DISCOURSE, By: Dr. Innocent Emmanuel MBBS, MPA, FMCPath, FWACP,
INTRODUCTION: The narrative of our health sector is that of a perpetual drive towards an alien practice of an exclusively Nigerian brand of health care delivery system, as professionals in this field daily indulge in a binge to reinvent the wheel. This is done with total disregard to the barest basics of international standards, nor with revere to the rudiments of healing practice of African ancestral practice, but stands in between as a rogue, crude, and amorphous, yet unrelenting selfish quest for making personal ends meet no matter who is at the receiving end.
The quest for self fulfilment by any means has so far beclouded our brains and stripped us of our humanity in spite of the glistening fact that we work in a workshop where the body and soul of humanity receives it's healing and revitalization. The most recent of these is the bill slated for a two-days hearing on the 29th and 30th September 2022 at the National assembly titled: "ANATOMY ACT 2021. A BILL TO REPEAL THE ANATOMY ACT 1933 LAWS OF THE FEDERATION OF NIGERIA 2004 AND ENACT THE ANATOMY ACT 2021 TO PROVIDE FOR THE ESTABLISHMENT OF THE ANATOMY COUNCIL OF NIGERIA, BRING THE PRACTICE OF ANATOMY IN CONFORMITY WITH CURRENT LOCAL AND GLOBAL REALITIES AND OTHER RELATED MATTERS THERETO."
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The bill has in its content so many perplexing irregularities that at best seeks to "mix water with kerosene" in a drive of adding salt to injury, a desperate attempt to fuel the fires and flourish the flames of enmity in the already unnecessarily negatively charged health sector.It confers on anatomist arbitrary powers over physicians (anatomic pathologist) in the hospital (ministry of health) setting, a field where the former has no business in this regard, though the two hold each other dear in a mutual relationship.
As there is no vacuum currently in the hospital or it's supervising ministry, there is a need to address the fundamental destructive issues raised by the essential framework of the proposed bill. This write-up brings forth the following clarifications as realities that are not meant to undermine or malign anyone or any profession but lay bare certitudes.
1. ANATOMY: This is a branch of natural science, a branch of biology precisely, dedicated to the structural organization of living things. It is subdivided largely into macroscopic and microscopic anatomy. The former uses unaided sight while the later uses the microscope to study and characterize human organs, tissues, and cells. Anatomy therefore is involved with the normal structure of organisms that have not been altered by disease processes. Anatomy has advanced to the dissection of animal (human) carcasses and cadavers. This dissection is essentially to study the structure of these dead animals for knowledge and research that may involve comparison between humans of different races, and between humans and different animal species.
An anatomist is a biological scientist who engages in the study of the structural make-up of living organisms. A vast majority of anatomist focuses on human anatomy as biomedical researchers and educators. Anatomists are individuals with intellect and sound knowledge. While the anatomist sees the dead as cadavers, medical doctors (anatomic pathologist) see same as patients to whom they ascribe the highest level of respect and empathizes over their demise, seeing that they have shared together the last days of the dead individuals life together in the solemn and precious act of treatment. To work in a clinical setting, anatomist must possess a Doctor of Medicine (Medical Doctor), subscribe to the Hippocratic/physicians' oath, and further be certified by the body certifying medical and dental practitioners.
2. ANATOMIC PATHOLOGY: This is a branch of medicine that studies the effect of disease on the structure of human organs, tissues and cells. As a medical specialty, anatomic pathology is solely dedicated to the diagnosis of disease in humans from tissue sample towards the management and treatment of illnesses.This includes but not limited to microscopy (cytopathology, histopathology) and macroscopy (surgical pathology and autopsy). Anatomic pathology unlike anatomy goes beyond normal structure, to study alterations in structure of humans because of disease processes.
To understand anatomical pathology, a full knowledge of anatomy is required as one must know the normal before he/she could understand what’s abnormal because of disease processes. To understand changes disease cause on human tissues, an individual must go through the tiring and seeming unending study in medical school over at least six years and be qualified and certified as a medical doctor.
An Anatomic Pathologist, the world over, is a physician (Medical doctor) who has undergone postgraduate medical training (at least five years postgraduate training) in anatomic pathology. This physician is dedicated to the provision of diagnosis of disease in both living humans from tissue samples and giving direction on the type of treatment required.
Anatomical Pathologists also give directions in theatre during surgeries, a process called intra-operative consultation. For instance, for the diagnosis of cancer, as for many human diseases, it is not cancer until the anatomic/histo pathologist says so. Anatomical Pathologist oversees the mortuary and perform autopsy (postmortem examination) on death bodies to determine the cause of death. The autopsy which could be of hospital type inter alia seeks to determine the cause of death; audit clinical practice; unravel rare or emerging disease process; teaching of disease process evolution and effect; and medical research. On the other hand, a forensic autopsy seeks to establish the cause of death and suggest the manner and mechanism of death to help the judicial system place criminals at the site of crime. Anatomic (forensic) pathologist therefore regularly appears in the court of law to provide expert opinion and testify to the findings of autopsy performed in cases of litigation. Anatomic pathologist, therefore, to be precise do not “dissect cadavers” to study the structure as do anatomists but perform “dissection on the deceased” to unravel the cause of death to provide closure for families of the deceased, supply far reaching information to doctors that treated the deceased and furnish the judiciary with hard evidence to adjudicate on criminal and sundry cases.
3. THE MORTUARY: This is a place (within or without the hospital) where dead (human) bodies are stored in anticipation of identification, autopsy, or respectful disposal (burial, cremation, etc). The dead bodies in the mortuary are not awaiting the study of their normal structure. These corpses are usually the result of disease processes which often than not have been attended to by a physician. Some have died of unknown causes or unexpectedly and will require further investigation in the form of autopsy to determine the cause of death. The cause of death could be natural or unnatural (homicide, suicide, accidental) and this thin line can only be drawn by an expert in disease processes that fully understand the dividing line between health and disease; normal and abnormal; natural and unnatural.
Therefore, the anatomic pathologist works and oversees the mortuary as a physician with the expertise in disease as it relates to the living or the death and can correlate all findings thereof towards a meaningful and beneficial end. The anatomist has no place in the mortuary as it is statutorily not a place for the study of normal structures but a place where medical services are rendered. The anatomist is best fitted in settings of biomedical research or educational institutions. A medically (medical doctor) qualified anatomist may be employed or consulted in the mortuary to offer expertise in research when necessary.
4. THE MINISTRY OF HEALTH: As the duty of the anatomists is largely limited to educational and research settings, a directorate of anatomy services will best be sited in the ministries primarily responsible for these, respectively the Ministry of Education and Ministry of Science and Technology. The ministry of health as presently constituted covers all issue relating to human remains and mortuary services. This is the ministry that supervise the anatomic pathologist. There is therefore absolutely no need of the directorate of anatomy service as this will amount to a duplication of functions and a fertile soil for conflicts and a continued pile of wasteful parastatals and statutory bodies. Furthermore, this will lead to demands for creation of other similar directorates such as that of Biochemistry, Physiology, (Medical) Microbiology, other sciences offered in preclinical/clinical aspects of medical education in the University thereby bringing them respectively in conflict with the Chemical Pathologist, Hematopathologist (Hematologist), Medical microbiologist, and of cause medical laboratory scientist.
5. A RECIPE FOR CRISIS IN THE HEALTH SECTOR: There may be a need to establish the Anatomy Council of Nigeria, but this should not be created to duplicate the functions of the Medical and Dental Council of Nigeria (MDCN), or to put these councils in conflicts. The medical and dental practitioners act regulates activities of physicians including Pathologists (and Anatomical Pathologists).
The MEDICAL AND DENTAL PRACTITIONERS ACT CAP M8 2004 Laws of Federation of Nigeria (Article 1) established the Medical and Dental Council of Nigeria (MDCN) which is responsible for “supervising and controlling the practice of homeopathy and other forms of alternative medicine; making regulations for the operation of clinical laboratory practical in the field of Pathology which includes Histopathology, Forensic Pathology, Autopsy and Cytology, Clinical Cytogenetics, Haematology, Medical Micro-biology and Medical Parasitology, Chemical Pathology, Clinical Chemistry, Immunology and Medical Virology.”
If this proposed law is allowed to pass, there then will come a time where lawyers on the sides of the isle will stand in the Nigerian court of law (perhaps the National Industrial Court of Nigeria) to quote it while the other counter in defense by quoting the medical practitioners act. The judge will be left in bewilderment the contents of the two mutually exclusive laws as canvased in a parallel drive to chaos. Any act of law that will add heat to the already charged health sector should be discouraged in the interest of Nigeria and Nigerians as we battle a precarious health system with abysmal indices. A stitch in time saves nine.
CONCLUSSION: The Anatomist practice anatomy, a branch of natural/biomedical science and as such should have an Anatomy Council of Nigeria which regulates the practice of anatomy domiciled largely in primarily educational and research institutions and ministries of education, science, and technology.
The Medical and Dental Council of Nigeria is already in place and regulates the activities of physicians which includes Anatomic Pathology (histopathology), a branch of medicine.
The proposed Anatomy Council of Nigeria should not be a duplication of a subsisting one (Medical and Dental Council of Nigeria), any of its parts, nor in conflict in the same vein. Since anatomy is not the study of disease, but a study of normalcy, it has no place in the hospital or the ministry of health in this regard, but rather in research institutions and the ministry of education and science and technology where it will be well utilized.
No law should generate and engender strive amongst hitherto peaceful brothers. No law should in any way bring the "priest of a shrine to preside over affairs of a church or vice versal” except such a law is deliberately conceptualized, designed, and assigned to bring about anarchy.
Dr. Emmanuel is of Department of Pathology, University of Jos and Department of Anatomic Pathology and Forensic Medicine, Jos University Teaching Hospital.
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