Tshopo, Democratic Republic of Congo — Between 2020 and 2023, more than 60% of patients tested at private laboratories in DRC's Tshopo province were misdiagnosed.
Marie Bolisawu sits on her hospital bed and waits to receive treatment. She had expected to be diagnosed with malaria. Instead, the lab found a thyroid problem. But Bolisawu, 27, doesn't trust the results. She'd originally been referred to a well-equipped private lab with qualified medical staff, she says, but it was too expensive. Instead, she went to a small lab with two employees that she could still barely afford. She paid 60 United States dollars for a diagnosis she doubts.
"I didn't have a choice if I wanted to get better," she says. "My head was hurting so much that I had to get those tests done."
Sixty percent of private medical laboratories in Tshopo province illegally employ unqualified staff who provide inaccurate test results, which leads to patients being misdiagnosed, getting improper treatment and suffering serious health consequences, says health inspector Jérôme Bolima of the Tshopo Provincial Health Inspectorate. His department is part of the Tshopo Provincial Health Division, which is tasked with coordinating health and environmental matters for the city of Kisangani and Tshopo province. According to their analysis, 65% of patients tested at private laboratories were misdiagnosed between 2020 and 2023.
"This is a very serious issue. Any inaccurate emergency diagnosis can lead to serious consequences, including patients dying within a few days," says Francis Baelongandi, the head of the Tshopo Provincial Health Division.
Global Press Journal reached out to nine owners and managers of unregistered private medical laboratories with poor diagnostic reputations. Five wouldn't talk with a reporter, and four denied the accusations that their results are inaccurate, with one blaming it on competitors who want to destabilize their business.
There are more than 90 public and private hospitals and health centers in Kisangani, Bolima says. Only two -- the major public hospitals -- have labs, but the fees are too expensive for many patients. This number does not include medical facilities that operate illegally because they haven't registered with the inspectorate.
Demand for medical facilities and labs has grown, as Kisangani's population more than doubled between 2000 and 2022, from 586,000 to 1,366,000 inhabitants, according to the province's statistics office. (Kisangani's population has since decreased to 853,616, in part because of people leaving the city and in part because the boundaries for the population count were recently redrawn.)
Around 2009, private medical laboratories opened throughout the city to fill the void, offer cheaper options and diagnose patients. But since 2020, the labs, often unregistered, have proliferated.
There were only three private laboratories in Kisangani in 2009, Bolima says. All were up to standard and registered. By 2021, there were at least 16, only five of which were registered. As of February, there were over 40 private laboratories. Only 16 are registered.
"Anyone can open a medical laboratory," Bolima says. "It's like running a business."
Private lab owners are not required to be medically trained, but their staff should hold degrees in medical laboratory science, Bolima says. It is a standard many labs don't meet.
Dismas Kitenge, president of Groupe Lotus, a human rights organization, says it is the government's fault that private laboratories seek profit, and ignore patient health and legal requirements. It's just a matter of the person in charge of a laboratory bribing the authorities so his laboratory can operate unchecked, he says.
"How is it that in one province or city, there is a provincial health inspectorate and provincial health division, but there are private laboratories that hire unqualified people as lab technicians but work quietly without being prosecuted by the law?" Kitenge says.
Bolima's inspectorate regulates labs, but its authority is not respected, he says. Lab managers appeal to higher powers, who give them the freedom to open and operate. The local government has no control over private laboratories, Bolima says.
In December 2023, Olga Akaya, 26, had stomach pains and was referred by a gynecologist to a private laboratory, where they diagnosed a problem with her uterus. But her pains got worse, and in March, she had emergency surgery on her fallopian tubes. They'd misdiagnosed her. She won't go back to the laboratory again.
Jean Taji, a gynecologist unfamiliar with Akaya's case, says many of the women he's referred to private labs for diagnostic testing have suffered complications after receiving treatment based on incorrect lab results.
"A patient of mine required emergency surgery due to an error in the private lab's diagnosis," Taji says. "A wrong diagnosis can result in inappropriate treatment and terrible consequences, especially for specialists."
He realized that not only did the laboratories have unqualified staff, but they operate without adequate equipment and are only interested in profit, he says. Now, he accompanies his patients to the laboratories to make sure they get the correct tests and results.
Lab technician Ruth Maboli, 28, who's worked for four years for a private lab she declined to name for privacy reasons and who has a degree in medical laboratory science, says laboratories need qualified technicians to safeguard their reputations.
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Emmanuel Azimali, 57, opened his private lab in 2018 because of the shortage of laboratories. He says he's never had a complaint.
"My lab had to meet the authorities' eligibility criteria, namely employing lab technicians, having proper facilities but also the right equipment, which is crucial for running diagnostic tests," says Azimali, who is trained as a primary care physician but isn't practicing.
Azimali says the government should close the labs that don't respect the standards.
Martine Balongo, 29, a private lab technician with a degree in medical laboratory science, agrees they should be closed but says that private labs serve a purpose.
She works in a small lab in a Catholic health center, and she says it's honest. Even though she doesn't have all the equipment she needs, she is able to do her job well. Laboratories like hers help with the shortage, she says, and she's proud to work there.
"It feels good when a patient is well examined and has received good treatment for his illness," Balongo says. "Good treatment comes from a good diagnosis."
Françoise Mbuyi Mutombo is a Global Press Journal reporter based in Democratic Republic of Congo.
