The hospital has again partnered with Transplant Links Community (TLC) of the United Kingdom, The Chase Fund, The National Health Fund (NHF) and Sandals International to give several dialysis patients the chance of living a more active and rewarding life, each with a healthy kidney. The UK team arrived on Sunday and the operations are scheduled get underway on Tuesday, October 7, 2014.
The initiative by CRH has been hailed by Minister of Health, Dr. Fenton Ferguson as “a bold step in government’s efforts to improve the quality of healthcare for all and to make services such as kidney transplantation more accessible to those in need.”
Dr. Ferguson also noted that the partnership with the UK experts in the field “will redound to the benefit of our health staff as it affords them the opportunity of getting additional hands on experience in a highly skilled area of surgery.”
The Health Minister has commended the Board of Management and all categories of staff at Cornwall Regional Hospital for their initiative, adding, “We have an excellent team of health workers and as Minister I will continue to support any initiative that will enable us to attain our 2030 goal of Jamaica being “a country with health care system that s affordable, provides services in locations that everyone can reach, has facilities that are well-equipped, and is fully staffed with highly trained personnel.”
Dialysis becomes necessary for persons with kidney failures, a problem that could result in death if treatment is not available. TLC helps save lives by setting up kidney transplant programmes in countries that have the infrastructure but not the expertise to run a kidney transplant programme.
Consultant Renal Transplant Surgeon and Medical Director of Transplant Links, Dr. Andrew Ready said “This next set of transplants is vital for keeping the momentum of the project going, and for us to teach the skills so that many more Jamaicans can benefit in the future.”
The introduction of kidney transplantation at CRH was first done in 2013 came against the background that “demand for renal dialysis is increasing as more patients are presenting with kidney disorders,” says Chief Executive Officer Anthony Smikle.
He adds, “Due to limited facility, most patients are placed on a long waiting list. Those who access haemodialysis need treatment three times per week; however because of the current limitations they only receive treatment twice per week.”
The Haemodialysis Unit at CRH has 14 beds but work is underway to equip a larger area which will allow for an additional four beds. It is expected that the expanded unit will be ready by the end of this month.
Also, on record the hospital has 123 patients receiving dialysis two or three times weekly and an additional 40 on a Continuous Ambulatory Peritoneal Dialysis (CAPD) programme which facilitates treatment at home four times per day.
However, the demand increases in perpetuity as each year the number of persons requiring dialysis increases. It is expected that some 60 patients per year require Kidney Replacement Treatment.
“Kidney disease is expensive to manage and the cost increases as the disease progresses,” says Smikle. There is also concern that given the limited resources locally, most of the patients have financial difficulties in acquiring this service overseas and therefore they stay on dialysis for the rest of their lives.
The CAPD programme is also very costly and has high readmissions due to inadequate supplies and high infection rates.
An analysis of inputs and outcomes has determined that expansion of the Kidney Replacement Programme at CRH would be cost effective and beneficial to the patients with a significant improvement in life expectancy, the hospital and the government which has the task of funding public healthcare under a regime of no user fees.
Batting for more kidney transplantation, Head of Internal Medicine at CRH, Consultant Nephrologist Dr. Curtis Yeates notes that “Dialysis patients are not as healthy as transplant patients. Once a patient receives transplant he can return to his normal life, that is, working and other recreational activities. The unemployment rate for this category has proven to be less when compared to the dialysis patients.”
Dr. Yeates points out that the life expectancy of a transplant patient is greater than dialysis patients. He adds, “Transplantation is more cost effective in the long-term. Studies have shown that it costs less by the second year of transplantation in comparison to dialysis including less admission to hospital and lower unemployment.”
Currently, the cost for treating the 123 dialysis patients who visit CRH each week is over $125 million for a year while the 40 CAPD patients come in at over $36 million annually.
It has been projected that over a three-year period, transplant cost would decline from about 44 to 29 percent that of dialysis.
Kidney transplantation also has economic value to recipients’ lives and the workplace. Of the 123 patients being dialyzed at CRH, 43 are still employed. Priority for transplants would go to those under 40 years old and recipients could be integrated back into national life with greater than 10 years contribution to economic activity. They would also be off the haemodialysis list, allowing for a better quality of life for more persons coming onto the waiting list.
Dr. Yeates points to some of the pluses for going the route of transplants; these include extension of a patient’s life expectancy and no more need for dialysis. On a wider scale, it is envisaged that the continued success of kidney transplants at Cornwall Regional will lift its status as a teaching hospital while enhancing the vision of it being a medical tourism hub in the Caribbean.
“This is an important milestone in this project. There are many people suffering from kidney failure in Jamaica, mainly because there is so much diabetes and high blood pressure. A transplant is their only hope of a normal life again. We will be working with the TLC team from the UK over the next week to carry out more transplants and transfer the skills to Jamaican medical staff,” said Dr. Yeates.
Reflecting on the three lives that were transformed last year as a result of this project, Dr Yeates recalled that “A sister gave a kidney to her sister; a wife gave a kidney to her husband, and a sister gave her kidney to her brother. They have all done really well. Carrying on this work is essential so that many more with kidney failure can benefit.”
Already, following on last year’s operations, transplanting has brought new skills to the healthcare team and this augurs well for the hospital’s general health care delivery and profile.
A year ago the UK doctors brought their specialist nurses with them for the transplants but this year they have indicated that they were very impressed with the level of professionalism and competence of in-house nurses, they would be using them instead. They also work alongside local doctors who gain greater insights into the practice that they will be able to do on their own overtime.
Another plus factor is that CRH dialysis patients opting for kidney transplants will not bear the added burden of going to Kingston where this surgical operation is being done for the past 20 years.
The TLC team will be led by Chief Executive Officer, Dr Jennie Jewitt-Harris, and includes kidney transplant surgeons, kidney specialists, nurses and operating theatre technicians who are giving up their spare time to travel to Jamaica TLC.”