Dialysis unit at the Kalubowila Hospital:

New hope for life

by Shanika Sriyananda

Weak in appearance but built with a strong will, the young Mahesh Kumara is confined to his hospital bed for more than 4 hours. For the last seven months, his blood is being filtered through a machine twice a week. The purification process has helped him to walk again and feel better than before.

A past student of Dharmaraja Vidyalaya, Piliyandala, 25-year-old Mahesh was clueless that his kidneys were not functioning properly well for sometime.

Suffering from bouts of fever every now and then he had high blood pressure when he was referred to the Colombo South Teaching Hospital, Kalubowila by their family physician for further investigations.

The ailment was diagnosed as 'kidney failure' and recommended a transplant. Electrician Mahesh and his family totally depend on the Rs. 10,000 earned by his sister, who is a computer operator. The treatment cost much beyond their financial earnings.

Unable to find a donor for the past several months, Mahesh is still alive, thanks to the blood purification process, which needs to be continued until a donor comes forward to donate a kidney.

He became a beneficiary of the newly set-up dialysis unit at the Kalubowila hospital. Recalling how bad his condition was at the beginning, that he could not walk and needed to hire a van to travel to the hospital for the weekly dialysis. "After few months I became normal and now I go to the hospital from Piliyandala by bus. I am much better now", he says.

His eyes are shining with hope when he said that one of his relatives has agreed to donate a kidney. "I can go ahead with the transplant", he smiles.

The young Mahesh dreaming for the day when he could walk into the shop again, where he worked as an electrician and earned around Rs. 7,000 a month, once the transplantation is over. "I want to complete the half-built house at Diyakada, a village, a kilometre away from Kahatuduwe", Mahesh says adding that he does not want to be a burden on his sister, who is the sole breadwinner of the family.

Mahesh has been selected to receive half the total cost of the surgery (Rs. 700,000) from the President's Fund. The balance, he says hopefully, could be collected from his relatives and friends.

A. V. fistula, a small pipe, has been fixed permanently on to his hand to connect the valves of the dialysis machine. The two dialysis machines at the unit function non-stop, as the number of kidney patients keep rising every day.

The plight of kidney patients is very pathetic. Very few are lucky to get dialysis treatment, free of charge from State hospitals but majority, go to the private sector, where the charges range from Rs. 4,000 to 7,000 per dialysis. As a whole, majority of the kidney patients find it impossible to bear the cost as it is beyond their means.

The unit has four dialysis machines, two of them donated by the Royal Melbourne Hospital and other two by the Jinasena and Company. With rising number of renal failure patients the long felt need of setting up of a hospital owned dialysis unit was found some years ago.

The dream became a reality with the entire efforts of the Kidney Patients' Welfare Association and other fund raising campaigns. Without being a burden on the Ministry of Health, the Unit was set up spending Rs. 1.5 million. "Mahesh and another youth, both in their 20s, are from very poor social and economic backgrounds.

The latter cannot undergo transplantation due to a medical condition and Mahesh is waiting for the donor to be ready for undergo transplantation. "So that two lives could be saved with the dialysis machines", Consultant Physician and Senior Lecturer of the Sri Jayewardenepura Hospital Dr. Kamani Wanigasuriya says.

According to Dr. Wanigasuriya, although the hospital has been upgraded to a teaching hospital several years ago, absence of dialysis facilities in the hospital was a major drawback. "Sometimes post-surgical patients need dialysis and before the unit was set-up we did peritoneal dialysis where you insert a small needle into the patient's abdomina and release the dialysis fluid.

This process needs constant supervision by a nurse round the clock for 4 to 5 days. This causes a lots of inconvenience to patients. This is the same procedure that we used, to treat our acute renal failure patients.

The post surgical patients, who had undergone abdominal surgery, were transferred to Colombo National Hospital for dialysis", she recalls.To fulfil the need, University Medical Unit had decided to upgrade the renal services in the hospital and sought help of the Kidney Patients' Welfare Association.

"With all the public money, where we held several fund raising campaigns the hospital was able to set-up this small unit eight months ago. Now we have a very efficient surgical section which could take in four patients at a time", Dr. Wanigasuriya adds.

According to Dr. Wanigasuriya, treating patients with chronic renal failure is very expensive and is difficult to give a chance to each and every patient. "So we have to give priority to patients from very poor economic background, given dialysis facilities at the unit until they undergo transplantation.

We can not accommodate several patients with chronic renal failure. We have to cater to the demand of acute renal failure patients particularly from the ICU, too", she points out adding the most difficult task of her life as a doctor is to say 'no' to patients who seek help for dialysis treatment.

"Because of the huge cost involved we have to select the needy patient to treat. We give priority to acute renal failure patients and those who are waiting to undergo transplantation", Dr. Wanigasuriya says.

According to her, when they diagnose a patient with chronic renal failure, they refer him or her to the Nephrology unit of the Colombo National Hospital to see whether the patient is well suited for the transplant. If the patient can not undergo a transplant immediately, until such time, he will be given dialysis at the unit.