Guyana needs training in Nephrology – Dr Nicholson

Mar 15, 2011 News

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– As part of efforts to tackle renal failure

The introduction of a nephrology programme is being touted as a crucial factor that could help address the kidney disease challenge which Guyana faces today. This is according to renowned Nephrologist, George Nicholson, of the Caribbean Dialysis Inc. in Barbados.
He recently pointed to the need for a post graduate training programme for bright young men and women in the practice of nephrology and renal transplantation surgery. Nephrology is a branch of internal medicine which deals with the study of the function and diseases of the kidney.
And putting such a programme in place is not likely to be a great task since according to him there is usually forthcoming support for such endeavours.

“This is not as difficult to arrange as it may seem. International Nephrology Societies are keen to assist in the implementation of such training programmes all the time,” Dr Nicholson asserted even as he emphasised the importance of dialysis and renal transplantation in addressing kidney diseases.
But in order to become versed in nephrology or suitably qualified in this area an individual requires many years of school and training which will ultimately see them becoming a nephrologist.
A nephrologist is a physician who has been trained in the diagnosis and management of kidney disease, by regulating blood pressure, regulating electrolytes, balancing fluids in the body, and administering dialysis.
Nephrologists are able to treat many different kidney disorders including acid-base disorders, electrolyte disorders, nephrolithiasis (kidney stones), hypertension (high blood pressure), acute kidney disease and end-stage renal disease.
In the United States, after medical school nephrologists complete a three year residency in internal medicine followed by a two year (or longer) fellowship in nephrology.
Procedures a nephrologist may learn in a training program include native and transplant kidney biopsies, ultrasound guidance, placement of temporary dialysis catheters, placement of tunneled hemodialysis catheters and placement of peritoneal dialysis catheters.
According to Dr Nicholson who has practised in this field for many years, the service of Nephrologists is of utmost importance even after renal transplantation. He recounted that two Guyanese patients were in receipt of kidney transplants between 1980 and 1990 but one of the patients had his kidney rejected because he reportedly could not afford drugs.
“At least, he didn’t indicate that he was out of drugs…and one is seeing this phenomenon in the patients who have been more recently transplanted. They get a kidney transplant, they feel well and they don’t think that they need any further supervision by a Nephrologist.”
“They disappear from my care. In fact some disappear and go to Bangalore or Bangladesh to get their transplants and they don’t come back to see me until they are rejected for the second time. This is an unfortunate circumstance and it is built around the failure of communication between physicians and patients,” Dr Nicholson noted.
This state of affairs, he said, brings to the fore the question of where Caribbean Nationals should venture to have their kidney transplants done. “Should they get on a plane and go to Bangalore and buy a kidney from a poor man or woman who is selling a kidney because their child needs an operation?
That is not something that allows me to sleep easily at nights…” He related that although Trinidad reported last year that it had performed 53 transplants in the preceding two years that still is not enough experience for them to profess to have a “real good” transplant unit. However, according to Dr Nicholson, “it is a fine start.”
In addition, he warned, against utilising the services of itinerant surgeons who may opt to come to Guyana to under transplant operations adding that “this is an activity which is frowned upon severely by the American Association of Transplant Surgeons.”
He pointed out that his hope for the advancement of renal replacement theory in the Caribbean will have to include the building of a collaborative activity between CARICOM States for the provision of expanded transplantation services within the Caribbean as oppose to the duplication of those services in each and every state.
He underscored that since renal transplantation has been performed in Jamaica for more than 40 years there is therefore a great body of expertise in the technical aspect of transplantation there.
He also highlighted that since the first living related donor kidney transplant in the Caribbean was performed in Barbados in 1980 it gives some level of credence to the operation there as well.

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