Evil of wrong diagnosis

•Pathetic story of Nigerians who have been deceived by lab results

By Henry Umahi and Sunday Ani

Kevin Abonyi got the shock of his life when a medical laboratory centre in Obollo Afor, in Udenu Local Government Area of Enugu State declared him HIV positive. He had gone to the medical facility to find out his blood group, genotype and HIV status, having resolved to get married.
A Mass Communication graduate from the University of Nigeria Nsukka, Abonyi, who was 38, could not understand what the laboratory attendant was talking about when the result was handed to him. He became deaf, dumb and paralysed. Somehow, he got hold of himself and with all the courage he could muster, he approached his prospective wife and broke the sad news. He also assured the girl that he did not believe the result and that he would get back to Lagos to visit another laboratory for another diagnosis.
After he visited a laboratory in Lagos, his hope of getting married to the woman of his choice was rekindled, as he was confirmed HIV negative. Highly elated at the turn of event, he travelled back to his village to break the good news to the lady, who also tumbled with joy. They visited Bishop Shanahan Hospital, Nsukka as well as the University of Nigeria Teaching Hospital (UNTH), Enugu, for further medical examination and the result was the same – HIV negative.
Today, Abonyi and the lady live together as husband and wife. And the marriage has produced three lovely children – two boys and a girl.
Narrating how she felt when she got the first news about her husband’s HIV status, his wife, Ifeoma, 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 said yes, 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 Lagos lab had given him a clean bill of health. Although, I did not doubt him, he insisted that we should visit Bishop Shanahan Hospital, Nsukka and UNTH for further examinations. Both hospitals confirmed that he was actually negative. My joy knew no bounds 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 and calmness and at the end of the day, it turned out to be a case of wrong diagnosis. So, I thank God for his life.”
Abonyi was lucky, but the same cannot be said of 42-year-old Uchenna Ugwueze, whose unfortunate death in June this year could be attributed to wrong 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 Chijioke, Uchenna’s younger brother, when he was taken to a specialist hospital for proper medical checkup, it was discovered that he had been suffering from Hepatitis B, which had already eaten deep into his liver. All efforts to save the ebullient young man by doctors failed. And the man died.
In the case of Pastor (Mrs.) Faith Ibeakanma, a wrong diagnosis made her marry someone she should not have. But for God’s grace, she would have been weeping in the valley of tears. Her story: “When I got admission into higher institution, they took our blood samples for various tests, including genotype. At the end of the day, they wrote that AA was my genotype and I carried the result till when I was about getting married. Secondly, there was a time I fell ill and my cousin who is a midwife working in a military health facility in Enugu decided to run all sorts of tests on me, including WIDAL, blood group and genotype tests. The result still confirmed my genotype as AA. With that I just told myself that I was free to marry an AS because they do tell us during marriage seminars that before you get married, there are things you must check; it is not all about love. You can love somebody but in the course of the relationship you will find out that you are not medically or genetically compatible or that your genotype does not match for bearing healthy children. They told us that if an AS marries another AS, for example, the sweetness of marriage could be terminated if they eventually give birth to children with sickle cell anaemia. Also, there are doctor friends that told us that it is practically impossible for a man who is AS and a woman who is also AS to have children without at least one of them having sickle cell.
“So, because of the two results of the tests I had done, I was convinced that I was free in that regard. Along the line, proposals for marriage were coming and finally God settled that aspect of my life. Ironically, I ended up with a pastor. Before the dowry was paid, we came to Lagos for something and my husband took me to a place he goes for tests and other things. I didn’t know anywhere in Lagos; in fact, that was my first time of coming to Lagos. He took me there and asked them to carry out a genotype test on me. When the result came out, it also confirmed that I was AA and that was how the journey of the marriage began.”
Then the tale began to twist. “By God’s grace, we got married and God helped and our first baby, a boy, came. I was planning to go for my national youth service. After few months, we found out that the baby was always falling sick. It was almost like a monthly routine; we were always at the hospital where they gave him drips and treated him of one infection or another. It was so terrible.
“At a point when we came to the hospital, the doctor invited us into his office and said that with the rate at which the baby was falling sick even after they had checked every other thing, he suggested that we go for a genotype test. We looked at ourselves and I was surprised at his suggestion. I felt it shouldn’t have come up because on three occasions I had done three genotype tests and all of them said I was AA. My husband had told me that he was AS but with my status supposedly as AA, we did not envisage any problem. Naturally, I was confused by the doctor’s suggestion. But as a child of God, I know that there comes a time in your life when you give Him reason and hold unto Him. The Bible says bring your strong reason. I told God that getting married to a pastor was out of my agenda and if the two previous results were written without proper tests, what about the place my husband took me to? I didn’t know the place; I had not gone there before. So, I couldn’t have influenced the result by any means. Come to think of it, there was no reason to have done that. And the lady there did not know that he was AS, so she couldn’t have said let her pity me or something like that.
“For some time, we reflected on what the doctor said and we decided to do another round of tests. The baby’s constant illness was not making us happy. After the spiritual, we needed to do that so that we could be relaxed; it wouldn’t cost us anything. So, we went to a place and they took our blood samples. My husband still came out AS but something changed; the result said that I was AS. We said no, that we had at least two solid sources of confirmation. I was personally shocked and I told the woman in-charge that that was not my result because I knew I was AA. I said if actually I was AS, it means that probably the child was suffering from sickle cell. That was what came into my mind. But at a point, I said that there was every possibility that the people made a mistake too. So, we went to another place for reconfirmation and they I was AS. We went to yet another laboratory, this time around we left our environment, and I was still confirmed AS.”
Fortunately for Ibeakanma, none of her four children suffers from sickle cell, which is a rare occurrence. Dry Paul Kandasami, an Indian, called it a miracle.
But Michael Igwe Ori suffered different fate. A wrong diagnosis showed that he had malaria parasite and typhoid while the truth was that his kidneys had packed up. So, he was fed with wrong medications. And the man died in April last year.
It’s a boy, no, girl
Many pregnant women are delivered of babies whose sexes do not tally with scan. Take this: Mrs. Chioma Ukwueze 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 male 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, as was interpreted by her doctor, she was delivered of a baby boy in April 2012. Today, she has three male children.
Mrs. Gloria Chidi, an indigene of Abia State, had a similar experience. She had three children already – two girls and a boy. The scan of her fourth pregnancy said she would give birth to a baby girl. The medical prognosis corroborated a prophetic pronouncement. She said a pastor in her church told her that she was carrying a baby girl. So, with the “mouthpiece of God” corroborating what medical science has said, she was left with no 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. Unfortunately, her husband did no live to see the baby, as he died a month before the baby was born.
Gyneacologist speaks
Dr. Chikodi Onyemkpa of Hossana Hospital, FESTAC, Lagos, has come across many cases of women, who were told they would have female children and they ended up having male children as well as those that were told they would have male children and it turned otherwise.
Sharing his experiences, he said: “I have seen so many of them; some of them actually creating very difficult social issues to manage and some passed off rather quietly. 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 pressure 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; some times that prediction might be wrongly done. So, we see them often.”
Asked to give an instance, Dr. Onyemkpa, who also doubles as a sinologist, said: “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 immunization 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. However, Dr. Onyemkpa would not toe that line of argument. He gave reasons the practice would continue, particularly in certain part 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 license was seized for six months because he did gender determination by scan 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 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 landmark judgment by the Supreme Court recently, a female child had no right to inherit property from her parents in Igbo land. She is married off for life and whatever she gets during her wedding is what accrues to her. If the parents die, whatever they leave 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 temporal 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 judgement has put paid to all that because by that judgment, it has to be noted that the constitution of Nigeria is superior to that 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 scans, the gynaecologist said: “One of the fundamentals in scientific enquiry is to learn about measurement. Why you need to learn about measurement is that there can be error. In fact, in any human design, 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 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 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 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. So, 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 as well as 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 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 that 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. So, 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 3D machine. So, 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.”
Lab scientist speaks
Throwing more light on the subject, a Medical Laboratory Scientist, with the Turning Point Diagnostic Centre, Amuwo Odofin, Mile 2 Lagos, Abuchi Nwanya, also said wrong medical diagnosis is a product of many factors. He said such factors as personnel, equipment as well as reagent could lead to wrong outcome.
He said: “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 test, 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 labs 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 test 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 that they are supposed to do it.
“Another factor has to do with sample or specimen. If you collect the wrong sample for a particular test or you put the sample in a 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 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 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, already you will 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 added: “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.”

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