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Lab scientists: Unsung heroes of medical practice in Nigeria

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Ofungwu

Mr. Felix Ofungwu is the Executive Director of ISN Products Nigeria Limited, one of the leading suppliers of medical diagnostic products and services in Nigeria. He holds a Bachelors’ degree in Economics (with distinction) from the Purdue University, Indiana, United States, and also a Masters in Business Administration (MBA) from Harvard Business School. With more than 15 years of professional services experience, Ofungwu has led client engagements across various industries, including healthcare, financial services, retail, gaming, consumer goods, industrial products, and transportation. In this interview with IJEOMA THOMAS-ODIA, he shares the idea behind the initiative to rearward and support exceptional Medical Laboratory scientists across the country.

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’What informed your decision to set up the Medical Laboratory Scientist of the Year initiative?
As a supplier of medical laboratory (lab) equipment, reagents and consumables, we have been in the business of supporting labs and lab scientists for 40 years now. Over that time, we have interacted with so many medical lab scientists and managers and one thing that struck us was that over the years, there is little or no recognition on their efforts and the role that they play in healthcare system.

Also, there is no proper appreciation for their role in providing accurate diagnoses and really helping patients to get diagnosed and treated better.

So, we thought we could use the ISN Medical Lab Scientist Year Award as a platform to first increase awareness and profile of lab scientists across the country, and secondly elevate the conversation around quality and the difference in quality in the various labs and practices of medical lab sciences. My goal is to foster the best laboratory scientists in the world. I don’t think we are far off. We are quite knowledgeable in this area. With a little bit of support and the right working tools, we can stand shoulder to shoulder with any laboratory scientists in the world. There is no doubt that the passion is there. It is everything else that we want to foster.

With the maiden edition, will you say you are on the journey to achieving this goal?
Yes, we have received a lot of goodwill. There is no doubt that it has led to an improvement of the nature of the profession. We could see almost a new pride as a result of that event, especially those that attended and witnessed the event. Again, we are also seeing a lot more positive conversations around quality laboratories and their practices. So, we are further along in that journey.

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What are those positive practices you hope to see in Nigeria’s medical laboratory profession?
There are a couple of things. Even before we get to the laboratory stage, we should see more doctors confirming their hypothesis, as to what might be wrong with the patient through the test results. So, if someone is sick, he sees a doctor and he/she takes note of his history and comes up with hypothesis, as to what might be wrong. The next stage is that the doctor is supposed to ask the patient to run some tests to confirm whether the hypothesis is right or wrong. So, one of the things we should be seeing is more doctors having their patients run these tests to validate what might be wrong with them.

On the other hand, when it gets to the laboratory stage, ensuring that the labs take on quality measures in running and analysing the test results. One way this can be monitored is through the External Quality Assurance (EQA). So, labs are supposed to send out their results to an accreditation or independent body, so the body will send them a sample that the results are known, and match what they are supposed to be getting for that sample. We want to see more labs subscribing the external quality assurance programmes and we are seeing a lot more labs looking to subscribe to External Quality programmes to confirm that the results they are getting from the lab analysis is actually accurate and not flawed in anyway.

There are several bodies that run EQAs; while some are run by the private sector, others are government affiliated. For instance, the Medical Lab Science Council of Nigeria coordinates quality assurance programmes, so it is a mix.

What, in your opinion, is responsible for misdiagnosis in lab results?
There are several factors that can be responsible. We found out that most of the errors in the medical lab chain occur at the pre-analytical stage. Before you run the samples on the system, errors have already been introduced. Errors can come from how you draw the blood, or specimen you are testing; what you used to collect it because, there are some collection tubes or containers that can be contaminated. There’s also the issue of how you handle it upon collection, because there are certain procedures you should observe upon collection. How you store the specimen prior to analysis, all of these processes could have errors introduced to them before tests is being carried out.

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So, the pre-analytical aspect we have found out to be the greater source of errors than the analytical aspect. If there are no errors in the pre-analytical part, for the analytical aspect, what systems or machines are you using, are they properly calibrated and maintained? Just like any instrument, if not well maintained, will get faulty.

Finally, the post-analytical chain of the diagnosis; how are the results collected and distributed? Sometimes, you can have a cross match or mismatch, where a result for Patient A is given to B. So, there are various areas where errors can be introduced, but we find out that the pre-analytical stage has the most.

As an organisation, how do you intend to militate against these errors you outlined?
We have products across the value chain that fits within the pre-analytical stage. We have specimen collection products, syringes, needles and tubes for collecting specimen. We also provide training on how to collect specimen correctly, how to handle and store it correctly. We play a role in the analytical side. We distribute quality instrument and systems that laboratories use to run their tests. In the post- analytical side, we coordinate an External Quality Assessment (EQA) programmes to ensure that the results patients are getting are the right results. We are a nationwide distribution company. We have 10 distribution offices across the country. We have instruments currently in every state and the Federal Capital Territory (FCT), with an install base site in over a thousand locations in the country. So, we are able to really service every part of the country and reach any part within a few hours.

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What role should Medical Laboratory scientists play at this period of the COVID-19 pandemic?
I think it is ultimate the same role they should play for any kind of disease, which is to confirm that the patient has that disease. Everyday, there are new symptoms that you should be watching out for including fever, cough, sore throat, weakness, fatigue, aches and pains. I am sure you know these symptoms are similar to other illnesses and so the only way to confirm who has the virus is to run a lab test. A lab is essential, as without it, you cannot confirm who has COVID-19, confirm the numbers or the prevalence in a particular area. Hence the lab is absolutely essential to managing this pandemic because they are arbitrates of truth of if a patient has COVID-19 or not.

Having run this business for a while, what do you consider as your biggest challenges?
There are lots of challenges that we face and some of them are macro challenges that many businesses face; challenges around infrastructure. As an importer, we also have the challenges with bringing products in and making sure we clear them on time and we are able to deliver them quickly to our customers who have patients to attend to, hence its quite urgent.

All the products we bring in have limited shelf life and so it is important we bring them in quickly and get them on site as soon as possible. A number of them also have cold chain requirements and so we must maintain them within that cold chain range, otherwise, we have to destroy that product and that introduces additional challenges in making sure that as soon as we get them in and transporting them, we keep them within the cold chain range up until they get to site. This is why we have multiple generators; we run diesels, we have automatic thermometers that monitor the temperature in the cold room. There is a lot going on in maintaining the integrity of the product all through the chain.

On a larger level, in terms of supporting the medical labs, there are still some confusions as to what a quality lab should look like; we have all sorts of mushroom lab all over the place and there isn’t enough monitoring at what they are doing. So, sometimes there’s confusion as to what a quality lab should look like. What we are trying to do, as ISN, is to clear off some of those confusions.

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Are you collaborating with the government to achieve these goals?
We have a good relationship with the Medical Lab Council of Nigeria, which has monitoring role of ensuring sanity in the practice; we work with the government to achieve this.

The healthcare sector is largely underfunded, how much do you think should be invested yearly in the sector?
About 20 years ago, members of the African Union (AU) met and deliberated on this question and they came up with the Abuja Accord. Nigeria was one of them and the host pledged to commit 15 per cent of their budget each year to healthcare. So, members of the African Union, who are signatories to the Abuja Accord committed 15 per cent of their budget to healthcare. We have never had 15 per cent of our budget allocated to healthcare; we hover around 2-3 per cent and so there is definitely room for improvement.

The Abuja Accord was well thought out and deliberated upon; the 15 per cent is a good number. There are couple of countries that have lived up to this and I think that is where we should look at

Investment in research is still low in medical laboratory field, how should we approach this?
Stakeholders have roles to play in healthcare system, especially in Research and Development (R&D). There are roles for the government, private sector and non- governmental oranisations (NGOs). At ISN, we commit a percentage of our profits every year to R &D and we use those funds to support various efforts that research bodies carry out. Currently, we are supporting a large effort by International Research Centre of Excellence based in Abuja. It is running a long-term study on co-morbidity related to Human Immunodeficiency Virus (HIV) and the connection between HIV and non-communicable diseases. This is fully funded by ISN.

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