DIY dialysis

Patients with Stage 5 kidney failure in Girandurukotte are getting some much needed relief with CAPD, a home dialysis procedure:

by Dhaneshi Yatawara

Dr. Lishanthe Gunerathne demonstrating how the dialysis done

Nilmini in her sterile room

The fluid bag

For Soysa Jayasekera of Galgelanda, Habarawa, Girandurukotte, life was never a bed of roses even before he was diagnosed with Chronic Kidney Disease of unknown etiology (CKDu). He died of a heart attack at around 2.00 a.m. on February 10 at the age of 55.

Hours before his death, he spoke to this writer, sitting outside his half-built house, surrounded by his family, and many grandchildren, about how well he felt after he started the new dialysis system. His biggest comfort, was that, he himself could do the dialysis at home without being in a chaotic hospital.

Jayasekara was one of the ten CKDu-affected people selected by the Medical officers to undergo a different kind of dialysis known as Continuous Ambulatory Peritoneal Dialysis (CAPD), introduced by the Girandurukotte District Hospital. Jayasekara's indefatigable spirit helped him to cope with his illness.

The day before he passed away, Jayasekara was discharged after being treated for two days at the Girandurukotte District Hospital. Doctors had conducted numerous tests, including an ECG, which were all okay. Yet, back at home he had complained about feeling slightly stuffy in the chest. His death shocked the medical staff at the Girandurukotte Hospital who had been treating him since 2008. "He was responding well to the CAPD but prolonged illnesses such as CKDu can affect a person in different ways," said Dr. Lishanthe Gunerathne, Medical Officer in Charge of the Renal Unit, Girandurukotte Hospital.

Despite Jayasekara's sudden death, there are nine more CKDU-affected people undergoing CAPD. The first of the group is 27-year-old Nilmini Priyangika, whose kidneys have failed 93%. Nilmini is a mother of two young children. Her husband is a soldier in the Army Artillery Regiment and cannot be around her throughout the day, as he is stationed far away from home. Despite her physical difficulties, Nilmini looks like any other ordinary busy housewife, running around a hyperactive three-and-a- half-year-old toddler and a busy primary school student.

Nilmini had been undergoing CAPD for nearly a year and as of now her condition has improved to near-normal level according to the medical officer's analysis.

Nilmini's predicament

Kidney failure was detected during her second pregnancy in 2012 and doctors suggested that the foetus be removed to save the mother's life - but she refused. The three-year-old toddler, the child she risked her life for, is her constant companion.

"After childbirth my condition worsened, although I was undergoing treatment. The only option was a kidney transplant but it was difficult to find a donor," she said, recalling the past.

Consultant Nephrologist of the Girandurukotte Hospital, Dr. Nishantha Nanayakkara and his like-minded Medical Officer-in-Charge of the Renal Unit, Dr. Lishanthe Gunerathne, suggested CAPD treatment for Nilmini.

With a few more years added to her life, Nilmini realised she would get the opportunity to look for a suitable donor and watch her two daughters grow. She accepted the challenge.

S.M. Samarakoon (30) is another patient who agreed to take on the CAPD challenge.

A father of a five-year-old daughter, from Keselpotha, Mahiyagana, he was attending the renal clinic to check an unusual swelling in the abdomen area, he had developed.

Samarakoon

Dr. Gunerathne, who examined Samarakoon, said it was a swelling under the skin and not from the abdomen and directed him to get a full blood count from the hospital lab and show the test results before leaving hospital. Samarakoon started CAPD in September 2015. He earns a living by farming and hiring his three-wheeler. With the kidney failure, he finds it difficult to work in the paddy fields but as the CAPD is in progress, he hopes to start hiring the three-wheeler again. "It is not much of an income in this part of the country where everyone is poor. But something is better than nothing," he said.

A few years ago, a simple blood test was a difficult task, at times, impossible, as the Hospital did not have a lab and a technician. Today facilities such as lab tests, scanning, ECG and many of the basic essential components are available in the Girandurukotte Hospital. "Our patients are not only from Girandurukotte. People from peripheral districts and adjoining provinces seek our service," said Dr. Gunerathne.

CAPD suitability

To select patients for the CAPD, under Dr. Nanayakkara's instructions, the Medical Officer in Charge has to personally inspect each individual case including home visits to assess whether the patient is suitable to operate the process by himself. "The patient's capacity to understand the situation, consent, personal hygiene levels all contribute when we make the selection," said Dr. Gunerathne.

All facilities

The two doctors are continuing the unwavering service of Dr. Thilak Abeysekera, the senior nephrologist who pioneered screening CKDu patients in Girandurukotte and the bordering townships since year 2000.

Today, the Girandurukotte Hospital is equipped with all facilities except the hemodialysis, which is the common dialysis many are aware of. On clinic day, patients are provided with all three meals with the help of a donor and when in shortage of donors the hospital staff provide the meals at their expense.

It means a lot to many of these poverty-stricken CKDu patients. Nearly 3,000 patients are registered with the hospital's renal unit. Among the detected patients over 77% are affected with the CKDu. The next step of the

Hospital is to build a community centre for the patients inclusive of all facilities. In 2000, when patient screening started in Girandurukotte, most of the CKDu patients detected had gone beyond stage 5. "Over time this condition got much better and currently we get patients below stage five," Dr. Guneratne said.

The Girandurukotte Hospital has been conducting screening clinics and awareness programs since year 2001. The biggest problem these people are facing, according to the Sanganayake of Uva/Bintenna and Chief Priest, Girandurukotte Buddhist Centre, Ven Naptawela Dhammananda Thera, is the inability to find a kidney donor as most of the time, the majority of the family are affected with CKDu and thus have no suitable donor.

[How CAPD works]

Continuous Ambulatory Peritoneal Dialysis a.k.a. CAPD is considered the most widely used cleansing (dialysis) system used for persons suffering from kidney failure. A specially made fluid, capable of absorbing toxins, is put in to the abdominal cavity. Using the fluid the abdominal cavity to wash vital internal organs in cycles. A soft plastic tube is inserted to the abdominal cavity and held in place with a cloth belt. Patients selected for CAPD undergo the dialysis procedure thrice a day for eight hours. The cleansing fluidd is supplied by the government and delivered to their door step by the dedicated medical officers.