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