Let’s talk chronic disease

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Thereunder, two dichotomous statements, separated by one week, is presented for the purpose of comparative analysis.

Firstly
“Guyanese remain in the dark about the dangers of kidney diseases”- Dr. Areefa Alladin, Chairwoman of Kidney Foundation Guyana.

Then
“…we’ve staff trained in terms of brain dead support services and we are working with the Ministry of Health to develop a strategy to educate the wider population on the benefits of organ donor transplants.”- Dr. Kishore Persaud, Head of Transplant Surgery.

Thus, a summary comparison. The first statement asserts that the basics of kidney disease the masses know not, while the second posits that the basics they’ve mastered, hence education on the complex, in renal transplantation, is the next logical step. But they both can’t be right, necessitating further exploration.

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Chronic Kidney Disease(CKD)
The kidneys are paired bean-shaped organs, the size of a fist, located in the loins just below the rib cage, on either side of the spine. They perform critical functions in waste elimination, regulation of blood acidity, maintain water and salt balance etc.

Nevertheless, like most pathologies, diseases of the kidneys can either be acute or chronic, where the distinction is guided by the period over which the condition developed. Thus, in acute kidney diseases, eg infections, evolution is over a period of days to weeks. In contrast, chronic kidney diseases evolution is over a period of months to years.

Consequently, Chronic kidney disease (CKD) is decreased kidney function for three or more months, of which poorly controlled diabetes and hypertension account for over 75% of the cases. What’s more, not dissimilar to staging in other diseases, the staging in CKD informs severity, which is a measure of the functional capacity of the kidneys, determined by the GFR blood and urine tests. As would be expected, more often than not, CKD would’ve an underlying trigger, that should be addressed in preventing further injury to the kidneys. But if it’s not expeditiously addressed, the CKD will progressively worsen, culminating in End Stage Renal Failure(EGFR).

And for this reason, with a CKD diagnosis, establishing the underpinning trigger(s) is paramount, to facilitate expeditious reversal. To that end, a battery of test, inclusive of blood, urine and scans are undertaken. Occasionally, a kidney biopsy is required, which entails ultrasound visualisation of the kidney, to guide a biopsy needle to take a sample.

Summary: CKD is common with uncontrolled diabetes and hypertension accounting for more than 75% of the cases. Notwithstanding, the aim should be one of prevention or slowing the rate of progression.

Management 
The overwhelming evidence is, patients who are knowledgeable about their health conditions, will play a more active role in their management, are more likely to be compliant with treatment, hence would’ve better outcomes. And inferred from this statement of fact is, if at risk patients are clueless about CKD, a common complication of diabetes, it’s more than likely that CKD education wasn’t provided, reflecting a Healthcare Sector not preventative medicine focused. Nevertheless, like any intervention, 100% guarantee isn’t assured, nonetheless this shouldn’t be received as a failure, rather it should be seen as an opportunity to optimise the treatment of the underlying condition, to decrease CKD progression eg diabetes.

Summary: Patient education leads to better outcomes, critical in the management of chronic diseases.

Whose responsibility?
Healthcare delivery systems are broadly stratified as Primary Care, Secondary Care or Tertiary Care.

In our context, Primary Care is at the level of the Health Centres, where Primary Care Physicians practice preventative medicine. Such that, someone with uncontrolled hypertension, at risk of develop CKD, mitigates against this through the Primary Care Physician facilitating patient education on hypertension and it’s complication, including CKD. Additionally, the Primary Care Physician, working collaboratively with the informed patient, would undertake interventions, inclusive of blood pressure medicines prescription and monitoring, suggesting life style modifications, along with blood and urine testing, all to mitigate against CKD.

In contrast, Secondary Care is at the level of our District Hospitals eg West Demerara Hospital, where patients are admitted for acute care.

Then Tertiary Care, is at the level of GPHC, providing care that’s not available in Secondary Care.

Therefore, from the aforestated, obvious it’s that Primary Care manages the vast majority of CKD cases and as a matter of fact, most chronic diseases. Nonetheless, they receive the least funding and investment, thus these chronic diseases are poorly managed. The consequent is, when Covid-19 presented, this cohort of patients had the worse outcomes.

PPP Hell Care 
In the first place, context must be provided by revisiting the opening statement, “Guyanese remain in the dark about the dangers of kidney diseases”- Dr. Areefa Alladin Chairwoman of Kidney Foundation Guyana.

And it can be inferred from this statement that patient education is not priority in our Primary Care, despite PPP being aware that the informed patient will likely play an active role in their care, are more likely to be compliant with their care hence will have better outcomes.

Now let’s revisit PPP solution; through their agent Dr. Kishore Persaud;

“…we have staff trained in terms of brain dead support services and we are working with the Ministry of Health to develop a strategy to educate the wider population on the benefits of organ donor transplants.”

And from this statement, it can be inferred that patients’ education in preventative medicine is irrelevant. Simply leave the patients in the dark to unwittingly cause themselves harm, then bankrupt the impoverished healthcare sector, to facilitate transplantation experimentation. And thereunder is one reason why transplantations aren’t cheap, as articulated by Dr. Kishore Persaud;

“…we send samples for testing till in Miami just to see if the donor matches with the patient which can cost at least a G$1 million.”

 So my concerns;
1. Dr. Kishore Persaud isn’t a transplant surgeon. The fact is, we have no transplant surgeons, insofar as transplantation requires much more than a masquerader.

2. Guyana isn’t ready for the complex medicine since we are still getting the basics wrong, evident in the recent case of a 3yr who died from abdominal pain.

3. Preventative medicine do save lives and dollars, yet PPP has placed zero investment in Primary Care, even as they invest billions in Specialty Hospitals we don’t need and could hardly afford.

But here’s PPP rationale, building specialty hospitals will provide contracts for their cronies, even as the newly built hospitals will be a white elephant for electioneering. Then this, both unsafe kidney transplantations and cardiac interventions will benefit their political doctors, but not you the patient. But unsurprised we’re, knowing that PPP will take care of Su but not you.



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