Medical Lab achieves ISO certification

Dr Balmiki Ramsaran, Medical Director of the facility found on Eastern Main Road, St Augustine told Business Day on Friday during an interview at his office that while he was pleased with the recognition, he was at the same time frustrated that no other local medical laboratory has sought ISO 15189 accreditation.

As far as Ramsaran is aware, no other medical laboratory in the Caribbean, has sought, or has been accredited with the prestigious standards and quality certification.

“With the ISO 15189,” he said, “I have brought first world status to our medicine laboratory in TT.”

The article, featured in the Lab World Magazine Volume 2, 2013 edition, is titled ‘Journey of a Medical Laboratory in a Small Developing Country to achieve International Accreditation.” The authors are Ramsaran, and standards and quality consultant Terrence Awai. Awai was also a former head of Trinidad and Tobago Bureau of Standards.

According to Ramsaran the journey of St Augustine Laboratory, which was established in 1981, was a difficult and expensive process, but it was also a rewarding one, and it gives international credibility to the work being undertaken locally.

The laboratory, which has a staff of 56, has two other laboratories, called “stat labs” at St Clair’s Medical Hospital and the Brian Lara Cancer Treatment Centre that caters to the immediate needs of in-house patients, and accident and emergency departments. A number of private doctors also use the services of the medical laboratory.

The medical laboratory in St Augustine conducts investigations in chemistry, hemotology, endocrinology, immunology, bacteriology, and parasitology.

The St Augustine Laboratory applied for accreditation and attained ISO 15189 from the Ontario Medical Laboratory Accreditation Board of Canada in 2008. In 2010 it again attained joint international accreditation with the Standards Council of Canada. It is now going through the process for ISO 15189 accreditation for the “stat labs” at the two private facilities.

Asked why he pursued international accreditation, Ramsaran said his dream was one of First World health care in TT.

“First World Health care does not come by just building new hospitals and purchasing new equipments. It comes by having standards, policies, procedures and trained staff,” he said.

Supervisors must be qualified and exposed to new developments, he said. “You cannot teach something that you do not know.”

It was frustrating, he said when ministers of health and Prime Ministers after Prime Ministers “talk about First World this and First world that and what they do? They build new hospitals and buy new equipments, but do not take on frontally quality and standards.”

It was the need for quality and standards that caused him, he said, “to take it upon myself to move in that direction.”

“When I decided that I was going to get international accreditation,” he said, “Mr Awai, thought that I was mad, and probably still thinks so, especially since, I had everything in my corner and things were going good.”

A foreign European consultant the then Government brought to Trinidad, he said, “told me that I could not make it because in TT you can’t get anything done properly.”

Nevertheless, he said that Awai came on board and has been the laboratory’s consultant since. Initially the lab achieved ISO 15189 accreditation for over 124 tests. “That was fantastic,” he said.

“I feel proud we have done it. Mr Awai and every single member of staff who works here, and have worked here before, did it,” he said.

Three weeks ago, he said the auditors from the Canada ISO office visited. They rated the facility over 97 per cent in conformity to standards and quality. “They rated us as good as, or, even better than some of the biggest labs in Canada, Australia, South Africa and New Zealand, for which they are responsible,” he claimed.

The entire accreditation process took four to five years and many times, he said, “we thought we could not have made it.”

Why accreditation, when the process is “tremendously expensive”? Ramsaran said, “I just wanted to do things properly, attain the highest standards and set the example for others to follow.”

When people come to TT for health care, he said, “They are not coming to see the place. They come to the hospitals they know are accredited. If we have these accredited facilities health care in TT, people would come here because they know it is cheaper than going to North America or Europe. People would come here if they know it is cheaper. People go to the Mayo clinics, not because of who they know. They go because those clinics are internationally accredited.”

At present, he said, “there are no standards in laboratory medicine in TT. Everyday we have labs opening all over the place. Tomorrow if the doubles man at Curepe wants to convert his cart to a laboratory, he could do it. There are no regulations and no licencing of labs. There are no stipulations or qualifications. There is no nothing. You can check that. Nobody cares. This is not happening just today, this was happening 50 years ago.”

Asked whether he has offered his help locally, Ramsaran said, “I have, but no one including, Ministry of Health and the TTBS have taken me seriously. It make me feel that they don’t care. They will not take the bull by its horns.”

He is willing to help and support anybody, he said, “to raise our own standard, own health care system and laboratory medicine to international standard. I want people to understand my message and don’t shoot the messenger. All I am going to say is that we can do it together.”

On account of the accreditation, he said that the facility must follow certain protocols. “We do not have better machines than other laboratories, but we have protocols that must be adhered to, including cross checking results, when in doubt.”

Unfortunately, he said that as no other lab is internationally accredited in TT or in the Caribbean cross checking cannot be done locally or regionally.

What could take the lab half an hour because of its protocols could take another lab a minute or a few minutes, he said.

“Could you imagine how places operate that do not have these systems and protocols to follow?” he queried. “It is frightening to think that there are places without protocols. We have protocols to follow for every single thing that we do, and we still have hiccups...mistakes, because we have human input.”

However, the advantage of the protocols, he said, “is that we could pick the hiccups before or after tests are completed.”

In spite of a lack of response, Ramsaran said, “I haven’t given up. I think we have something good. I don’t think they are ready as yet. Next 20 years or so they will know it is the way to go.”

And in terms of those who has recognised the accreditation, Ramsaran said, that last year he got a telephone call from a Professor Mahase Gupta of India congratulating him on the achievement of a Third World country attaining international accreditation.

“He was amazed. He thought it was something the rest of the world should know how a Third World country could do it and others in the First World and Second World were struggling to achieve it.”

Feeling slighted by the lack of recognition locally on the achievement, Ramsaran said that apart from then Prime Minister Patrick Manning who sent him a congratulatory letter, he said that no one from the Ministry of Health or the TTBS, or others in authority, have offered him congratulations.


"Medical Lab achieves ISO certification"

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