Renal Palliative Care

CKD – Renal Palliative Care

 

 

Background

Chronic Kidney Disease (CKD) commonly occurs due to hypertension and/or diabetes. It affects middle aged or older people of both sexes and affects the glomerulus of the nephron.

Chronic Kidney Disease of unknown origin (CKDu) on the other hand is a distinct entity where relatively younger people, mainly males get effected independent of diabetes or hypertension and it affects the tubules of the nephron.

Presently an estimated 400,000 people in the North Central, Northern Eastern and Uva Provinces have been affected and 25,000 have already passed away from DKDu. Since the first reported case was detected in 1992 in Siripura Village in Padaviya, the prevalence of CKDu has doubled every 8 years and is estimated to affect nearly 40% of the population of Sri Lanka by year 2032.

The reason for CKDu is still being investigated but several studies done up to now by the WHO, and other universities, indicate that heavy metals such as Arsenic, Cadmium etc. from poor quality agro chemicals, glycophysate (from the weedicide Roundup), heat stress, hard water in the endemic areas etc. may be individual or combined contributing factors.

The government of Sri Lanka through various agencies and ministries and NGOs has provided rain water tanks, Reverse Osmosis water purification units, Kanda programs is schools in the area (using organically grown ride encourage organic farming), educational programs to prevent CKDu up to now. It has also banned certain agro chemicals from being used in certain districts of Sri Lanka.

More needs to be done to collect adequate data of affected individuals, do population based prevalence study throughout the country and to find out the possible cause or causes so that proper preventive measures can be put in place. The preventive measures that are already being carried out needs to be evaluated for their effectiveness as well.

At the present moment Sri Lanka needs about 2500 dialysis machines but only have 249 including the private sector as per the Society of Nephrologists. Proper trained Dialyses nurses and Nephrologists are also a major limiting factor to enhance the dialyzing capacity.

Due to the large numbers involved a Renal Transplantation program for a definitive cure is extremely hard sustain. Most of the patients on dialysis end up needing renal palliative care, which is also not well established in Sri Lanka. Even during dialysis, the patients get so many symptoms such as fatigue, pain, uraemic itch, restless leg syndrome, loss of appetite and sleep, depression etc. which needs to be properly managed through palliative care.

Apart from the physical issues faced in Prevention, Treatment and Palliative Care, there are other more damaging financial and psychosocial issues affecting these patients and their families.

When the younger male farmers who are normally the sole bread winners of their families are affected by CKDu, the wives and the children also get affected in a big way. Due to financial hardships they sell their family homes. Go into debt, resort to prostitution, children’s schooling gets interrupted, causing major damage to the very social fabric that keeps them together as a family unit.

The damage CKDu causes the patients and their families are such that it will affect the countries DGP, and eventually cause complete social destruction. If 40% of Sri Lankans will be affected by year 2032, the country’s economy will almost cease to exist.

About Shanthi Foundation Australia

• It is a registered Charity in Australia.
• It is registered with the Australian Council of Not for profits and Charities (ACNC)
• It has Deductible Gift recipient (DGR) status
• The Vision – Shanthi meaning peace is striving to develop & propagate Palliative Care throughout the world, especially in developing countries such as Sri Lanka to give Dignity & Comfort to people afflicted with a life limiting illness such as cancer, CKDu.
• It is also involved in the prevention and treatment of life limiting illnesses.

What Shanthi Foundation Australia has done up to now in Sri Lanka

• Introduced Renal Palliative Care to Sri Lanka (and India) – March 2014 through workshops in Colombo, Anuradhapura together with the Society of Nephrologists in Sri Lanka.

• Installed and is maintaining 13 Reverses Osmosis machines in13 schools & villages in the Northern, Ester, Uva and North Central provinces to give clean drinking water to keep our next generation from getting affected with CKDu.- 2014
• Training of doctors, nurses in Palliative care through courses conducted in Colombo, Anuradhapura, Kandy &
Batticaloa with the College of General Practitioners Sri Lanka. –July 2014
• Training of doctors, nurses and social workers in Community Palliative Care in collaboration with the
National Cancer Control Program of the Ministry of Health Sri Lanka. – July 2014
• Collaborating with the Lien Foundation Singapore to conduct a Master Trainer Program in Palliative Care
for 50 consultants including 18 Oncologists at the National Cancer Institute in Maharagama, Sri Lanka.
(ongoing)- since 2013
• Provided 11 fully funded Shanthi Scholarships to send 11 Doctors & nurses to do 6 week Certificate Courses in
Palliative Care in Kerala, India. – 2013/4

Proposed future activities of
Shanthi Foundation in Sri Lanka

• Increasing Dialysing Capacity in the North Central Province
• Renal Palliative & Supportive Carte Units in the CKDu affected areas.
• Palliative Care Units/ Hospices to look after cancer patients throughout the country
• Head and Neck Cancer Hospice in Vavuniya District to look after patients with oral cancers due to betel chewing
• Training and Mentoring of doctors, nurses and social workers
• Community Palliative Care Units to look after patients in their own homes in the affected area.
• Preventive Educational programs in schools and villages for cancer & CKDu
• Providing Reverse Osmosis Water purification plants to schools & villages
• Research – to collect proper data, prevalence study country wide, finding causes & treatments for CKDu including
indigenous ayurvedic treatment- this will do in collaboration with the Australian Institute of Palliative Medicine, George Institute for Global Health Sydney together with local & international Research Centers & Universities.

Conclusion

The time has come for all of us to put aside our differences and egos to help our country get rid of this menace once and for all. The repercussions of not doing so, will be felt for generations to come.

 

 Dr. Suharsha Kanathigoda
 Patron PCASL
 Consultant Staff Specialist in Palliative Medicine, Calvary Health Care ACT, Australia.
 Lecturer Australian National University (ANU), Founder & Chairman of Shanthi Foundation Australia.
 (shanthi-foundation.org), Director –Australian Institute of Palliative
 Medicine Research Fellow- The George Institute for Global Health- Sydney, Australia.