McMaster University

McMaster University

Hamilton doctors saving lives in Guyana

Hamilton Spectator
Joanna Frketich
April 13, 2012

Hamilton doctors are using their own time and money to provide dialysis and train pediatricians in Guyana.

They are also planning to start doing kidney transplants in the South American country.

“There are a lot of lives directly or indirectly at stake,” said Dr. Alistair Ingram, director of the nephrology division at McMaster University and one of the doctors involved. “It’s going to save a fair number of lives.”

Guyana has two certified pediatricians for a population of more than 750,000.

It only pays for 13 treatments for those in kidney failure, which is about one month of dialysis. Anything above that costs about $600 a week, which is out of reach for more than 95 per cent of the population.

“After that, you’re on your own, so what happens essentially is people have 13 treatments, they go home and they die,” said Ingram. “It’s really quite tragic.”

The plight of patients in Guyana was brought to the attention of Hamilton’s doctors by vascular surgeon Dr. Budhendra Doobay. He was born in Guyana and worked at Hamilton General for 30 years after coming to Canada in 1975.

“If we don’t do this, all the people we are helping will die,” he said. “They are very young people with young children. If we can give them a lease of life of 10 to 15 years more ... they can see their children grow.”

At first, the Hamilton doctors were skeptical.

“Obviously we were sympathetic but there are a large number of issues to setting up a hemodialysis unit in any place, particularly in a poor country,” said Ingram. “First and foremost among them is access to large amounts of ultrapure water for dialysis. In Guyana, people drink water out of bottles. There is no ultrapure water. We said we really don’t see how this can happen.”

Six months later, Doobay came back saying the unit was ready. He’d donated his family home in Guyana and got 10 dialysis machines from Humber River Regional Hospital and Sunnybrook Hospital. His cousin, who runs the water supply in Guyana, got the required water and he had extra funding raised by Vishnu Temple in Richmond Hill.

“They wanted to get going and at this point we realized he was serious and he could overcome obstacles,” said Ingram. “We said, ‘If you’ve gone this far, we’re definitely prepared to be involved.’”

The unit opened in September and 15 patients are now getting dialysis with hopes to slowly scale it up to 60 patients. Hamilton kidney doctors use their own time and money to fly down every two months to see patients. In between visits, local doctors keep in contact for questions or advice. The patients pay what they can and if they can’t pay, they’re treated for free.

The next step is to start a live donor kidney transplant program to get patients healthy again. The government has agreed pay for the lifelong medications. In return, Hamilton doctors will perform the transplants and care for the patients while they recover.

They’re hoping to do their first transplant within the next six months.

The effort to train pediatricians is equally ambitious. It requires a doctor from Hamilton to be on the ground in Guyana for two weeks every month. Physicians teach remotely from Hamilton the other two weeks. They all use their own money and vacation time to do it. Currently there are three doctors from McMaster Children’s Hospital splitting the work.

“It’s an eye-opener,” said Dr. Katrin Scheinemann, one of the organizers. “We as a high income country have a responsibility to lower-income countries.”

Five physicians in Guyana started the specialty training in October and there are plans to add three doctors a year.

“Our main focus is on building their capacity,” said Dr. Brian Cameron, director of McMaster’s International Surgery Desk.

It’s a massive undertaking that will likely take 10 years before Guyana can sustain the residency program on its own.

Funding is needed for the residency program, which provides three years of specialty training to doctors in Guyana. Scheineman said they’re looking into grants or doing clinical trials at the same time.

There’s a lot of potential for study in the main pediatric ward, which is two rooms with about 20 beds each.

“It’s not like here,” she said. “It’s a good eye-opener on how you can do good medicine without the equipment.”


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