Kidney talks failure

A seven-storey, state-of-the-art medical facility in Maligawatte remains unused, while medicos wrangle over who should use it. Meanwhile, suffering kidney patients hope the President will step in, writes Nadia Fazlulhaq. Pix by Sanka Vidanagama

The Ministry of Health has decided to ask President Mahinda Rajapaksa to step in and settle a long-standing dispute between doctors and members of the medical academic world over who should be manning an as-yet-unused state-of-the-art facility for kidney patients.

The bone of contention is the National Institute of Nephrology, Dialysis and Transplantation, a Rs. 500 million, fully equipped, seven-sto-rey kidney treatment facility in Maligawatte, Colombo 10. The facility has still not been officially opened.

The Rs. 500 million National Institute of Nephrology, Dialysis and Transplantation.

Since the facility was completed and equipped in 2008, the facility remains closed, shutting out thousands of kidney patients in urgent need of medical attention, while medical groups continue to wrangle over the facility’s usage.

The Government Medical Officers’ Association (GMOA) says the facility should be used exclusively for the treatment of kidney patients, while the Medical Faculty of the University of Colombo says the facility could be shared equally by medical and research teams.

The Ministry of Health, normally the deciding authority in such situations, has decided to raise the matter at the highest level by bringing it to the notice of the President.

Health Minister Nimal Siripala de Silva told the Sunday Times that the ministry was of the view that research and treatment could both be comfortably accommodated in the Maligawatte facility. “This dispute has been dragging on for some time, and Health Ministry intervention alone is not the answer,” the minister said. “The prolonged dispute is only further delaying the opening of the nephrology institute.”

The GMOA maintains that kidney medical research is best conducted where kidney disease is most prevalent, such as in areas in the north-central part of the country. According to a GMOA spokesman, doctors are prepared to work in the nephrology institute only if it is dedicated exclusively to kidney treatment, and not split up for research purposes as well.

“The GMOA has clearly said the nephrology institute should be run as an independent unit, and that it should not house research work of the university’s Medical Faculty,” said the GMOA spokesman. “Research centres should be set up in areas where the disease is markedly prevalent.”

The Maligawatte facility is equipped with a Rs. 40 million dialysis unit. Dialysis machines cleanse the blood of impurities or toxins, work normally done by healthy kidneys.

“In a year some 7,000 patients are in need of dialysis,” the GMOA spokesman said. “It is sheer waste to have all this equipment and not use it. Blood dialysis is expensive and the average person cannot afford it. The GMOA maintains that dialysis treatment is a top priority, especially with the number of kidney patients increasing.”

The GMOA spokesman said doctors wanted the nephrology institute to be run exclusively by Health Ministry consultants. Meanwhile, the medical academics are hoping the President will intervene and settle the matter.

Professor Rezvi Sheriff, director of the Postgraduate Institute of Medicine and a senior professor of medicine at the University of Colombo, said the medical academic fraternity believed the Maligawatte unit could easily accommodate both treatment and research activities.

The only building space in use is the G/F, by the Dental Institute.

“We want it to be run jointly by both the Health Ministry and the Faculty of Medicine,” Prof. Sheriff said. “There was an earlier agreement to allocate one-third of the facility for treatment purposes, but later this was increased to 50 percent. We have now decided to approach the President on this matter.”

The National Institute of Nephrology, Dialysis and Transplantation is part of the National Hospital of Sri Lanka. “The institute is an expansion of the renal unit of the National Hospital,” said National Hospital director Dr. Hector Weerasinghe. “It has more facilities to treat the increasing number of kidney patients.”

Every year, some 20,000 persons suffering from renal failure are reported from around the country, with more than 50 percent from the North Central Province.

Health Ministry epidemiology unit consultant Dr. Navaratnasingham Janakan said treatment for chronic kidney disease was costly, requiring either a kidney transplant or blood dialysis.

“When it comes to chronic conditions, you have two choices – a transplant or dialysis,” Dr. Janakan said. “Dialysis is required at least once a week, and costs Rs. 10,000 rupees per treatment. Currently, doctors are recommending one treatment course a month because of the cost and because facilities are limited. A kidney transplant, of course, is much more expensive.”

Common causes of kidney disease in Sri Lanka are environmental toxins such as cadmium, fluoride, aluminium and pesticide poisoning. Snake-bite, the ingestion of Ayurvedic medicines, dehydration and alcohol addiction are also causes of kidney problems. The use of aluminium vessels, rather than clay pots, for cooking and storing water could result in kidney problems.

Geographical areas where kidney failure is widespread are the districts of Anuradhapura, Ampara, Trincomalee, Vavuniya, Kurunegala and Polonnaruwa, and parts of the Eastern, Uva and Northern provinces.

Some 15,000 cases of kidney failure have been identified in the North Central Province, according to Dr. D. B. Wijekoon, director of the Anuradhapura Hospital. Patients suffering from diabetes and hypertension were frequent victims.

Kidney failure was the most common cause of death at the Polonnaruwa Hospital, with an average of four deaths a week, according to Dr. M. Bandara, a medical officer attached to the hospital’s haemodialysis unit. “Most of the victims are in the 25-to-50 years age category, the labour force age group,” he said.

The only part of the seven-storey Maligawatte complex currently in use is the ground floor, which has been taken by the Dental Institute.

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