Monitoring medical laboratories

Stabroek News
November 3, 1999

Some years ago testing to determine the presence of diseases and viruses in the human body was restricted to public hospitals around the country and the few private ones in the city.

In those years, the waiting period for test results, blood tests specifically, was interminable, especially for the ill. Many persons died without their illnesses being diagnosed. And while a post mortem examination would have shown that the person had had a heart attack, the reason for the heart attack remained obscure. Forensic tests on dead bodies, extremely rare in those years, were only done when foul play was suspected.

In those dark years too, experienced physicians, rather than have them endure the wait, often in pain or discomfort, inferred what their patients were suffering from based on family history and/or symptoms associated with certain diseases which they exhibited. They treated these symptoms.

The situation has improved, about one dozen laboratories proliferate around the city, some with branches in rural areas. These laboratories advertise testing for almost every disease known and in the spirit of true competition have begun to offer "quick tests" for which results can be had in minutes and at lower prices.

This is a major step forward for Guyana. Knowledge of what ails is the first step in treating illnesses as it is widely known that certain symptoms are common to several diseases. Indeed, many persons have been able to arrest the development of what could have been a life-threatening illness because a test provided specific information.

But there is also a downside to this. Numerous reports have been made of laboratories issuing wrong results, the fallout of which is misdiagnosis by doctors, patients receiving the wrong medication or unnecessary operations. Sometimes death occurs.

This is not peculiar to Guyana. Laboratory testing is done by human beings and therefore the human error factor has to be considered. And contrary to common belief, it does occur in the developed countries where most Guyanese would prefer to have their medical tests and treatment done. However, the incidents are isolated and controls which are instituted subsequent to such incidents reduce them even further.

What is unfortunate in Guyana is that the system of checks and balances is rarely observed in the public institutions over which the Ministry of Health's Standards Division has control. Who then monitors the private laboratories? No one. Director of Standards and Technical Services in the Ministry, Dr. Davis, said that the old Hospitals Act only covered hospitals. Private laboratories were trusted to do their own monitoring. However, he said, the Hospitals Act is to be amended shortly and the draft is awaiting Cabinet's approval.

Before flexing their syringes and test tubes, private laboratories should apply to the Ministry of Health and the Guyana National Bureau of Standards for the necessary approval. Among the imperatives is the employment of a pathologist, a microbiologist and a physician. This is not always done. As one forthright lab owner pointed out, sooner or later the Standards Bureau will get around to standardising medical laboratories and then the delinquents will be in a mad rush to put their houses in order. One hopes that this will be sooner rather than later.

And as regards the draft amendment to the Hospitals Act, the Ministry of Health needs to take steps to expedite it. The amendment will provide for the monitoring of medical labs. The Ministry must have trained officers in place to conduct such supervision and with far-reaching powers to order the re-running of tests where necessary. Perhaps, in the interim, international health organisations can provide such technical personnel. They can also be appealed to to offer the necessary training for locals. The law should also give the Ministry the authority to shut down laboratories where blatant non-compliance with the requirements exist.

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Guyana: Land of Six Peoples