Professor Andrew Z. Cakana. (. FIBMS; MB CB; CTM; M Med Sc.; FRCPath [UK] . Disclosures. Contractor for R&D Oncology Janssen Pharmaceuticals.. Session speaker for . Sarnofi. Pharmaceuticals.. Consultant Pathologist for Medical Laboratories.. ID: 132846
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Laboratory Medicine in Zimbabwe: How advances became retrogressive.
Professor Andrew Z. Cakana
FIBMS; MB CB; CTM; M Med Sc.; FRCPath [UK]Slide2
Contractor for R&D Oncology Janssen Pharmaceuticals.
Session speaker for
Consultant Pathologist for Medical Laboratories.Slide3
'As natural selection works solely by and for the good of each being, all corporeal and mental endowments will tend to progress towards perfection.'
Charles Darwin 1809-1882Slide4
‘Zimbabwe College of Pathologists’ and ‘Association of Pathologists of Zimbabwe’: turf wars.
Scientists with MSc/M Phil or higher are registered as clinical scientists in the register.
Formed the ‘Zimbabwe College of Pathologists’.
‘Medical Pathologists’, namely
, Immunologists and Haematologists are members of the ‘Association of Pathologists of Zimbabwe’.
Now split by discipline in the register (Path-
Are these associations/colleges misleading and
-representing themselves? What is the impact of this on ZIMA colleagues?Slide5
The Generalist pathologist covered all disciplines of pathology.Cadre no longer trained.Pathologist was strictly laboratory based, and hardly consulted patients.
Pathology has several disciplines and cadres are trained in one of them.Some disciplines are see and treat patients:Haematology, immunology and chemical pathology are clinical disciplines.Locally, No recognition of clinical disciplines from administrative colleagues, funders, and sometimes even some councils.
Zimbabwe has remained stuck with old classification: clinical vs non-clinical.Slide6
Allan Mills autobiography 2013Slide7
Modern Founders of Zimbabwe Medical Technology.Slide8
The Medical Technologist: yester years vs today.
Trained over 6 yrs, in an apprenticeship manner. 4 yrs. generalist and two more for specializing. 80% practical and 20% theory. Taught by ‘hands-on’. Entry qualification was ‘O’ and ‘A’ levels. Specialist registration populated by appropriate cadre.GeneralistSpecialist
4 yr. UZ course, leading to HMBLS degree. 20% practical and 80% theory. No specializing envisaged. Taught by ‘theorists’.Entry, excellent ‘A’ levels.No new registrants. M Phil cadres in biochemistry and microbiology.Register has:GeneralistsSpecialistsClinical Scientists.
The practical subjects such as Histology, Haematology and Microbiology have been hit the hardest, ‘lots of brain and no hands and eyes’.Slide9
Health Professions Authority.
Created by law: the Health Professions Act 2004.
Several councils created.
Medical Scientist Council vs Medical and Dental Practitioners Council.
Councils adversarial instead of complementarity.
Pathologists assigned supervisory role but labs belong to Scientists.
Clinical Pathologists require 2 HPA registrations: MDPCZ as consulting rooms vs laboratory rooms (Council of Scientists) for the same procedures.
Inspecting the same toilets, water and disposing of needles.
AFFOZ will not issue ‘numbers’ without both!
Financial survival for the HPA and Councils vs pragmatism?Slide10Slide11
“The mason who builds a house which falls down and kills the inmate shall be put to death.”
Hammurabi of Babylonia 3000BCSlide12
Laboratory QA and Accreditation.
ZINQAP offers a voluntary service to improve quality in Laboratories.
Labs pay for participating.
Performance not published.Slide13
2 (1 research and 1 clinical)
CIMAS Medical Lab has
since been accredited in Zimbabwe
Schroeder et al 2014Slide15
Pathology services and local tariffing.Slide16
Development of local expertise and survival of local laboratories.
opinion on histology overtaken by cross border couriers and
-examination on all specimens.
Cross border specimen movement on routine work means pathologists no longer need to reside or operate from country of registration.
How does the country develop local expertise?
Who comes to the table to negotiate the local tariff?
Who gets sued for incorrect cross border specimen results?Slide17Slide18
Future training of the scientists
Consensus on the gaps of the current cadre:
No ‘on the bench’ experience at exit.
Creation of ‘on the bench’ MSc starting with Haematology.
The cadre to exit with practical and management skills to include quality assurance.
Potentially to be allowed to head departments and open laboratories?
Short courses on ‘skill deficits’ being set-up and will be ongoing.Slide19
are already being trained by the department at UZ Medical School.
Plans are in place to train haematologists with emphasis in both clinical and laboratory medicine.
Dearth of medical microbiologists and chemical pathologists.
Acceptance by medical colleagues (ZIMA) and Funders (to include AFFOZ) that some disciplines see patients.Slide20
Regulation of Laboratory Medicine by HPA and councils.
Complementarity of disciplines has to be recognised
HPA (and relevant councils) must be made to understand the nature of pathology specialization and the relationship between cadres.
Registration of pathologists must be simplified in line with other clinical specialities.Slide21
Participating in local quality assurance programme is currently voluntary.
The laboratories pay a fee to receive quality assurance material.
Performance in the scheme is not published.
Accreditation is also voluntary, and lack of accreditation is also not publicised.
Could there be a re-visit to this approach to both participation to local scheme and accreditation?Slide22
Other activities by pathologists.
Membership of Association of Central and Eastern Africa.
Haematologists planning to make a COEH, centralized expertise, and centralized expert activities such as stem cell transplants.
Plan includes community haematologists.
Laboratory Medicine should be a concern of all of us: done well,
It’s a relief to all.
Thank you for your attention.