Bright and sunny is the yellow T-shirt that she wears, along with the matching slide to keep her hair in place. Although not visible through the face-mask, the wide smile is tangible as her beautiful eyes light up with a twinkle. Hope is what is obvious not only from the demeanour of the daughter but [...]

The Sunday Times Sri Lanka

With a new kidney in her, Dulakshika waits to get back to school

The Lady Ridgeway Hospital for Children conducts its first kidney transplant and the donor is none other than the little patient’s own mother

Not even a murmur, as blood is drawn from Dulakshika. Pix by Amila Gamage

Bright and sunny is the yellow T-shirt that she wears, along with the matching slide to keep her hair in place. Although not visible through the face-mask, the wide smile is tangible as her beautiful eyes light up with a twinkle.

Hope is what is obvious not only from the demeanour of the daughter but also the mother and though they will be celebrating the Aluth Avurudda away from home, the customs and rituals will be followed to the letter.

While celebrating life itself as the Sinhala New Year dawns, 11+ Dulakshika, will also be thankful that there is no greater love on earth than that of a mother for her child.

For, Dulakshika is the very first to undergo a kidney transplant at the Lady Ridgeway Hospital (LRH) for Children in Colombo and the donor is none other than her own mother.

Having got a new kidney on February 25, we meet mother and daughter on April 1 at the LRH as Dulakshika has come for a blood test to ensure that everything is fine within her body.

From Hambantota, mother and daughter will not be able to go back home for the New Year, as Dulakshika should be close to LRH for three months after the transplant, for monitoring.

So her grandparents will come bearing small gifts to their temporary home, which is a tiny boarding in Jayewardenegama, to light the hearth at the auspicious time, boil the milk, partake of the kiribath, kevum and kokis and shower blessings on them both.

It had been a speck of a wound on Dulakshika’s ankle back in December 2014 that triggered the troubles of this family which is eking out a living from the wages the mother earns at a garment factory.

Tough has been the life of the mother and daughter but worse since this illness struck them. “The wound was attended to at the hospital close to home and it did heal, but an angry swelling followed soon after,” says the mother.

This necessitated more rigorous treatment at the Karapitiya Teaching Hospital, with a month’s stay in January 2015, disrupting both the mother’s work and the daughter’s studies. It was a severe infection which also involved Dulakshika’s kidney and she had to undergo dialysis followed by a transfer to the LRH where a decision was taken that she needed a kidney transplant.

Then the Paediatric Nephrology Unit of the LRH had come to the fore as her saviour, with support and help from numerous others.

The little girl had Acute Glomerulonephritis following a streptococcal infection, says Consultant Paediatric Nephrologist Dr. Vindya Gunasekara, pointing out that usually the patients recover without a problem. But in about 5%, complications can arise and one such is a renal shut-down for which dialysis would be needed. Unfortunately for the child she had also acquired a secondary infection which aggravated the kidney problem, causing irrevocable, permanent kidney damage.

Therefore, the only option was a transplant and the mother immediately wanted to be tested and was found to be a very good match, says Dr. Gunasekara.

The pioneering efforts were then initiated by Dr. Gunasekara who tapped into the expertise and skills of the National Hospital’s Consultant Vascular and Transplant Surgeons, Prof. Mandika Wijeyaratne & Dr Rezni Cassim and Consultant Anaesthetist Prof. Anuja Abayadeera; and LRH’s Consultant  Paediatric Anaesthetists Dr. Champika De Alwis, Dr. M. Premaratne, Dr. S. Jayawickrama & Dr. S. Weerakoon who supported the surgery as well as provided post-operative care and Consultant Paediatric Nephrologist Dr. R. Ranawaka.

Much had happened behind-the-scenes prior to the first paediatric kidney transplant at the LRH, we learn, with unstinting support from the Health Ministry as well as LRH Director Dr. Kumar Wickramasinghe.

“Everyone chipped in to make it a successful transplant, paving the way for many more,” says Dr. Gunasekara, referring to the support of LRH’s Consultant Paediatric Surgeons including Dr. Ranjan Dias, Dr. Malik Samarasinghe & Dr. A. Lamahewage; Consultant Radiologists and Consultants-in-Charge of the Laboratories; the staff of the LRH Paediatric Nephrology Dialysis and Transplant Unit as well as the medical and other staff of the Operating Theatre and Surgical Intensive Care Unit; and the National Institute of Nephrology, Dialysis and Transplant at Maligawatte and the Medical Research Institute, Colombo.

Up to the time of Dulakshika’s surgery, paediatric kidney transplants were only being performed at the Peradeniya Teaching Hospital and Dr. Gunasekara is also appreciative of her mentor and Consultant Paediatrician Prof. Asiri Abeyagunawardena of that hospital who encouraged her in this direction.

The precision with which two hospitals worked in tandem is described by Dr. Gunasekara with pride. The transplant being scheduled for February 25, the mother and the child were opened up around the same time but one at the National Hospital and the other at the LRH. In an operation lasting about two hours, the LRH team had removed the diseased kidney of Dulakshika and was ready when the National Hospital team harvested the mother’s kidney, added some preservatives, gently placed it in an ice-box and brought it in one of their own vehicles to the LRH.

Dr. Vindya Gunasekara

“Time is of essence,” says Dr. Gunasekara, adding that the sooner it is transplanted after harvesting the better it is for the longevity of the kidney. “So it has to be simultaneous surgery.”

When asked why it took so long for the LRH to launch kidney transplants, she says that there are many requirements that need to be fulfilled such as a skilled team, operating theatre-time which is very precious and also a ward demarcated for patients with complicated kidney problems.

As the Aluth Avurudda dawns, Dr. Gunasekara is hoping that LRH would be able to come to the aid of six other children on dialysis who are in dire need of new kidneys.

Some of them have matching donors, but the others need to find unrelated donors or cadaveric kidneys. “Therefore, we need a good kidney donor programme,” she adds.

With some children coming from distant villages, the costs to the families are heavy as they have to rent out rooms in Colombo, while the families’ budgets are also hard-hit because at least one parent has to be with the child.

Even though Dulakshika and her mother are struggling for survival finances-wise, as they hold hands and look into each other’s eyes, their lives are back on track. Clever Dulakshika, though she has missed nearly a whole year of schooling, is not idle. She is always poring over the textbooks the school has sent through relatives, as she is one of their brightest students.

Sitting down with the teachers who visit the LRH, she shows off her prowess at nothing less than mathematics.

Hope glimmers in her pretty eyes as she yearns to go back and keep scoring over 90 marks for mathematics……..and as her future opens up, like the dawn of a new year with all its promises, she is determined to study hard and become a teacher.

Dulakshika will certainly be able to do so, with her mother’s kidney functioning as her own within her body, made possible by the skill and dedication of doctors both at the LRH and the National Hospital who work for the benefit of the humblest of the humble in Sri Lanka.

The costs keep piling up

Please help this mother and daughter to meet the numerous costs that they are faced with by making a small contribution to Account No. 75128370 with the Account Name: P.K. Gayangani at the Bank of Ceylon, Ambalantota branch.

The costs are piling up for them, what with boarding fees amounting to Rs. 10,000 each month in addition to the electricity bill as well as heavy transport costs. Their financial burdens are aggravated by the mother not being able to work for more than a year due to Dulakshika’s illness.

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