Contributed by Ken Sikaris, Chair, IFCC Committee on Analytical Quality
The IFCC Education and Management Division (EMD) supervises the Visiting Lecture Program (VLP) which allows member societies to seek some support for visiting lecturers in an area of need. The Nigerian Association of Clinical Chemists requested a lecturer on the topic of analytical quality for their biannual scientific meeting to be held in Calabar in 2005. Naturally, the EMD approached its own Committee on Analytical quality (CAQ) to provide a speaker and preferred the speaker to be one of the CAQ members. The CAQ was actually in transition so as one of the two continuing members, and chair of the committee, I accepted the invitation.
Most biochemists know only anecdotes about Nigeria, such as Internet scams and Miss Universe Pageant protests. More importantly, Nigeria has a burgeoning population of about 160 million, the largest in Africa and is blessed by fertile soils and reliable rainfall. Furthermore a prosperous oil industry was established in the 1950's, although even since independence from the British Commonwealth in 1960, the economic strength of this resource has not had major benefits to the population as a whole leading to protests against the foreign oil companies.
It is also a paradox that in a country blessed with so many natural resources; many Nigerians only have access to a health system typical of a developing country. The NACC was established in 1975 and reborn in 1999 largely under the drive and benefaction of Dr 'Popo' Akinyanju. This great man died in September 2004 and this was the first NACC meeting without him. However, he will always be remembered, especially during the memorial lecture established in his honour that should open all future meetings.
Dr Sonny F. Kuku, a private laboratory director as well as a truly internationally qualified endocrinologist gave a plenary lecture which was directed toward laboratory leadership and called for the various professions that make up laboratory medicine to acknowledge each others training and strengths and get on with advancing laboratory medicine in Nigeria as his close colleague 'Popo' would also hope.
Following that opening, Prof Jack Ladenson from Washington University in St Louis and I gave a symposium on quality assurance. Prof Ladenson spoke on laboratory quality assurance that should always include pre-analytical and post-analytical procedures while I spoke on the value of external quality assessment. We were both aware that many laboratories in Nigeria have limited analytical quality control and a national external quality assurance does not exist. Nevertheless, it is important to reinforce the value of these global standards while trying to establish some in house approaches in these areas appropriate to the resources available to the laboratory such as patient pools and sample exchange.
The second day and third days of the conference included numerous presentations, largely from trainees which were of a good standard and often focused on problems such as environmental toxicology and diabetes in this challenging health environment. Prof Ladenson also spoke on his work with Pathologists Overseas Inc supporting laboratory projects particularly in Eritrea and Bhutan. My second lecture addressed the clinical interpretation of our results and how understanding the basis of reference intervals, biological variability and measurement uncertainty facilitates interpretation while also determining the minimum standards that should be applied in any laboratory. I was especially heartened by the enthusiastic interest in these topics by the senior trainees which suggested to me the future of laboratory medicine in Nigeria could be in good hands.
The Nigerian capital is now Abuja which is centrally located but I flew into Lagos, a sprawling city of around 20 million people and previous capital before flying on to Calabar in Cross River State. Calabar is a much quieter, cleaner and greener city than Lagos. It has always been a trading port and unfortunately its history includes a prolonged period as a major slave port from Africa. Another historical peculiarity of the area is the story of revered Mary Slessor, the missionary that convinced people that baby twins were not evil and their lives have been spared ever since.
Calabar is renowned for its cooking and its peculiar cuisine which includes yams, cassava, plantain bananas, Afang soup and edikaingkong soup were unusual and delicious. I enjoyed the fish and ox stripe casserole and lamb pepper soup. Most people in Calabar travel around as pinion passengers on commercial motorbikes but our hosts provided transport provided through the host institution; The University of Calabar and the UniCal Hotel.
The weather at this time of year is very warm and humid which makes refreshing breezes particularly pleasant. I am grateful for the considerable advice and support required to ensure a successful visit to Nigeria. The appreciation and desire of our colleagues in Nigeria to be equivalent members of our global professional community was well worth that support.
Some of the registrants at Day 3 of the NACC Biannual meeting in Calabar, Cross River State, Nigeria. Front row: Dr J Anetor (Treasurer), Prof A E Udoh (Meeting Chair), Prof J E Ahaneku (VP), Dr K Sikaris (Aus), Dr P H O Amodu (Pres. NACC), Dr O. O. Oladipo (Secretary), Prof J Ladenson (USA), Prof D M Bolarin, Prof O A Dada and Mr PO Bassey. Prof A B Okesina (behind KS) and J.A.A. Onakoya (behind Dr Amodu), Dr. Itam (behind Prof Ladenson), Prof Agbedana (behind Prof Okesina), Dr Tunji Soriyan (behind Prof JL), Dr. Maisie Etukudo (extreme left rear in blue with glasses)