Spate of wrong medical diagnosis in Nigeria worry stakeholders

Enugu-born Kevin Abonyi got the shock of his life when a medical laboratory test he underwent in preparation to take a wife turned out positive. Mr. Abonyi had walked into a medical laboratory centre in Obollo Afor, Udenu Local Government Area of Enugu State to find out his blood group, genotype and HIV status, having resolved to settle down as a married man.

A Mass communication graduate from the University of Nigeria, Nsukka, Mr. Abonyi could not understand what the lab attendant was talking about.

He literally and technically became deaf. He saw his world caving in but as a devout catholic with a strong faith in God, and knowing that he had lived a morally-upright life all his youthful age, he immediately regained his consciousness, remained calm, cool and collected, courageously approached his would-be wife and broke the sad news to her.

He also assured the girl that he did not believe the result and promised to conduct further tests in Lagos for a proper diagnosis.

However, after he visited a laboratory in Lagos, his HIV turned out negative. This sharply contradicted the earlier result and at the same time rekindled his hope of getting married to the woman of his choice.

Satisfied and highly elated at the turn of events, he travelled back to his village to break the good news to the lady, who also tumbled with joy. Together, they visited Bishop Shanahan Hospital, Nsukka, as well as the University of Nigeria Teaching Hospital (UNTH), Enugu, for further medical examinations and the result was the same – HIV negative.

Today, Mr Abonyi and the woman live together as husband and wife, and the marriage has produced four lovely children, two boys and two girls.

Narrating how she felt when she got the first news about her husband’s HIV status, his wife said: “When he told me that the laboratory test result from Obollo-Afor said he was HIV positive, I was devastated.

“Although he remained calm, promising to visit a better facility in Lagos, I was confused.

“When I told my elder brother, he plainly asked me if I loved him. When I answered in affirmative, he told me to go ahead with the marriage, despite his HIV status.

“I had already made up my mind to take my brother’s advice when he came back with the news that the result from the Lagos lab had pronounced him HIV negative.

“Although I did not doubt him, he insisted that we should visit Bishop Shanahan Hospital, Nsukka and UNTH for further examinations. Both hospitals’ results confirmed that he was actually negative contrary to what the first result from Obollo-Afor said.

“My joy knew no bound and I give God all the glory because many people would have done some terrible things as soon as they were told that they were HIV positive, but in his own case, he took it with maturity, calmness and absolute faith in God, and at the end of the day, it turned out to be a case of wrong diagnosis. So, I thank God for his life.”

Kevin was lucky but the same cannot be said of a 42-year-old young man, simply identified as George whose unfortunate and sad death recently, according to his younger brother, was as a result of wrong medical diagnosis.

The father of three from Enugu State was said to have been diagnosed of ulcer and he had all along been treating ulcer until his condition became too critical.

According to the deceased’s younger brother, when he was taken to a specialist hospital for a proper medical check, it was discovered that he had been suffering from Hepatitis B, which had already eaten deep into his liver.

All efforts to save the young, ebullient George by doctors proved abortive as he painfully gave up the ghost, leaving behind a young wife and three kids; no thanks to wrong medical diagnosis.

Also, Mr James Kayode and his wife went for medical checks to know their blood group, genotype and HIV status as usual before they got married and every result turned positive.

They got married and had their first child. But trouble started after the baby kept falling ill quite often, barely one year after he was born.

During one of their many visits to the hospital, a test was carried out on the child and it turned out that the baby has Sickle Cell Anaemia, meaning that the baby’s genotype is SS.

The parents were confused, because while they had all along believed that they were both AA as the lab result showed before they got married, the reality is that they were both AS.

They ran a fresh test which confirmed that they were both AS, meaning that the test they had before marriage was wrong. That was how the Kayode family was thrown into medical troubles that they did everything to prevent.

Much as the incompetence and carelessness of some lab scientists have sent many to early graves, nullified potential marriages, caused wastage of financial resources and psychological torture, it is also dismantling a lot of marriages.

In Africa, it is common knowledge that special attachment is given to male children. It is believed that male children will continue with the family lineage when their fathers are dead, and as such, male children are highly prized.

In Nigeria, the Igbo people of South East attach very great importance to male children because of the above reason.

A woman who is unable to give birth to a male child is most likely going to have marital problems. It is either her husband considers taking a second wife or he makes life miserable for the woman by continually reminding her that she could not perform the simplest duty of bearing a male child like other women.

Sometimes, the woman is mocked by society because she did not have a male child.

At some other time, she is stigmatized depending on the kind of family she is married to. Such is the gravity of importance attached to male children in Igbo land.

Some men have taken second and even third wives in the quest for a male child, while others have terminated their marriages because of their wives’ inability to have male children.

Mrs. Chioma Ezeadi was told by her doctor in a private clinic in Ago area of Lagos State that she would bear a female child during her first pregnancy.

According to her, she was worried because her husband had already told her that he would want a male child first. It did not matter if she would have female children subsequently. What mattered was that her husband wanted their first child to be a male.

She said she could not tell her husband what the doctor told her because she was not sure what his action could be, even though it was her first pregnancy.

But, contrary to the scan result as was pronounced by her doctor, she was delivered of a baby boy eventually to her surprise. Today, she has three male children.

A similar incident happened to Mrs. Gloria Ibe from Abia State. She has had three children already, two girls and a boy. The scan result of her fourth pregnancy said she would give birth to a baby girl.

The medical prognosis was corroborated with a prophetic pronouncement. She said a pastor in her church equally told her that she was carrying a baby girl.

So, with the mouthpiece of God corroborating what the medical science had said, she was left with no iota of doubt as to what the sex of her unborn baby would be.

She went ahead to buy baby clothes and other things in advance bearing in mind that a baby girl was on the way.

However, she ended up giving birth to a male child but unfortunately; her husband did not live to see the baby. He died a month before the baby was born.

The negative effects of wrong medical diagnosis, ranging from suicide to cancelled marriages, broken homes, economic wastage, emotional and psychological torture among others, are catholic and of grave concern to many Nigerians.

Lab scientist speaks

Throwing more light on the subject, a Medical Laboratory Scientist, with one of the medical diagnostic centres in Amuwo Odofin area of Lagos, Abuchi Kingsley, said wrong medical diagnosis is a product of many factors.

He said such factors as personnel, equipment as well as reagents could lead to wrong outcomes.

He told DAILY POST that: “Like the person that had Hepatitis B and was told he had ulcer, it is possible he actually had ulcer but it depends on what test that was sent to the lab to be done.

“In other words, if you come to run a test for ulcer, a laboratory scientist will not go further to check if you have Hepatitis or any other ailment. He will only do the ulcer test, which you requested for.

“For patients who go for Genotype tests, I can say that some labs do not employ qualified personnel. They often engage the services of quacks and they go about giving wrong results to people.”

He also attributed the ugly trend to the inability of some lab diagnostic centres to carry out what he termed quality control.

He said: “Some labs do not have what we call quality control. A quality control is what you do before you start a patient’s test. It will tell you whether the kit you want to use is not good or not.

“Simply put, it means using known positive and known negative samples to run your reagent.

“For instance, if your reagent gives you a known positive sample to be negative, then you know that the reagent or the equipment is not good to function that day.

“Again, for those tests that don’t give positive or negative but a value like blood sugar, before you use your equipment to run a blood sugar test, there are some pathological samples that have high sugar level, normal sugar level and low sugar level.

“You run all these on your equipment and if they show that these controls are what they are, you know that you are good to go and you will have confidence in any result you are releasing.

“But some labs do not carry out this quality control, either because they want to minimise cost or they don’t know they are supposed to do it.

“Another factor has to do with the sample or specimen. If you collect the wrong sample for a particular test or you put the sample in the wrong bottle, it will definitely give you a wrong result because in the collection of these samples, we have different bottles and different containers.

“Some tests require collecting the specimen at a particular time. Some tests require that you collect the specimen before the patient eats in the morning.

“A patient that wants to do a Fasting Blood Sugar test should not eat in the morning before coming because if the person eats before his/her specimen is taken for the test, it will give a wrong result.

“The same thing applies to a patient that wants to do a Fasting Lipid Profile. It is also the same process for culture tests, like blood culture or urine culture. The samples should be collected in a sterile bottle.

“If the sample is collected with bottles that are not sterile, you will already be getting something that is not from the patient. So, sample collection and the time of such sample collection is very important in determining the accuracy or otherwise of a lab test.”

He summed up his submission, saying, “In summary, the factors that lead to wrong diagnosis are categorised into pre-analytical, analytical and post analytical errors. There are errors that happen prior to analysis.

“There are some that happen during the analysis while others happen after the analysis. After analysis occurrences have to do with reporting.

“A lab scientist can do a proper test but a typist can mess everything up. It can also be during transmission of the result.

“That is why professionalism and training for anybody that works in the lab is very important. Everybody needs to be trained and retrained regularly.”

Gynaecologist speaks

Also, sharing his experiences as a gynaecologist of many years standing, Dr. Chikodi Onyemkpa of The Healthcare Hospital, THH, Festac, Lagos, said he has seen so many of such cases; some of them actually creating very difficult social issues to manage.

“In our culture, we have a tendency towards male gender preference and that is related again to some economic considerations, and so, these two standing together, tend to mount enormous pressures on the pregnant woman.

“There is often a tendency to want to know the gender of the baby in the womb. Sometimes, it comes off very well; sometimes that prediction might be wrongly done. So we see them often,” he told our correspondent.

Asked to give an instance, Dr. Onyemkpa, who also doubles as a sonologist, continued: “I have come across a situation where a woman was expecting a female child because the scan had told her so, but eventually when we did a surgery and brought out the child, it was a male child.

“It was a good disappointment in the sense that she was hoping that that would be her last surgery.

“But if it was a female child like the scan had said, that meant that she would go for another surgery again because she usually gave birth by surgery. But it turned out a male child; so that was a good disappointment to her.

“I remember another young girl, who became a second wife because her husband was looking for a male child. She did a scan and she was told she was carrying a male child.

“Her husband started treating her like a queen. Eventually, the baby was born and it was a female child. It was such a disappointment that the father was not interested in even allowing the woman to go for the immunisation of the new born baby.

“The disappointment was so devastating because they were anticipating a male child and they had already prepared for the ceremony that would follow.”

Considering what follows when the anticipation turns the other way round, many would argue that it will be advisable not to reveal the sex of the unborn baby to the pregnant mother after the scan, but, Dr. Onyemkpa would not toe that line of argument.

He gave reasons the practice would continue, particularly in certain parts of Nigeria.

He said: “In some jurisdictions, it is unlawful to reveal the gender of an unborn child. I easily remember India, where a doctor’s licence was seized for six months because he did gender determination by scanning for a pregnant woman.

“Some cultures are that strict but in Nigeria, we have no such law. You can do gender determination and state it clearly here in Nigeria.

“Interestingly, some persons will come for a scan basically because they want to determine the sex of the baby and if you want to exchange shoes with them, you will see why it is very important for them to know.

“Until the very landmark judgement by the Supreme Court recently, a female child had no right to inherit property from her parents in Igbo land; she is married off in life and whatever she gets during her wedding is what accrues to her.

“If the parents die, whatever they left cannot be accessed by the female child and so, you see that if a woman is married into an average Igbo family, until she has a male child, she likens her marriage to a temporary residency permit because in the demise of her husband, whatever she laboured for with her husband, will be passed on to the relations of her husband, who are males, since her own female children are forbidden by culture to access their father’s inheritance.

“However, the Supreme Court’s judgement has put paid to all that because by that judgement, it has to be noted that the constitution of Nigeria is superior to the customary law which is almost followed to the letter.

“So, there is always the eagerness for a wife from that environment to know what the gender of her unborn baby is. If you give birth to a male child, people will say that you have now firmed up your position in your husband’s house.

“Until then, the woman has not really legitimised her permanence in her husband’s house. So, if she is pregnant, you will see why she wants to know the gender.

“If she has the first, second and even the third one all girls, you understand why some of us in the hospital will see a woman who has had a baby but she is not happy because much as she has had a safe delivery, the baby can still not firm up her marriage.”

On what could be responsible for the wrong outcome of scan results, he said: “One of the fundamentals in scientific inquiry is to learn about measurement.

“Why you need to learn about measurement is that there can be errors. In fact, in any human designs, there is a margin of error that is allowable.

“That is why in scientific research, you say that something is significant or not because it is actually about making provisions for those errors.

“So, we know that there can be a false positive result or false negative result. For instance, if you come into this room and there is a pin on this floor and you looked around and didn’t see the pin and you declare that there is no pin in this room, you have made an error; you have declared a false negative result or a false absence of pin, but there is a pin.

“In another situation, if there is no pin on the floor and for whatever that is happening to your eyes, you looked very well and declared that there is a pin, you have just declared a false positive result because you said there is a pin, whereas there is no pin.

“So, in every measurement, provision is made for that possibility. By the same token, you find that if you do a scan and you say it is this while what you are saying is not there, it is actually in that false positive result declaration because you have stated what is not there.

“So, scientific measurements and enquiries know that this is a possibility. And when you make a measurement, you bring a lot of things together such as the person taking the measurement, the instrument with which the measurement is taken and the environment determining finally what happens.”

He went further to draw an analogy of what could lead to wrong medical diagnosis with a motor accident.

He said: “When there is an auto accident, the investigator will try to establish whether it was a human error, mechanical error or environmental error.

“You want to find out what actually went wrong. In like manner, when there has been a result that is not expected or that has tended to have deceived everybody, there is the need to go back and check what could have been the cause.

“Easily, we will place the blame on the shoulders of the observer but in fairness, it just may not always be the case because the machine and other sundry issues are also involved. That is why the person that did the test, and what the clarity of picture quality is, are important.

“There are some pictures you see in two dimensions, but if you can see such pictures in three dimensions, it will be better.

“So, even in scan machines now, there are 2D machines, there are those that are said to be 3D and you even have the 4D scan machine. So, apart from the depth, you see action.

“Occasionally, I have been scanning and the baby in the womb urinates and I showed the mother and she is excited because it is not just that her tummy is swollen; what is inside her is living and she is seeing the action it is performing.

“If you use a certain machine, you will see clearly; it is not just that you are seeing the flash of the urine, you will even see the place that the urine is coming from.

“Every party can relate to that. Those that are in the industry will know about the scan machine that creates baby face; the scan machine that can create picture in 3D format; even colour picture, so that parents are able to see the face of the baby in the womb or even look at the pelvic region and be able to see the gender.

“So, it will not be what the scanner said. If for any reason in future, we have a different outcome, it is what I saw that you saw; that is actually how I report.

“Errors can come from the observer if you are using a 2D machine because you may not see the female genital as well as you could see if it is a 3D machine.

“There are chances of error if you read the lines wrongly, and of course, the issue of machine is generally going to reduce or enhance the result accuracy.”