How wrong diagnosis sends patients to early graves

Job Osazuwa

For about five minutes, Mrs. Odechukwu Magdalene was consistently staring at a piece of paper handed to her by the laboratory unit of the Lagos State University Teaching Hospital (LASUTH). Then she looked into space and shook her head repeatedly.

“I have been wasting my money and time all these months. Where do I start from now? What kind of life is this?” she said as tears welled up in her eyes.

She had just been diagnosed with kidney disease at the hospital. This came after she was told at a private hospital that she had stomach infection. At another private hospital, she was also told that she might have been suffering from food poisoning. It took six months for her true health status to be unravelled. At that point, unquantifiable damage had been done.

Many patients’ ailments have been further complicated by medical workers who are supposed to be solution providers. There have been diverse sad tales from victims who were barely lucky to remain alive to share their ugly experiences. But some of the affected people were not lucky enough, as they have been sent to their early grave as a result of wrong diagnosis. Some hospitals have made costly errors but simply refused to own up even when they later realised the mistakes.

Merely looking at a patient, it is common seeing the doctor telling the patient that he or she is suffering from malaria or fever. In most hospitals, any patient with a high temperature is hastily said to have been struck by malaria. Then tablets or injections are administered by the doctor.

Over the years, patients and their relatives have drawn the battle line with health care managers, summoning them to explain why they misled them or their relatives. There have been accusations and counter-accusations. The plaintiffs won some of the litigation, while the defendants also won some.

Across the country, victims of wrong diagnosis are seen being transferred from one hospital to another, with doctors giving different verdicts on the cause of their situation. Unarguably, many people would have perhaps survived their ailments, if not for the wrong diagnosis at the beginning of their health challenges.

Experts have repeatedly said that early detection was important in the successful management of most ailments. And when this is punctured, the end result is better imagined than experienced. There have been instances where cancer was mistaken and treated as pneumonia for months.

During the 2019 World Cancer Day, the executive director of Care Organisation Public Enlightenment (COPE), Mrs. Ebun Anozie, stated that, in terms of cancer diagnosis, Nigeria still has a long way to go, as 70 per cent of cancer patients are misdiagnosed.

“My late father, for example, was misdiagnosed and badly treated in his cancer journey. Sadly, I have witnessed numerous cases. We have many cases of a false positive and false negative. This leaves much to be desired. Unfortunately, we take our health issues for granted in Nigeria and use the term ‘na something go kill man.’ Being penny wise and pound foolish regarding any health issue is deadly,” she said.

One of those affected by wrong diagnosis is the national chairman of the All Progressives Congress (APC), Adams Oshiomhole. He has lamented how doctors wrongly diagnosed the breast cancer that eventually claimed his wife, Clara, on December 7, 2010.

Speaking at a function at the University of Benin Teaching Hospital (UBTH), Edo State, Oshiomhole called for a review of Nigeria’s medical system so that doctors treat patients only in that aspect in which they have competence. He added that the menace of wrong diagnoses could be prevented by government, if it provided robust regulation on the health system. The former labour leader said that he would have sued the doctors involved in his wife’s case had it happened in another clime.

Oshiomhole said: “You visit a hospital, one doctor is a gynaecologist, psychologist, paediatric, and the doctor treats everything. My wife was unfortunate to have been diagnosed as having something different while the cancer in her breast was growing. This generalised system of medical system is what we must review.”

It has also been discovered that wrong diagnosis could come about when people’s treatment-seeking behaviour is poor, especially when they are looking for cheap service. In some instances, people are not able to pay for all the tests they are meant to do, thus a doctor’s conclusion, based on the few tests conducted, might not be sufficient to make the right and exact diagnosis.

For this to be corrected, many have advocated the need for modern laboratory equipment to be made available in all health centres. But there are worries that many hospitals in Nigeria today do not have the necessary diagnostic machines, which should provide confirmatory evidence.

The list of such misdiagnoses is almost endless, even as experts and other stakeholders have described most of the deaths as avoidable. Aside from causing avoidable deaths, misdiagnoses have also left many victims with new and strange ailments and could condemn them to a lifetime of permanent disability. Legs and arms have been amputated as a result of wrong diagnosis.

Laboratory scientists, technologists, physicians and other health workers have identified poorly trained medical personnel, quackery and lack of adequate modern equipment in Nigeria to aid practitioners in arriving at informed decisions as among major factors fuelling misdiagnosis. There is also the issue of poor ability to analyse and interpret even correct observations, facts and results of tests done.

Some concerned Nigerians have called for doctors to make themselves available for continuous training and recertification in order to minimise wrong diagnosis.

While there are no available statistics on the number of deaths or complications resulting from misdiagnosis annually, in 2017, the World Health Organisation (WHO) revealed that about 80,000 of the 100,000 diagnosed cancer cases in Nigeria annually die partly due to misdiagnosis.

Also, the case of late Chief Gani Fawehinmi (SAN), one of Nigeria’s foremost human rights activists, is instructive.

Gani was diagnosed with pneumonia and was undergoing treatment for that in Nigeria, but by the time his case got critical and he was flown abroad, correct diagnosis showed that he had cancer. At that point, it was too late to cry as the cancer had reached an advanced stage. The ailment later killed him.

Aware of the inherent dangers associated with Nigeria’s health facilities, most top government officials, the rich and those who can scrape together the funds to afford it travel abroad for treatment.

Another perspective to human error is the shortage of medical personnel, which usually leads to fatigue. Against the standard set by WHO, Nigeria is in gross deficit of one physician to 3,500 patients, instead of one physician to 600 patients.

Medical workers at government-owned hospitals have lamented the pressure they face daily while attending to thousands of patients, which could make them commit costly errors.

The registrar of West African Postgraduate College of Medical Laboratory Science (WAPCMLS), Dr. Godswill C. Okara, said quackery and wrong health-seeking behaviour of some Nigerians were responsible for most of the reported cases of misdiagnosis. He pointed out that most people would not visit accredited facilities for diagnosis in the name of looking for cheap service.

Said he: “I agree that there are false results everywhere. Ten people will go to the laboratory; nine of them will come out with malaria or typhoid. But what is happening is that many people who are not medical scientists are operating as one. Because of the increasing unemployment and mere exposure to the hospital environment, these people set up a laboratory and begin to diagnose people. These are not medical laboratory scientists.

“Our porous environment is a fertile ground for such practices to thrive. When the medical laboratory council visited these clinics for inspection, the owners started calling those in high offices in Abuja; and the next thing, the inspection team was recalled. Some hospitals, in order to hire cheap labour, will go as far as hiring people that are not trained and licensed to operate as medical laboratory scientist. It is the public that will be at the receiving end.

“I remember, in 2016, our association was on statutory inspection of some laboratories in Lagos; there was so much pandemonium. Some owners of private hospitals prevented the inspection team from visiting their clinics. This is because some of them didn’t meet the requirements. When misdiagnosis happens, they give a dog a bad name.

“We saw a policeman who arrested someone who converted his bedroom to a blood bank, where he was busy bleeding donors for as much as three times within a short period. Because he was not trained, he didn’t know the limit or spacing when donating blood. One of the victims came down with an illness that led to the man’s arrest.

“When the quack was interviewed, it was discovered that he didn’t study medical laboratory science. He was just an impostor.”

Also stressing the need to eradicate quackery from the industry, the registrar and CEO of Medical Laboratory Science Council of Nigeria (MLSCN), Dr. Tosan Erhabor, told Daily Sun that the council would not relent in checking quackery across the country. He said that the body was working towards achieving zero tolerance for unwholesome practices.

“We have visited 14 states to see the quality of laboratories in place. At the moment, we have quacks being tried in the high court. We will continue to try erring persons, whether medical laboratory scientists or charlatans. This is to sanitise the system.

“The state of the laboratory is not where it is supposed to be, but we as regulators are working round the clock to see that there is a tremendous improvement.

“On June 1, the MLSCN will roll out a policy on quality management system, which will be the minimum requirement for any laboratory to practise in Nigeria, both public and private. With this policy, it is either you get it or you don’t practise. Every laboratory must be accredited because this is the right way to go. We want to have more facilities accredited so that there would be better result from diagnosis. It is beyond mounting equipment; we are also looking at putting it to use to see whether it is in line with manufacturer’s specifications,” Erhabor said.

Another victim of wrong diagnosis, Arthur Uchegbu, said: “I was a bit lucky that I was able to detect my own on time. The first hospital I went to told me that I had malaria, which l treated for about two weeks but there was no improvement.

“I was surprised when l went to another hospital and I was told that I had chronic infection. The doctor particularly told me that l was lucky to have discovered the error on time. The previous hospital was simply wasting my time and money.”