Laboratory medicine matures in Africa: How should Nigeria translate talent to impact?

We could not attend an important conference on Laboratory Medicine in Africa this month because we were involved in another important event in London at the same time, so you can imagine our excitement when a dear colleague - Iruka Okeke sent us her take from the conference. Iruka has contributed a lot to the development of laboratory medicine on the continent. Her seminal book -  Divining without Seeds: The Case for Strengthening Laboratory Medicine in Africa is compulsory reading for all those really interested in improving health care in Africa. 

By Iruka N Okeke

It was my privilege to attend the first scientific meeting of the African Society for Laboratory Medicine (ASLM; Dec 1-7, 2012, Cape Town) .  Yes there were the usual plenaries, symposia, break-out sessions, exhibitions and networking opportunities, but this was so much more than just another scientific congress.  Barely two decades ago, certainly in most of Africa, medical laboratory science was the hole in which biologists or chemists with little training or ambition fell into and settled to the bottom with a dull thud.  A few stars led pivotal programs but the vast majority would report daily to a bare bench or, in frustration, seek genuine employment in other sectors.  This was the state of affairs in spite of the fact that most patients on the continent had an infectious disease that could easily and reliably be diagnosed with a simple laboratory test and that testing was essential to optimize treatment. 

So much has changed in the last decade and as one who as argued throughout this time for strengthening laboratory medicine in Africa, the meeting afforded a truly delightful opportunity to see how laboratory medicine has blossomed over the continent in the last decade.  In addition to the better-known developments in point-of-care testing for malaria and laboratory capacity building for HIV diagnosis and monitoring, it was heartening to see considerable progress in the diagnosis of other common diseases, in diagnostic test development, and a much-needed rise in morale among laboratory scientists.

Laboratory medicine is by no means at its summit.  Things appear good now because they were until recently deplorable but we still need plenty of growth.  The majority of African laboratories are far from accreditation but through the ASLM-motivated Strengthening Laboratory Management Towards Accreditation (SLMTA)  and Stepwise Laboratory Improvement Process Towards Accreditation (SLIPTA), a good number are closer to accreditation than they might otherwise be.  Progress has been faster for  laboratory services specializing in certain diseases, particularly those associated with vertical programs with strong advocacy:  HIV, TB and malaria.  However, others – and critically unspecialized diagnostic labs - are not far behind.  Training and mentoring programs and best practices and support are spreading like contagion these labs can now detect.  There were promising sessions that described progress with surveillance for meningococcal meningitis in the meningitis belt and dangerous infections ranging from viral hemorrhagic infections to cholera.  In some sense, laboratory development was largely driven by the response to the AIDS epidemic.  It is a relief to see that it is extending beyond this.  Perhaps less well represented at the meeting were clinical chemistry  cellular pathology, which we will need increasingly to diagnose chronic conditions as non-communicable diseases become increasingly prominent.  Appropriate diagnostics will improve our ability to prevent and control infections and to avoid becoming victims of our own success, we need to develop other diagnostics in parallel.  

At the meeting itself, Nigeria and South Africa were disproportionately represented among delegates.  Not having the ‘home’ advantage of the South Africans (or the Visa-free entry for non-Africans), it was great to see so many Nigerians who had invested a lot to attend and passionately engage in one of the most pressing health-related issues of our time.  The Nigerian Minister of Health was in attendance, as were ministers or deputy ministers from at least six other countries, including South Africa.  In addition to giving keynote addresses, some of us were privileged to witness the Ministers hone and then sign a Call for Action of historical significance.

Nigeria’s Minister Onyebuchi Chukwu was a leader in the discussions that finalized the document and this is potentially one of the many contributions that led to his selection for the Best Laboratory Champion Clinician Award.  As much as I did learn from the scientific sessions, the Award session was equally telling for me.  Perhaps reflective of the collaborative effort that is required to build and deliver effective diagnostic services, most of the awards were appropriately to laboratories http://www.aslm2012.org/aslm-2012/awards .  Over 30 clinicial labs received awards for achieving international accreditation within the last two years.  Most of these were South African labs (South Africa has more accredited labs than the rest of the continent combined) but awards did go to labs in Botswana (4), Kenya (2) and Mali (1).  There were also six Best Practice Lab Awards, which went to labs in Burkina Faso, Botswana, Zambia, South Africa and Uganda.  Wondering about Nigeria’s clinical laboratories?  So was I and it was admittedly a relief to hear that one almost-but-not-quite accredited Nigerian lab did receive an honorable mention in the Accreditation award category.  There were only two awards to individuals, the aforementioned Champion award to our minister, and a Lifetime Achievement Award, which went to renowned South African virologist Barry Schoub.  Most impressively, Nigeria secured three of the five nominations in these two individual categories (Professors Tomori and Idigbe were both nominated for Lifetime Achievement Awards).  Clearly we have the scientific talent and quality of mind in Nigeria to be admired and celebrated on our continent.  Indeed the citation for Professor Tomori remarked on how he had been instrumental in building the exemplary Polio laboratory network through 30 African countries. 

Why does our excellence reflect so strongly in individual honors and much less so in collective ones?  This was the thought that kept running through my mind as I left the auditorium after what should have been the most uplifting and light-hearted session.  In later discussions with my Nigerian colleagues in attendance, this question was resounded. I am very proud of our honorees, and of the impact we were able to make at the conference.  However, it is not enough for any or all of us to be great individually or even collectively.  Our country and its institutions must be greatened too. 

[For more on the ASLM conference, please watch the ASM website at www.aslm.org and Lab Culture, the association’s magazine available from that website, in the weeks to come]

Iruka Okeke is a microbiologist at Haverford College.  She is author of Divining without seeds:  The case for strengthening laboratory medicine in Africa (Cornell Univ Press, 2011).