The Bustamante Hospital for Children’s (BHC) paediatric renal unit has been in operation for more than five years without the use of peritoneal dialysis (PD) machines.
As such, the medical staff has had to do without the use of the critical equipment and routinely deliver life-saving support manually to patients with renal disease who are 12 years of age and younger.
But on Monday, the renal unit received a donation of two PD machines valued at J$910,000, which will minimise the many risks involved in the previous operations of needing to manually administer the dialysate.
The donation was organised by the Jamaica Kidney Kids Foundation (JKKF) and financed by the CHASE Fund.
Dr Sandrica Young Peart, consultant paediatrician and paediatric nephrologist at the BHC, explained in a Gleaner interview that the manual process used in the past, which involved nurses interacting with the bags of fluids given to and taken from patients, increased the risk of touch contamination and the possibility that the patient would contract an infection.
The machine, on the other hand, would carry out all the steps automatically, she said, with nurses only needing to key in the appropriate settings for the machine to undergo the dialysate.
This would lessen the strain on the medical personnel, and be more time effective.
“We’re extremely grateful because we’ve never had a peritoneal dialysis cycle previously. We’ve been advocating for this for over the last five years, and it is a joyous moment to finally have cyclers available because we not only do chronic dialysis, but we do acute dialysis. So, if a patient comes in and they develop kidney failure then they need dialysis … a patient who has dengue can develop renal failure [and a patient] who has COVID-19 [can] develop renal failure, so these are patients who need dialysis, and we sometimes have to do it manually,” she explained.
NOT ENOUGH
In the next five years, Dr Young Peart expressed the hope that the BHC will become the second facility to have a formal paediatric dialysis unit available where chronic dialysis is provided.
Currently, The University Hospital of the West Indies (UHWI) is the only hospital at which children under age 12 years with end stage kidney disease (ESRD) can receive chronic dialysis.
“That would be the hope because right now we’re only doing acute dialysis, meaning that if a patient comes in and needs dire dialysis, we offer it. But sometimes because of other issues, it may not work effectively, and we have to transfer them to university (UHWI) for haemodialysis, and then there is the added cost issue that come with it as well, and so the parents would really benefit a lot from us having the machines here,” she said.
At the BHC, at least 10 children per year receive PD. Each year, about two to four children with end stage renal disease under age 12 years receive long-term intermittent peritoneal dialysis (IPD) as chronic renal replacement therapy instead of the safer automated peritoneal dialysis via a cycler, and 10 children receive acute IPD for reversible acute kidney injury. Thus, it is anticipated that approximately 14 children will benefit annually.
The hospital’s vast number of patients who require dialysis, according to Dr Young Peart, meant that even while the staff was grateful for Monday’s donation, the two machines were just not enough.
Because of this, nurses would still need to use manual processes where necessary in addition to these equipment.
“We would be happy with another three machines [as] this could at least be used to manage the numbers that we have,” she said.
CRITICAL PARTNER
Latoya Aquart-Foster, project manager of the CHASE Fund, told The Gleaner that the CHASE Fund has had a long-standing relationship with the BHC, having done many interventions over the years of which the three most recent ones included donations of laparoscopic machine, a computed radiography (CR) machine, and a microbiological incubator.
The CHASE Fund was established 20 years ago, and operates through the Office of the Prime Minister providing support to Jamaicans through its areas of mandate, including culture, health, arts, sports and early childhood education.
“Whilst CHASE extends itself to assisting all corners of society under our mandate areas, we particularly do all we can to assist children, which of course is one of our most vulnerable groups in society, and so when this request came to us we did all we could to secure an approval as quickly as we could,” she told The Gleaner.
Dr Maolynne Miller, founder of the JKKF, told The Gleaner that the CHASE Fund has been a critical partner in supporting causes related to renal care over the years.
The Fund has also been integral in the JKKF’s ongoing provision of dialysis consumables.
“It is one thing to get a machine [but] if you can’t afford the fluids, and the tubing and all the cassettes that go with it, you’ll just have a dead machine. So, every year they give us a grant of varying sums between eight and $10 million to keep this thing going,” she explained.
The JKKF, a non-profit organisation, has been in existence from 2012. Its objective is to improve care for kids with kidney disease across Jamaica, especially those who are struggling financially.
The JKKF includes an outreach and advocacy division, a family support network, and is actively involved in the training of medical professionals, Miller said.