Experts advocate guidelines for ultrasound scan use

Do you want to be a passenger in a brand new car driven by a novice? But that may just be the lot of many Nigerian health seekers using ultrasound scan machine for diagnostics. WOLE OYEBADE writes.

FOR every Nigeria-bound container coming from Europe, there is at least medical equipment stuffed in the goods. Among the equipment is an ultrasound scan machine that is used in medical diagnostics and treatment prescription for a patient.

To save or kill, the machines – second-hand more often than not – soon find their way into public and private health facilities because ultrasound scan machine is now the gold standard in modern healthcare practices.

Besides the machine not properly checked for quality assurance, they go into use by untrained health workers that are condemned to learn by trial and error! The consequence is often dire, and far more than a learner taking first driving lesson on the Lagos Third Mainland Bridge!

Experts reckon that the influx of such medical equipment into the nooks and crannies of Nigerian health system is a welcome development, though with a caveat that they are becoming dangerous weapons in the wrong hands.

Ultrasound scan machine, a painless test that uses sound waves, helps to create images of organs and structures inside the body during a medical investigation. Doppler and duplex scans are used to visualise blood or fluids flowing through the body.

Professor of Obstetrics and Gynaecology, University of Leicester, Justin Konje told The Guardian that ultrasound scan has become the status quo to most healthcare practitioners and a delight that Nigeria is fast catching up.

It is the symbol of modern medical care, Konje said.

“So, everybody now is able to purchase ultrasound scan for us. But, while it is very useful, it can also become a very dangerous weapon and that is one of the key problems currently faced in Nigeria,” Konje said.

His colleague, also at the University of Leicester Hospital, Dr. Osric Navti, concurred that ultrasound machine is like a weapon that would be misused in the hands of people that lack the expertise, which is why the health seeker must be wary.

According to Navti, “If you have a pregnant woman, where the placenta is in the wrong place and she goes for scanning in the hands of someone who doesn’t understand ultrasound, the fellow will in the report say there is a problem with the placenta where there is no problem.

“The pregnant woman goes to her doctor in the hospital and she may end up having an operation that is not necessary; and may develop complications from the operations which is completely avoidable. There are lots of examples like that in Nigeria now. Remember these women are our aunties, sisters, wives and friends.”

Navti and his colleague who spoke at the fourth edition of the international Ultrasound scan and Doppler training programme in Lagos, said lack of guidelines and standard, especially among private facilities should worry the concerned stakeholders.

They observed that the need for standard was more urgent considering the peculiarity of Nigeria, where over sixty-five per cent of the health seekers patronize private providers, majority who are in business for profit reasons.

Konje said that there must be guidelines on how these machines can be adopted in clinical practice and mechanism to monitor the results that are produced by the health workers who use these machines.

He observed that machines of such caliber are imported into most countries in the world, but in strict compliance to regulatory rules.

According to him, it is a wake up call on bodies like the Postgraduate Medical College, College of radiology and their counterpart in Obstetrics and Gynaecologists among others — “the policemen in Nigerian health system” — to provide the guidelines, standards and ensure the mechanism of quality assurance in ultrasound scan use.

“Bodies like these are supposed to provide leadership and direction. That is what happens in other parts of the world. Either they are not able to do it, or they do not have the power to enforce the standard that can be driven nationally.”

Medical Director at the Eko Hospitals, Dr. Olusegun Odukoya, noted that the call for “setting standards” had been on for a while but without much effect.

Odukoya recalled that there were standards that were put in place, but “they often die a natural death where they are not implemented.”

“There was a directive that certain people should not be performing certain procedures but we have quacks that are performing the same procedures and no one is seeing to that,” he said.

On how to go about setting the standards, Odukoya said it begins with rekindled enthusiasm and encouragement among the specialists, government’s political will and then the general public, who needs to be abreast of the standard and demand services accordingly.

The MD called on experts to draw the guideline that will form the gold standard nationally. “Then, there must be people that will monitor it. If they come into your hospital and they found that you are not performing up to standard you are penalized.

“It is to make sure that everyone do the right thing; that is the quality assurance. We have found that where guidelines are set, standard and protocol are monitored, then quality of healthcare services improve.”

Konje, however, warned against the blame game culture that may further hinder the use of ultrasound scan in most private facilities.

“We must avoid a situation where some people who have these ultrasound machine are now scared of coming forward because they know that they would be called incompetent and sanctioned. The only way to nurture them to be good users is to support them rather than being critical.”