Causes of wrong diagnosis of diseases in Nigerian Hospitals by Dr. Bassey

Dr. Bassey Enya Bassey, president of the Association of Medical Laboratory Scientists of Nigeria (AMLSN) has identified some of the  reasons that are  responsible for the wrong diagnosis of illnesses in Nigerian hospitals.


You may recall that the popular actor Sadiq Daba was diagnosed in Nigeria to have prostate cancer that has spread to other parts of the body, as well as Leukemia that requires surgical operation. However, in the United Kingdom same conditions- prostrate cancer was said no to have spread and the Leukemia not requiring any surgical operation whatsoever but simple medications to treat.


Many others like late Gani Fawehinmi (the human rights lawyer and activists), late Prof. Dora Akunyili (former Director General of the National Agency for Food and Drug Administration and Control) are a handful whose illnesses were wrongly diagnosed in Nigeria.


Since an estimated 70 percent of all decisions regarding a patient's diagnosis, treatment, hospital admission and discharge are based on laboratory test results, Dr. Bassey believes the causes of wrong diagnosis in Nigeria could not be unconnected with the followings:


1. Employment of  wrong professionals to conduct laboratory tests:
The country is faced with situations where wrong professionals are employed to conduct laboratory tests. If a hospital wants to employ laboratotry personnel, they should ensure that the people they recruit are the right personnel.


2. Wrong environment:
The laboratory space in Nigeria is not adequate and where it is adequate does not conform to international standard. If they want to build laboratory they should ensure that the laboratory conforms to specification set by the country.


3. Wrong equipments:
If they want to buy lab equipment, they should ensure that the equipment is up to standard, conforming to the right specification. But that is not happening in Nigeria.

There should be right personnel, right equipment and right environment. So, when you get the right personnel, right equipment and right environment, you are sure that your diagnosis will be up to 98 per cent accurate.


The Way Forward:

The Federal Ministry of Health (FMOH) should setup the Department of Medical Laboratory Service to cater for over 20,000 medical laboratory scientists in Nigeria. Once that department is established we will have a command structure, which will translate to getting the right personnel, the right equipment and the right environment. So, if the laboratory does not get it right,. you cannot get it right. No such department exists in the FMOH.

As far back as 2007, some partner organisations came together and identified this weakness and recommended the setting up of National Medical Laboratory Service Policy for the country and part of the recommendation was the setting up of the Department of Medical Laboratory Services in the FMOH. Since 2007 that has not happened.

The absence of this proposed department and the policy have impacted negatively on laboratory services in the country.

Implications of this absence is that:
There is no coordination of laboratory services in Nigeria, which means when you send a battalion to the field nobody is coordinating. So, everybody does what he wants to do and that is not right.

Operators of laboratory services recruit any type of person they want to be in the laboratory; there is no right equipment because the people who make recommendation for equipment that are supposed to be in the laboratory are not laboratory scientists ‘ab initio’; there is no right environment because the environment we find ourselves as laboratory scientists is very hostile.

Causes of wrong diagnosis of diseases in Nigerian Hospitals by Dr. Bassey

Dr. Bassey Enya Bassey, president of the Association of Medical Laboratory Scientists of Nigeria (AMLSN) has identified some of the  reasons that are  responsible for the wrong diagnosis of illnesses in Nigerian hospitals.


You may recall that the popular actor Sadiq Daba was diagnosed in Nigeria to have prostate cancer that has spread to other parts of the body, as well as Leukemia that requires surgical operation. However, in the United Kingdom same conditions- prostrate cancer was said no to have spread and the Leukemia not requiring any surgical operation whatsoever but simple medications to treat.


Many others like late Gani Fawehinmi (the human rights lawyer and activists), late Prof. Dora Akunyili (former Director General of the National Agency for Food and Drug Administration and Control) are a handful whose illnesses were wrongly diagnosed in Nigeria.


Since an estimated 70 percent of all decisions regarding a patient's diagnosis, treatment, hospital admission and discharge are based on laboratory test results, Dr. Bassey believes the causes of wrong diagnosis in Nigeria could not be unconnected with the followings:


1. Employment of  wrong professionals to conduct laboratory tests:
The country is faced with situations where wrong professionals are employed to conduct laboratory tests. If a hospital wants to employ laboratotry personnel, they should ensure that the people they recruit are the right personnel.


2. Wrong environment:
The laboratory space in Nigeria is not adequate and where it is adequate does not conform to international standard. If they want to build laboratory they should ensure that the laboratory conforms to specification set by the country.


3. Wrong equipments:
If they want to buy lab equipment, they should ensure that the equipment is up to standard, conforming to the right specification. But that is not happening in Nigeria.

There should be right personnel, right equipment and right environment. So, when you get the right personnel, right equipment and right environment, you are sure that your diagnosis will be up to 98 per cent accurate.


The Way Forward:

The Federal Ministry of Health (FMOH) should setup the Department of Medical Laboratory Service to cater for over 20,000 medical laboratory scientists in Nigeria. Once that department is established we will have a command structure, which will translate to getting the right personnel, the right equipment and the right environment. So, if the laboratory does not get it right,. you cannot get it right. No such department exists in the FMOH.

As far back as 2007, some partner organisations came together and identified this weakness and recommended the setting up of National Medical Laboratory Service Policy for the country and part of the recommendation was the setting up of the Department of Medical Laboratory Services in the FMOH. Since 2007 that has not happened.

The absence of this proposed department and the policy have impacted negatively on laboratory services in the country.

Implications of this absence is that:
There is no coordination of laboratory services in Nigeria, which means when you send a battalion to the field nobody is coordinating. So, everybody does what he wants to do and that is not right.

Operators of laboratory services recruit any type of person they want to be in the laboratory; there is no right equipment because the people who make recommendation for equipment that are supposed to be in the laboratory are not laboratory scientists ‘ab initio’; there is no right environment because the environment we find ourselves as laboratory scientists is very hostile.

AIMS PROFESSIONAL EXAMINATION GUIDELINES

The AIMS Professional Examination

The AIMS Professional Examination is a written short answer paper of three (3) hours, conducted twice a year in March and September in a number of venues in Australia and overseas.

The examination consists of the following sections:

·         Clinical Chemistry 22 marks

·         Haematology 22 marks

·         Medical Microbiology 22 marks

·         Transfusion Science 22 marks

·         Histopathology/Cytology 12 marks

Total 100 marks

All sections are compulsory. To pass the Examination candidates must obtain a total of 50% or more, with a pass of at least 50% in each section. Completed examinations are not released under any circumstances

Applicants who are successful in the Examination will be classified as a Medical Laboratory Scientist.

Please note:  If you have not completed stage 1 of your assessment of professional skills and qualifications then you are not able to apply for the professional examination.

AIMS Professional Examination Application Deadlines

You must apply in writing to sit the AIMS Professional Examination using the application form which will be provided in the examinations pack once stage 1 has been completed in your assessment of professional skills and qualifications.

Closing dates to receive this application form are:

1st December for the March Examination

1st June for the September Examination

Applications to sit the Examination must be received no later than 4pm on the specified date.

You should receive notification of your examination and venue by:

·         The second week of February (for March examinations)

·         The second week of August (for September examinations)

If you do not receive notification by 15th February (March examination) or 15th August (September examination) please contact AIMS immediately.

English Language Requirement

All applicants must submit a valid IELTS report form showing an overall band score of 7.0 or better (Academic or General). AIMS consider an IELTS report to be current for three (3) years from the date of issue.

AIMS also accept the following English language assessments as equivalent to an IELTS overall band score of 7.0: TOEFL (95 points), and Pearson PTE Academic (65 points).

The only exemption to this rule is if you have already provided AIMS with a valid IELTS, TOEFL, or Pearson PTE Academic test report which accompanied your application for Assessment of Professional Skills and Qualifications. If this is the case then you do not need to supply it for a second time provided the application for the AIMS Professional Examination is received within three years of the date of your assessment.

Photographs

Please attach one (1) passport sized photograph to the application form.

Fees

All Fees are in Australian Dollars and are non-refundable. Visit the AIMS website for current fees.

How to Lodge Your Examination Application

Send by post your completed application form together with the required attachments (see below) and submit to:

Postal address: Australian Institute of Medical Scientists

PO Box 1911

MILTON QLD 4064 AUSTRALIA

Courier address: Australian Institute of Medical Scientists

Unit 7 / 31 Black Street

MILTON QLD 4064

AUSTRALIA

REQUIRED ATTACHMENTS

ü  Complete application form with the declaration signed

ü  Complete payment information or enclose a cheque / money order or draft

ü  Attach a valid IELTS, TOEFL, or Pearson PTE Academic certificate

ü  Attach one (1) passport sized recent photographs

Results

It will take up to ten (10) weeks to receive your professional examination result. Results will be given as either a PASS or FAIL. Exact marks will not be given.

Further Information

Email: contact@aims.org.au

Website: www.aims.org.au

The AIMS Professional Examination

The AIMS Professional Examination will be held in centres in Australia and other countries twice yearly, in March and September.

The examination is a three (3) hour short answer paper and is set at the level expected of a professional medical scientist with at least two years post graduate experience. All questions must be attempted.

The examination is divided into five sections:

·         Clinical Chemistry 22 marks

·         Haematology 22 marks

·         Medical Microbiology 22 marks

·         Transfusion Science 22 marks

·         Histopathology/Cytology 12 marks

Total 100 marks

To pass the AIMS Professional examination, candidates must obtain an overall total of 50%, with a pass of at least 50% in each section.

Major Areas of Knowledge

The major areas of knowledge expected of candidates are as follows:

Clinical Chemistry

An understanding of the underlying techniques utilised and methodology behind the measurement of common chemistry anylates and their clinical utility including:

- Blood gas and electrolytes measurement

- Urea, creatinine, and creatinine clearance, uric acid

- Glucose, glucose tolerance, HbA1c

- Liver function tests

- Lipid analysis

- Thyroid function tests

- Adrenal function tests

- Plasma proteins and protein electrophoresis

- Specific plasma proteins e.g. CRP

- Principles of enzyme assays.

- Enzyme tests e.g. amylase, creatine kinase

- Calcium, phosphates, magnesium

- Bilirubin including neonatal bilirubin measurement

- Myocardial function tests.

- Common tumour markers e.g. Prostatic specific antigen, CEA

- Basic virology tests now performed in core lab settings

- Point of care testing

Microbiology

- A basic knowledge of infectious diseases and organisms most commonly associated with these diseases. There will be a greater emphasis on bacterial diseases, but some knowledge of parasitic, fungal and viral disease is also expected.

- Collection, handling and processing of samples including the minimal criteria for acceptance of samples

- Presumptive identification of major groups of bacteria based on microscopic and colonial morphology on a variety of common media and the use of key basic identification test such as catalase, oxidase and atmospheric growth requirements.

- Principles of major methods of susceptibility testing i.e. disc diffusion, agar dilution and broth dilution and the relationship between breakpoints, MIC and susceptible/resistant categories.

- General principles of Quality Control.

- Microscopy:

o Function and maintenance of a modern binocular microscope, including setting up and using for bright field, phase contrast and darkfield microscopy.

- Staining techniques:

o Gram stain

o Ziehl Neelsen

- Knowledge of Normal Flora (indigenous flora) of major body sites or absence of normal flora in sterile body sites.

Haematology

- Principles of automated cell counting

- Macrocytic anaemia

- Microcytic anaemia

- Normocytic anaemia

- Myeloproliferative disorders

- Lymphoproliferative disorders

- Production of erythrocytes, leucocytes and platelets

- Iron metabolism

- Intrinsic and extrinsic coagulation pathways and methods of testing

- Bleeding disorders

- Anticoagulant therapy and methods of monitoring this therapy

- Natural anticoagulants

- Fibrinolysis.

Immunohaematology / Transfusion Science

- Antibody structure and function

- Antibody production

- Blood donation testing

- Blood components

- Blood group systems

- Antibody detection and identification

- Pre transfusion testing

- Quality assurance in the blood bank laboratory

- Antigen/ antibody interaction.

Histopathology and Cytology

- Preparation of specimens for light microscopy including fixation and tissue processing, decalcification technique and general staining methods such as Haematoxylin and Eosin stain, Van Gieson stain and Masson`s Trichrome stain.

- Normal histology especially basic tissue types

- Histochemical methods as applied to light microscopy such as PAS and Perls` Prussian Blue for Iron.

- Fixation of cytological specimens

- The Papanicolaou staining technique

- The cytological features of inflammation and neoplasia in cervical smears

- Normal cell types in cytological specimens

Laboratory Safety and Quality Control

- Safe handling of biological specimens

- Safe handling of hazardous chemicals

- Sterilisation and disinfection procedures

- Handling of infectious specimens

Principles of quality assurance and quality control

- Basic charting and rules for rejection of results.

- Simple statistical evaluation. Reference ranges methodology – parametric and non parametric

- The role of internal quality control and external quality assurance

- Uncertainty of measurement

Basic Laboratory Procedures and equipment

- Normal and Molar solutions

- Basic laboratory calculations

- Basic laboratory equipment and its appropriate use

- Spectrophotometry

- Immunoassay

Recommended Reading List

Any edition of the texts below from the last 10 years would be suitable

1. Manual of Clinical Microbiology. 10th Ed.

James Versalovic Editor in Chief 2011 American Society for Microbiology.

2. Practical Haematology. 6th Ed.

Dacie and Lewis Churchill Livingstone.

3. Medical Laboratory Haematology

Hall and Malia Butterworths.

4. Technical Manual. 10th Ed.

American Association of Blood Banks.

5. Textbook of Diagnostic Cytology

The New South Wales Institute of Technology Information and Publications unit.

6. Cellular Pathology 2nd Ed.

Cook,D.J 2006 Scion Publishing

7. Difiores Atlas of Histology with functional correlations 10th Edition

Eroschenko,V.A 2005 Lippincott

8. The Fundamentals of Clinical Chemistry

Tietz, Saunders Saunders

9. Clinical Chemistry

Kaplan Mosby- Williams Publishers.

10. Essential Guide to blood groups

Daniels and Bromilow Wiley Page 7

MIGRATION TO AUSTRALIA AS A MEDICAL LABORATORY SCIENTIST

MIGRATION TO AUSTRALIA AS A MEDICAL LABORATORY SCIENTIST/BIOMEDICAL SCIENTIST

OVERVIEW.

Applicants wishing to apply to migrate to Australia as a Medical Laboratory Scientist or Medical Laboratory Technician under the General Skilled Migration visa categories will need to have their skills assessed by AIMS. AIMS will assess applicants as "suitable" or "not suitable" for the nominated occupation against the requirements it has established.

The Department of Immigration and Border Protection Australian Skills Recognition Information website (http://border.gov.au/ ) also provides information on working as a Medical Laboratory Scientist or Medical Laboratory Technician in Australia.

Medical Laboratory Science / Laboratory Medicine in Australia

In Australia, most of those engaged in medical laboratory science are employed in public hospitals or private diagnostic pathology laboratories. There are two levels of practice:

Medical Laboratory Scientists are normally employed in diagnostic clinical laboratories, and they work in the field of laboratory medicine. They conduct medical laboratory tests on blood, body fluids and tissues and apply knowledge and methodology from various scientific disciplines to assist clinicians in the diagnosis, treatment and prevention of human disease. Responsibilities include the quality and reliability of test results and may include interpretation of these results and the development of new test procedures.

Medical Laboratory Technicians perform or assist with laboratory tests on blood, body fluids and tissues in medical and pathology laboratories under the direction of medical laboratory scientists and operate diagnostic and monitoring equipment used in support of health professionals.

Employment in Australia

As in most countries, the practice of a profession in Australia requires evidence of an appropriate level of education and practical experience. There is no statutory registration of Medical Laboratory Scientists in Australia.

Successfully migrating to Australia as a Medical Laboratory Scientist or Medical Laboratory Technician is no guarantee of employment in Australia as a Medical Laboratory Scientist or Medical Laboratory Technician.

The AIMS assessment Process

AIMS can provide advice only on applying for a skills assessment. All other questions relating to migration should be directed to the Australian Government Department of Immigration and Border Protection (DIBP).

Applicants’ skills and qualifications will be assessed by AIMS to determine whether they are suitable for the applicant to work as a Medical Laboratory Scientist or Medical Laboratory Technician. AIMS will assess applicants as "suitable" or "not suitable" for the nominated occupation against the requirements it has established. An applicant’s skills assessment must be included with their visa application to the DIBP, and applicants must be prepared to show DIBP all the documentation they have relied upon when seeking a skills assessment. Applicants should keep a certified copy of their skills assessment and all other relevant documentation for their own records.

Please note that all applicants are assessed on a case-by-case basis and this information is provided for guidance purposes only. The assessment committee determines the eligibility of the applicant to work as a Medical Laboratory Scientist or Medical Laboratory Technician.

To be assessed as a Medical Laboratory Technician

The minimum requirements for a Medical Laboratory Technician are that an applicant has completed an award in medical laboratory science assessed as comparable to an Australian diploma from a Technical and Further Education College, based on the AEI Country Education Profile criteria, plus a minimum of two years diagnostic medical laboratory experience within the five year period immediately prior to applying for assessment OR registration with the New Zealand Medical Laboratory Science Board.

Applicants who do not qualify to sit the Professional Examination or who fail to pass the Examination may also be classified as a Medical Laboratory Technician.

To be assessed as a Medical Laboratory Scientist

The assessment process for Medical Laboratory Scientist is in two stages and usually includes a written examination (the AIMS Professional Examination).

Stage 1: Document assessment

The first stage is a document-based assessment. Applicants who hold an AIMS accredited degree will be classified as a Medical Laboratory Scientist and will not be required to take the written examination. It is the responsibility of all prospective applicants who hold an AIMS accredited degree to ensure the subjects completed comply with the AIMS accredited pathway in order to gain assessment as a Medical Laboratory Scientist or Professional membership of AIMS. These requirements are stated in the AIMS accreditation report held by the university. Prospective applicants should contact the program co-ordinator at the University for Advice on these requirements.

The skills and qualifications of applicants who do not hold an AIMS accredited degree will be assessed individually to determine eligibility to sit the Professional Examination.

Applicants who have an acceptable science degree (equivalent to Australian Qualifications Framework level 7 or 8) and two years post graduate professional experience in a diagnostic medical laboratory within the five year period immediately prior to applying for assessment will usually be assessed as eligible to sit the Examination.

An acceptable science degree is one with subjects relevant to pathology that meets the AIMS minimum requirements and is assessed as comparable to an Australian bachelor degree based on the AEI Country Education Profile criteria.

An acceptable science degree should include FULL units (not part units) of the following subjects:

Ø  Human Anatomy

Ø  Human Physiology

Ø  Chemistry

Ø  Biochemistry

Ø  Immunology

Ø  General Microbiology

Ø  General Pathology

Ø  Human Molecular Biology

and should include at least two (2) of the following professional subjects:

Ø  Clinical chemistry

Ø  Haematology

Ø  Medical microbiology

Ø  Transfusion science (Immunohaematology)

Ø  Histopathology/Diagnostic cytology

Pharmacy and biotechnology degrees are not normally acceptable degrees, but some units of these degrees may be acceptable.

Stage 2: The AIMS Professional Examination

Applicants assessed in stage one as eligible may apply to sit the Professional Examination. This is a written short answer paper of three (3) hours, conducted twice a year in March and September in a number of venues in Australia and overseas.

The examination consists of the following sections:

Ø  Clinical Chemistry 22 marks

Ø  Haematology 22 marks

Ø  Medical Microbiology 22 marks

Ø  Transfusion Science 22 marks

Ø  Histopathology/Cytology 12 marks

Total 100 marks

The Examination is set at the level expected of a professional Medical Laboratory Scientist with at least two years post graduate experience. All sections are compulsory. To pass the Examination candidates must obtain a total of 50% or more, with a pass of at least 50% in each section.

Applicants who are successful in the examination will be classified as a Medical Laboratory Scientist.

If assessed as eligible to sit the AIMS Professional Examination, applicants must apply in writing using the application form (which will be provided in the examinations pack once stage 1 has been completed).

Closing dates to receive this application form are:

1st December for the March examination

1st June for the September examination

Applications to sit the examination must be received no later than 4pm on the specified date.

Compulsory Requirements for All Applications

All documentation must be certified

Correctly certified supporting documentation

A certified copy is a photocopy that has been stamped and signed by a suitable certifying officer (as stated below) who verifies that they have sighted the original document and that the photocopy that they are certifying is a true copy of that original.

Each photocopied page of all documentation must be certified on the face and must show clearly the words "certified true copy of the original", the signature of the certifying officer and the name and address or provider/registration number of the certifying officer. It must be possible from the details provided for AIMS to verify the certifications by contacting the certifying officer if necessary.

Who does AIMS accept to certify my documents?

Documents certified in Australia may be certified by a Justice of the Peace or a Notary Public.

Documents certified in a country other than Australia must be certified by a Notary Public or an official of an Australian Embassy or Consulate.

Please note that AIMS WILL NOT accept any other form of certification. If incorrectly certified documents are provided with an application it WILL NOT be processed and the fee will NOT BE refunded.

All applicants submitting an application for assessment of their professional skills and qualifications whether seeking the classification of Medical Laboratory Scientist or Medical Laboratory Technician are required to provide:

1. English Language Requirement

A valid IELTS report form showing an overall band score of 7.0 or better (Academic or General). AIMS consider an IELTS report to be current for three years from the date of issue.

AIMS also accept the following English language assessments as equivalent to an IELTS overall band score of 7.0: TOEFL (95 points), and Pearson PTE Academic (65 points).

2. Completed signed application form

3. Supporting documentation

Must include all qualification certificates (or statements of completion issued by the educational institute in which the qualification was obtained) and all corresponding academic transcripts (showing FULL subject names).

4. Photographic identification

Applicants must provide a certified copy of their passport.

5. Work experience (if applicable)

Evidence of postgraduate professional experience in a diagnostic medical laboratory (a verification letter from an employer/past employer stating job title, hours of work, duties required and the dates of employment, on company letterhead).

6. Three (3) passport sized photographs signed on the back

Optional Documents that can be provided

1. Licences / Registrations

Evidence of current or previous licences held

2. Record of completed educational courses

3. Evidence of continued education in the workplace

How to Lodge an Application:

Send three (3) certified sets of documents: (one (1) originally certified set and two (2) duplicate photocopied sets)

Checklist:

·         Completed signed application form

·         Qualification papers and academic transcripts (showing full subject names)

·         Photographic identification (e.g. passport)

·         Evidence of professional work experience (verifying dates of employment)

·         Evidence of registrations / licences

·         Valid IELTS Test Result (or TOEFL (95 points), and Pearson PTE Academic (65 points))

·         Record of educational courses completed

·         Three (3) passport sized photographs signed on the back

Submit to:

Postal address:  Australian Institute of Medical Scientists

PO Box 1911

MILTON QLD 4064 AUSTRALIA

Courier address:  Australian Institute of Medical Scientists

Unit 7 / 31 Black Street

MILTON QLD 4064

AUSTRALIA

Reviews and Appeals:

An applicant who believes that his or her case has been wrongly assessed may seek a review of the assessment. The application for the review must be in writing, and should include the reasons for seeking the review. There is no charge for this review, which is conducted by the committee that made the original assessment.

If, after the review, the applicant still believes that he or she has been wrongly assessed, the applicant may appeal the assessment. The appeal must be in writing, stating the reasons for the appeal, and including additional documentation (if relevant). The appeal will be conducted by a committee other than that which conducted the original assessment. A fee of AUD200.00 is payable for the appeal.

Further Information:

Email:  contact@aims.org.au

Website:  https://www.aims.org.au/

For complete information and processes, please visit the official webpage of Australian institute of medical scientists: https://www.aims.org.au/services/assessment-options/medical-laboratory-scientist

HISTORY OF MEDICAL LABORATORY SCIENCE IN NIGERIA (conclusion).

MLS IN NIGERIA:  THE STORY SO FAR (PART 3)

The brilliant performance of Nigerian students sufficiently impressed the colonial administration to occasion the experiment of sponsoring Nigerians to the UK to study for Associates of the London Institute of Medical Laboratory Technology. In 1950 the first Associate emerged in the person of Mr. R.A.O Shonekan.  By the end of 1960 Nigerians holding Associates of the London Institute of Medical Laboratory Technology had exceeded 20. Thereafter, they came like a swarm of bees.
What appeared to be the logical consequence of this positive development was the London Institute’s decision to make Nigeria the first country outside Britain to conduct her intermediate exams. The final diploma of the Institute eventually followed this. The creation of the Nigeria Institute of Medical Laboratory Technology in 1968, independent of London was inevitable. Ever since, the limitless sky has been the limit for the Nigerian Medical Laboratory Scientists

MLS IN NIGERIA: THE GRAND FINALE

The journey to becoming a profession to be reckoned with started during military regimes in 1968. First it was the regime of Gen. Yakubu Gowon who promulgated degree No 56 of 1968 that created the then Institute of Medical Laboratory Technology of Nigeria. Next, was the military administration of Gen. Olusegun Obasanjo that made MLT a profession by degree No 5 of 1978. Then came degree No.54 of 1999 that gave the change of name from IMLTN to IMLSTN after series of agitations.
Respite then came our way in 2003 through the help of Hon. Kunle Jenrade (a member of the profession in the then NASS). Act 11 of 2003 assented by Chief Olusegun Obasanjo change the name to MLSCN and consequently conferred on us the name SCIENTIST.
In all of these, it’s pertinent to note that the profession has moved from being Lab boys through obtaining diploma (Associate) to degree (BMLS) and recently the clamour for MLSD.
The question now is WHO ARE YOU?
Finally, "A difficult time can be more readily endured if we retain the conviction that our existence holds a purpose, a cause to pursue, a person to love, a goal to achieve." - John Maxwell.

HISTORY OF MEDICAL LABORATORY SCIENCE IN NIGERIA

MLS IN NIGERIA: THE STORY SO FAR (PART 1) 

MLS has evolved from Laboratory Technician through Technologist to the Medical Laboratory Scientist of today. This is in consonance with the humble beginning of all professional groups e.g. Medicine started as an apprenticeship course and gradually developed into a diploma programme before the current degree programme. In Nigeria, the Yaba College of Technology and Kano Royal School of Hygiene trained and awarded diploma to the initial sets of medical doctors. Similarly, Pharmacists were trained as diploma holders until the Obafemi Awolowo University, Ile-Ife introduced the degree programme.
Rudimentary MLS education in Nigeria started in 1920. In those early days the responsibilities of Nigerians in the historical laboratories as they were then known were very minimal, mainly running errands for the colonial laboratory technician who was invariably a demobilized serviceman from the British Army Medical Corps of World War 1. These sets of Nigerians had little or no formal education and were known as laboratory boys.

MLS IN NIGERIA: THE STORY SO FAR (PART 2)

By 1940 the situation had greatly improved and the then African staffers of the hospital laboratory (consisting of nationals of the then British and West Africa) were categorized into laboratory attendants (the lab boys and the laboratory technician assistants, who were the better educated ones). This later group could perform urine and stool analysis, bacteriological examination of urethra smears, sputum and pregnancy tests by the male-toad technique popularly known as MTT
By 1948 the first formal and full-time training school had come into existence, admitting trainees with a minimum entry qualification of Cambridge School Certificates or its equivalent for a three-year course. This led to increase in the number of towns in the country having hospital laboratories. It’s worthy of note to say that, the syllabus of this training course had since been elevated to the standard, which was obtained in the UK for laboratory technicians.

THE SCIENCE OF HISTOPATHOLOGY WITH REGARDS TO PUBLIC HEALTH

 Most young women die from cervical cancer which has turned out to be a notable public health issue in Nigeria and yet it is preventable.

 

INTRODUCTION.   

  Cervical cancer is a malignant cancer of the cervix uteri or cervical area.  This disease causes the cells of the cervix to grow abnormally.  If not treated early, it can cause death.  Signs and symptoms include irregular bleeding from the vagina such as bleeding after menopause or after sexual intercourse.
It may also present with vaginal bleeding but symptoms may be absent until the cancer is in its advanced stages.  Treatment consists of local excision in its early stages and chemotherapy and radiotherapy in advanced stages of the disease.
Pap smear screening can identify potentially pre-cancerous changes.  Treatment of high grade changes can prevent the development of cancer.  In developed countries, the widespread use of cervical screening programs has reduced the incidence of invasive cervical cancer by 50% or more.
Human papillomavirus(HPV) infection is a necessary factor in the development of nearly all cases of cervical cancer.  HPV vaccine is effective against the two strains of HPV that cause most cervical cancer.  It has been licensed in the United States and European Union.  These two HPV strains together are currently responsible for approximately 70% of all cervical cancers.  Since the vaccine only covers some high-risk types, women should seek regular Pap smear screening even after vaccination.
About 0.5% of cervical cancers occur in pregnant women and about one third of women are under 35 years when given the diagnosis.  The survival rates for the pregnant versus the non-pregnant woman are very similar.  It is safe to have a Pap smear during a prenatal stage.

TYPES OF CERVICAL CANCER.
There are two types of cervical cancer - Squamous cell cancer and Adenocarcinoma.  These are both named after the type of cell that becomes cancerous.  In the early stages of the disease known as 1A and 1B, the cancer starts to grow into the deeper tissues of the cervix. This is treated with surgery or radiotherapy. 

The same treatment is given for stages 2A and 2B where the cancer spreads around the neck of the womb. 

In stages 3A and 3B, the cancer spreads into the pelvis; this is treated with radiotherapy and chemotherapy.
The most serous stages of the disease are 4A and 4B, where the cancer spreads to other organs.  This often includes a combination of surgery, radiotherapy and chemotherapy.

CAUSES OF THE DISEASE

The HPV infection is a necessary factor in the development of almost all cases of cervical cancer.  It happens when normal cells in the cervix change into cancerous cells.
This change normally takes several years – 5 to 30, but can also happen in a short amount of time before the cells turn into abnormal cells developed on the cervix that can be found by a Pap test
Prior to diagnosis, cervical cancer wasn’t given the attention it requires.  Although the number of cases of the disease has halved in recent years, it remains the second most common cancer in women under the age of 35.
To start with, cervical cancer affects the cervix - the lower part of the womb, also known as the uterus.  According to Macmillan Cancer Support, it can take many years to develop.
It occurs when abnormal cells contained in the cervix known as cervical intraepithelial neoplasia (CIN), become diseased.  CIN is as a result of virus infection referred to as the human papillomavirus(HPV).  It is mainly passed on during sexual intercourse.
Most women who have had unprotected sexual intercourse in their lives will contract the virus but in most cases, their immune system removes it and they won’t know they’ve had it.  Women are said to be more prone to developing cervical cancer if they:

-- smoke,

-- start to have sex at an early age,

-- have many sexual partners,

-- have taken the contraceptive pill for a long time, or

-- have a weakened immune system such as in HIV infected women. 

These are referred to as behavioral risk factors.

SIGNS AND SYMPTOMS

The early stages of cervical cancer may be completely asymptomatic; vagina bleeding contact bleeding or a vaginal mass may indicate the presence of malignancy. Also, moderate pain during sexual intercourse and vaginal discharge are symptoms of cervical cancer. 

In advanced disease, metastasis may be present in the abdomen and lungs or elsewhere.
Symptoms of advanced cervical cancer may include among others:

-- loss of appetite,

-- weight loss,

-- fatigue,

-- pelvic pain,

-- back pain,

-- leg pain,

-- single swollen leg,

-- heavy bleeding from the vagina,

-- leaking of urine or faeces from the vagina, and

-- bone fractures.

PREVENTIVE MEASURES.

Regular screening can increase the survival rate of cervical cancer by 75%.  In order to identify and treat CIN cells in good time, women must have smear tests.  About 4.4 million women are invited for cervical screening each year in England with about 24000 of them having a severely abnormal cervical screening result.
Women are invited to attend a smear test from the age of 25 to 65 although, if sexually active, women are encouraged to come for testing from the age of 20. They are given every three years up until the age of 49 and then every five years from the ages of 50 to 64.

TESTING AND SCREENING.

The test itself involves inserting a spatula into the vagina to take a sample of cells. These cells are then taken to the clinical laboratory for inspection. Although slightly an uncomfortable procedure, it is quick, painless and saves lives.
At least women should go for testing once every year. The good news is that, if spotted early enough, cervical cancer is very treatable. So it is important that women everywhere take regular smear tests.
The most serious stages of the disease are 4A and 4B, where the cancer spreads to other organs. This often includes a combination of surgery, radiotherapy and chemotherapy.

It has been observed that less than 0.1% of Nigerian women avail themselves this screening and less than 1% Are aware of the existence of this killer disease, thereby killing a woman every one hour.  Although it is the easiest of all cancers to prevent, cervical cancer kills more 24-35 year old women in our society than any other cancer in any other part of the world.
The World Health Organization (WHO) has projected a 25% rise in the disease over the next decade in the absence of widespread intervention.
It takes about N1000 only (local Nigerian currency) to screen one woman, but a good number of under privileged ones cannot afford it. Therefore, it is imperative for the government to invest in it and save mothers’ lives from this preventable disease.

TREATMENT OF CERVICAL CANCER.

MICRO-INVASIVE  cancer (Stage 1A) is usually treated by hysterectomy, which means removal of the whole uterus including part of the vagina.  For stage 2A, the lymph nodes are removed as well. An alternative for patients who desire to remain fertile is a local surgical procedure(LEEP) or cone biopsy.
If a cone biopsy does not produce clear margins, one more possible treatment option for patients, who want to preserve their fertility is a trachelectomy.  This attempts to surgically remove the cancer while preserving the ovaries and uterus, providing for a more conservative operation than a hysterectomy.
It is a viable option for those in stage 1 cervical cancer, which has not spread.  However, it is not yet considered a standard cure , as few doctors are skilled in this procedure.  Even the most experienced surgeon cannot promise that a trachelectomy can be performed until after surgical microscopic examination, as the extent of the spread of cancer is unknown.  
If the surgeon is not able to microscopically confirm clear margins of cervical tissue once the patient is under general anesthesia in the operating room, a hysterectomy may still be needed.
This can only be done during the same operation, if the patient has given prior consent.  Due to the possible risk of the cancer spreading to the lymph nodes in stage 1B cancers and some stage 1A cancers, the surgeon may also need to remove some lymph nodes from around the uterus for pathologic evaluation.
A radical trachelectomy can be performed abdominally or vaginally and there are conflicting opinions as to which is better.  A radical abdominal trachelectomy with lymphadenectomy usually only requires a two to three day hospital stay and most women recover very quickly.
Complications are uncommon, although women who are able to conceive after surgery are susceptible to pre-term labour and possible late miscarriage.  It is generally recommended to wait at least one year before attempting to become pregnant after surgery.
Recurrence in the residual cervix is very rare if the cancer has been cleared with the trachelectomy.  Yet, it is recommended for patients to practice vigilant prevention and follow up care including pap screenings, colposcopy, with biopsies of the remaining lower uterine segment as needed every 3-4 months for at least 5 years-to monitor for any recurrence in addition to minimizing any new exposures to HPV through safe sex practices until one is actively trying to conceive.
Early stages less than 4cm can be treated with radical hysterectomy with removal of the lymph nodes or radiation therapy.  Radiation therapy is given as external beam radiotherapy to the pelvis and brachytherapy.
Patients who have high risk features found on pathologic examination are treated with surgery and chemotherapy in order to reduce the risk of relapse.
Larger early stage tumors more than 4cm may be treated with radiation therapy and cisplatin-based chemotherapy, hysterectomy or cisplatin chemotherapy followed by hysterectomy.
Advanced stage tumors are treated with radiation therapy and cisplatin-based chemotherapy.  On June 15, 2006, the US Food and Drug Administration approved the use of a combination of two chemotherapy drugs, hycamtin and cisplatin for women with a late-stage cervical cancer treament.
Combination treatment has significant risk of neutropenia, anemia and thrombocytopenia side effects.