The COVID-19 pandemic has knocked awake our need to question our healthcare systems. I have been following comments, especially on social media regarding what medical scientist are doing about the outbreak. Yesterday I came across a post asking if Ghana had any medical scientist at all. I decided to read the comments to see if anyone will actually say something close to the truth of our reality in this country. Coronavirus outbreak: are there a scientist in this country? Yes, there are, and this article may be an eye-opener if you really want to know about the situation.
I will make it clear that I’m not a neutral as far this write up is concerned. I’m a medical scientist but I will try to make my arguments as objective as possible. My hope is that when there is national attention on our laboratories, things will get better for our diagnostic and surveillance efforts in this country.
It is not surprising that many people do not know about the medical scientist in this county. They don’t work directly on patients but are often behind the scenes. If you are admitted your blood/urine/stool sample is taken and sent to the medical laboratory for the scientist to carry out investigations to help understand your condition. Without their input, the physician or nurse in charge of your case may be doing guesswork at best.
To put things into perspective, in this current issue of coronavirus outbreak medical scientist are the people who confirm the cases. They run sophisticated analysis on suspected samples to determine if someone is positive or not.
Unfortunately no matter how brilliant or experienced our medical scientist are, they need the infrastructure to be able to do much. Ghanaians want to hear in the news that their own scientists are also working on a vaccine. They want to see their scientist being talked about in the news globally. That is why they are asking, “Do we also have scientists in this country?”
Unfortunately, scientists cannot do this in their rooms. They need structure and sophisticated facilities to work. And not just that, to be able to compete at the global level, they will need funding in hundreds of millions of dollars. The reality of the matter is that today, we are still struggling with our level 2 biosafety facilities in this county. Most of the facilities even at the teaching hospital can barely stand the global standardization test. How many research centres do we have in Ghana?
To be able to carry out advanced medical research, some special kind of laboratories are required. There are safety level protocols a laboratory have to meet to be able to carry out some medical research for the risk to workers and the public. This safety levels rank from level 1 to 4.
There are about 50 level 4 laboratories in the world which is the only level that is allowed to study highly infectious agents such as the SARS-COV-2 which is the virus implicated in this current pandemic. Out of that 50 labs, only 2 are in Africa, one in South Africa and the other in Gabon. The United States alone has 15 of them.
To put things to perspective, even in China, only one laboratory has the required biosafety standards needed to study the COVID-19. This laboratory was built in 2003 after the first SARS outbreak. So Ghana still has a long way to get there in terms of infrastructure.
Medical laboratory studies are not like other professions, it has implications on the general population. The health of the community and the scientist are at risk here. So the scientist in this county does not have the freedom to study just anything. Most often our brilliant scientist has to export their studies to the developed worlds and is rid of the bragging rights if there are any novel findings later. That is just our current reality in this country.
Let’s even talk about our domestic issues.
In 2010 after an external observation of the healthcare system it was recommended that the country needed a strong diagnostic sector. This necessitated the development of national medical laboratory policy. This policy was meant to put structure to how medical laboratory science works in this country. It was to help Ghana reach the global minimum level of standardization.
Have you heard people complaining that they were tested positive for a particular condition in one lab and negative in another? Well, most of these cases happen because there is no standardization in the practice of medical laboratory in this country. We are not even talking about advanced studies, just our domestic routine testing. There is no single policy that guides the practice.
Everyone at that time saw the need to work on the policy document. Millions of tax payer’s money and other international aid was spent on a committee that was set up for this job.
And in 2014, with over 20 committee meetings, the draft policy document was completed by a team from the MOH, it was redirected and this time it was supported by the USA government with 1.5 Million Dollars for the implementation process.
Unfortunately, professional politics set in. A letter from God knows where came asking for a halt in the process. Apparently the physicians in the country wanted to remain heads of medical laboratories despite a clear boundary spelt out by the constitution of Ghana. According to the laws of Ghana physicians and medical laboratory scientists are two distinct professions.
They are all independent members of the health care team. The physicians did not see a need to head pharmacy departments, nursing units and other members of the health team. All they wanted was to continuously head medical laboratories which the policy if implemented, would have completely abolished.
But ask yourself, can lawyers replace teachers as heads of schools? Every profession in this country is developed enough to manage its own affairs.
Unfortunately, as absurd as that sounds, the national laboratory policy has since been put to the shelves covered in dust. The country still operates with the primitive kind of service in the country. If not for the gallant efforts made by the professionals to clean up the system despite the many difficulties, the diagnostic sector in this country would have been worse.
Where does Ghana stand among other African countries?
In 2015, just some five years ago, Ghana had the highest number of four-star laboratories in Africa that had been certified by the African Society for Laboratory Medicine (ASLM). We had 5 of the nine 4 star labs in Africa. Our diagnostic system and professional are often seen as the light of the African diagnostic sector.
But today the reality is different. Ghana is almost lagging behind due to the government lack of attention to the sector.
Since 2015 when we were held high for having the most 4 star laboratories, the number has grown to 52 labs across Africa. Ghana has only managed to add just one 4 star lab since then. In simple terms, we had 55% of all 4 stars labs in Africa in 2015, today we have just 11%. Nigeria has 2 more than us and the majority of the development is happening in East and South Africans.
Despite this, Ghana currently has one of the top medical laboratory human resource in the world. Ghana was the second country globally to implement professional doctorate for medical laboratory science and the first in Africa. It has been 4 years today and not any other African country has been able to implement this momentous level of growth.
Meanwhile, Nigeria not only has the medical laboratory policy document, but they also have a council for medical laboratory scientist. This council regulates the profession but in Ghana, the medical laboratory scientist is bundled with 12 other allied health professions. Yet the other Africans still look to us in awe. Imagine what the profession would do if the government just paid a little attention to the sector.
Ghana stands tall and can boast of more than 40 doctors of medical laboratory science since the development. The reason this development is not impacting much is that the infrastructural requirements are not being met. The professionals have acquired advanced body of knowledge and skillsets but the infrastructure for implementation remains highly unmet. Today, Incas Diagnostics is producing test kits (including novel test kits) right here in Ghana. The scientist in charge is a Ghanaian and it should tell you the kind of scientist we have in this country.
A country’s medical system rest on its diagnostic capacity. If the diagnostic capacity is weak there cannot be a strong healthcare system. That is why other countries are spending millions of dollars to strengthen their diagnostic industry.
Imagine if coronavirus had come out of Ghana, it is the medical scientist who has to detect this through medical surveillance systems. They are then supposed to run tests to understand what they are dealing with and report to the international bodies. Unfortunately, we are not ready. I don’t even want to imagine what would have happened if that was the case. We need to be ready, nobody knows what is coming next or where it will come from.
So despite the highly skilled and experienced body of medical scientist in this country, there is nothing that can be done until the structures are there to support the developing profession. Ghana has to get serious and start by implementing the national medical laboratory policy which will provide the framework for growth in the sector. We are losing our place as the top in Africa despite the momentous improvement in the human resource.