laboratory document which was last ratified by all the professional groups under HeFRA: “the minimum qualification for a person in charge of a laboratory shall be a qualified medical laboratory scientist with a minimum of a first-degree certificate (with 5 years post qualification experience and in good standing with the Allied Health Professions Council of Ghana)."

6. The creation of the single spine: scale type 1 and scale type 2 salary structure is a subject for discussion for another day.

Quite recently, the Ghana Association of Certified Registered Anesthetists went on strike demanding a name change from Physician Assistants – Anesthesia to Certified Registered Anesthetists in their quest to fight professional suppression (see citinewsroom.com publication “Striking anesthetists withdraw all services in demand for a name change”).

The GMA who is at the helm of affairs in most hospital management positions has thus shown a very clear plan to subdue all other health professionals under their control as though they in the GMA are the most competent & own the bona fide rights to all leadership roles in the health sector.

Already, many medical officers have neglected their primary role of patient care and management of patients with various diseases but competing with trained hospital administrators to become hospital administrators; have monopolized positions like Chief Executive Officer (CEO) of teaching hospitals, medical superintendent, director of the Regional health directorates.

The GMA & GCPS in spite of all this, think they need to be heads, managers, and directors at all levels of the medical laboratory (as they recommended to the Aryeetey committee in 2016) – this is unacceptable and will not be tolerated.

Studying a 6-year MBChB (Doctor of Medicine & Surgery) doesn’t naturally make one a leader in the healthcare sector and it is a first degree like the 6 - year programs in MLSD (Doctor of Medical Laboratory Science), PharmD (Doctor of Pharmacy) & OD (Doctor of Optometry).

The MBChB is not superior to any program as each program trains its graduates and practitioners for specific roles in the world of work. Top leadership in the healthcare sector should be opened to all health professionals with the requisite leadership qualifications and not only people from a particular profession.

The general objectives for the training of laboratory physicians captured on pages 3 & 4 of the March 2012 edition of the “curriculum for membership and fellowship in laboratory medicine” include:

1. Skills in performing laboratory tests in the area/areas of specialization.
2. Skills in investigating and diagnosing diseases in the laboratory.
3. The ability to establish and/or manage a laboratory.
4. The ability to perform research.
5. The ability to provide excellent and skilled oral and written communication of laboratory results and interpretation to clinicians.
6. The ability to be a leader in the medical laboratory.
7. The ability to manage hematological disorders in the case of hematology, microbial infections in the case of microbiology and toxicological problems in the case of chemical pathology.
8. The ability to offer intraoperative consultation in the case of histopathology and run a FNAC clinic in the case of cytopathology.

Why will the GCPS train MOs (Medical Officers) to perform all the above-listed tasks already competently performed by medical laboratory scientists except objectives 7 & 8?

That notwithstanding, it is not the job of medical laboratory scientists to perform those tasks (objectives 7&8) as management of disease conditions & intraoperative consultation are performed by physicians in the wards, clinics & consulting rooms but not in the laboratory.

Results interpretation is already being carried out by medical laboratory professionals. Moreover, laboratory physicians DO NOT need the medical laboratory space to do result interpretation but can interpret these in their consulting rooms just as our friends send us lab results of tests they performed elsewhere for explanation and interpretation.

Laboratory physicians should focus their energies in treating their patients at the wards & clinics; interpret laboratory results to their colleague medical officers at the consulting rooms, wards, and clinics; help their colleague medical officers choose appropriate laboratory tests supposed to be conducted in the light of the patients’ condition rather than wanting to fight laboratory professionals over medical laboratory space.

We do not want laboratory physicians’ supervisory support – and we will not tolerate any form or attempt of professional encroachment or professional colonization. The international standard for medical laboratories (ISO 15189:2012) which was adopted by the Ghana Standards Authority (GSA) as the Ghana Standard (GS ISO 15189:2015) stipulates that work and leadership in the medical laboratory should be carried by the medical laboratory scientists.

The GMA has changed its stance from “demanding headship of labs at all levels” to “headship of labs should be decided by hospital management” knowing very well it is predominantly their kind in top management positions who will choose them over us. Whatever the case is, leadership roles of laboratories at all levels must be held & played by medical laboratory scientists as stipulated by ISO 15189:2012.

Arguments that medical officers (anatomic pathologists) perform grossing & cut-ups of biopsies & autopsies not in consulting rooms but in laboratories do not also fit into this conversation. There are clearly defined work roles for staff in the histopathology laboratory and these do not overlap - Medical laboratory scientists (histotechnicians/histotechnologists) have roles distinct from that of medical officers (anatomic pathologists) just as there are no role conflicts between that of midwives and gynecologists although they work in the same space.

On the other hand, roles laboratory physicians in hematology, chemical pathology, and microbiology seek to perform in the laboratory is in conflict with roles already being performed by the medical laboratory scientists – for this reason, comparison of these (laboratory physicians in hematology, microbiology & chemical pathology) with laboratory physicians (in anatomical pathology) doesn’t make sense.

The training of laboratory physicians in hematology, chemical pathology & microbiology in parts of the world is to assist in managing patients’ disease conditions as stated in objective 7 above and not fight medical laboratory professionals over laboratory space.

Arguments like “a medical officer studies a bit of everything in the healthcare system” by members of the GMA aren’t uncommon. A medical laboratory professional taking some courses in pharmacology or accounting as part of his/her medical laboratory coursework doesn’t give him/her the right to parade himself about as a pharmacist or accountant.

An academic program in economics or accounting with some coursework in law (for instance company law, law of contract & sale of goods, etc.) with all due respect doesn’t make one a lawyer. Time to come, should we expect nurses with a specialization in hematology nursing to start clamouring to work in or head hematology laboratories because they studied hematology nursing rather than practice the service they trained to offer (which is to nurse patients with hematological conditions at the wards and clinics)?

Should we anticipate that medical laboratory scientists and more specifically and especially doctors of medical laboratory science (who undertake ward rounds as part of their training) will be seen someday scrambling for headship roles of our various wards? Going by the argument of “studying a bit of everything in the healthcare system”, all healthcare professionals do “study a bit of everything in the sector.”

Should medical laboratory scientists (specialist laboratory hematologists) not be allowed to continue diagnosing patients with hematological conditions in the laboratories or should they also start advocating to be allowed to treat patients with hematological conditions at the wards and clinics (which is the job of the clinical hematologist or laboratory physician in hematology)?

Conversely taking of bone marrow aspirates; treatment & management; seeing of patients with hematological conditions are carried out at the wards, clinics & consulting rooms, and not in the laboratory. Every academic and/or professional program has a syllabus, course content, and other requirements for licensing (for those that require a license).

Taking postgraduate training in; pharmacology doesn’t qualify one who is not a pharmacist to become one; anatomy and experimental surgery as studied by some non-medics doesn’t qualify one to become a surgeon.

Knowledge acquisition is good for the purposes of wanting to provide the best care for patients. It is therefore unacceptable for the laboratory physicians to come fight laboratory scientists over laboratory space or seek to provide unwanted supervisory support to the work of medical laboratory professionals.

The “right tool” should be used for the right job - professionals and partners in the healthcare sector should live in mutual respect for one another, respecting boundaries and NOT UNNECESSARILY INTERFERING IN ONE ANOTHER’S WORK as is seen being done by the GMA.

After years of issuing a joint statement between the Royal College of Pathologists (RCPath) & the Institute of Biomedical Science (IBMS) on “the role of biomedical scientists in histopathology reporting”, this “opened” doors for the training of medical laboratory scientists (biomedical scientists as they are called in the UK) in the “dissection of category B and C tissue pathology samples, followed by the more complex D and E cases, histopathological reporting of cases from pre-determined body systems (gynecological and gastrointestinal tracts)”.

It is believed that the training of anatomic pathologists (traditionally reserved for medical officers) will be exclusively reserved for medical laboratory scientists in the future so the medical officers focus on direct patient care. Unfortunately, in Ghana, the GMA will rather prefer fighting medical laboratory scientists over medical laboratory space

The president of the society of family physicians, Dr. Emmanuel Ati called for support in the training of more family physicians in a publication titled “train more family physicians to strengthen healthcare – the society of family physicians to government.”

The deputy general secretary of the GMA, Dr. Titus Beyuo confessed during a televised show of 20th May 2020 on GHONE TV (State of Affairs) that “there is only one medical officer in my district and no surgery can be performed if that medical officer is out of the district”. He further confessed that “as of February 2021 we have had only 8 properly trained intensivists in Ghana in the height of COVID. 3 of the 8 being Ghanaians and the remaining 5 on loan from Cuba.”

In spite of these and other unreported problems bedevilled with the GMA, they rather found it prudent setting in motion a plan to train not less than 250 laboratory physicians in 2016 who they intended posting to the teaching, regional, and district hospitals across the country as laboratory heads. It is time the GMA sets its priorities right and stopped fighting over laboratory space.

I believe some lessons could be taken from the words of Ghana’s first president Dr. Kwame Nkrumah when he said that “if the change is denied, or too long delayed, violence will break out here and there. It is not that man planned or willed it, but it is their accumulated grievances that shall break out with volcanic fury.”

The Ghana Association of Medical Laboratory Scientists (GAMLS) as a professional association is working very diligently towards resolving the problems confronting the association, professionals, and the practice of the trade in Ghana and we do not intend to add the GMA & GCPS to our myriad of problems. I will talk to you another time. Please do take care my love.