Blazing a life-saving trail, Dr. Azim Gangji is a ‘Special Person’

Aug 04, 2019 News, Special Person

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“You cannot say you are successful if you lose your patient within 10 years… we haven’t been successful in that case. If a person dies within two years, we have failed. If the kidney is maintained beyond 10 years then it is a win, and if it is maintained for 15 years, then we can say, we have hit the standard.”

By Sharmain Grainger

What started out as a routine visit by a medical practitioner to volunteer his expertise to this developing country some nine years ago, has since morphed into a life-saving quest with no end in sight. At the centre of this endeavour is Dr. Azim Gangji, a Transplant Physician, Academic Clinician, and Professor of Medicine at McMaster University in Hamilton, Canada.

Through an invitation from Guyana-born Vascular Surgeon, Dr. Budhendra Doobay, who himself offered his services for many years at McMaster too, Dr. Gangji made the journey to these shores to help set up a dialysis unit at the Georgetown Public Hospital Corporation [GPHC] back in 2010. It was while sharing his expertise there that he came across a man who Dr. Gangji recalled was in a “profound state of kidney failure”.
The young man, in his early 20s, was already a family man, with two young children, but after observing his advanced state of kidney failure, it was clear to the physician that the future was not promising. There was no way that this young man was even going to see his children grow into their teenage years. In fact, within days he could’ve been added to the country’s renal failure mortality statistics.
“I could not offer him anything because of his advanced renal failure, all I could have told him was to get your life sorted out, because you may not be around much longer…that was the worse feeling ever,” Dr. Gangji recounted during an interview.
MORAL RESPONSIBILITY
The interaction with that young man has remained etched in Dr. Gangji’s mind, so much so that he wanted to give even more support to Guyana. This, of course, has duly earned him the privilege of being named our ‘Special Person’ this week.

With the blessings of his wife Shellina, and children Shyanna and Aidan who he oftentimes leave behind in Canada to come to Guyana, Dr. Gangji was able to become one of the key players who helped to set up the Annandale, East Coast Demerara-based Doobay Dialysis Centre, as an addition to the service offered at the GPHC.
The East Coast facility has since developed into the Doobay Medical and Research Centre [DMRC] which offers so much more than dialysis, and Dr. Gangji’s sees his unwavering support as his moral responsibility as a learnt physician, to help ensure that, as far as possible, people do not die prematurely.

Reflecting on the days before the Annandale Dialysis Centre really took off, Dr. Gangji recalled that patients were dying from acute kidney failure, a situation that should have never obtained. In fact, he revealed that depending on the type of disease a person is inflicted with that causes them to develop renal failure, treatment could ensure that the symptoms are essentially reversed.
“They just need about eight to 10 weeks of support and they can recover, and it is only after they don’t recover during this period that the condition becomes chronic and they have to start dialysis,” Dr. Gangji explained.
Although the lives of many patients have been prolonged through dialysis, which is offered at a very subsidized cost at DMRC, the brilliant physician had long recognised that this simply wasn’t enough. He spoke of this even as he considered how the life of one of the Centre’s patients was snuffed out recently after being on dialysis for the past nine years.
STRATEGIC COLLABORATION
It was his acquaintance with such eventualities that caused him to support the DMRC’s move to forge a strategic collaboration to ramp up the treatment support for renal failure patients.

Based on American/Canadian/European statistics which Dr. Gangji is privy to, about 40 percent of patients on dialysis survive a mere three to four years after they start this renal replacement therapy, and many do not even enjoy a good quality of life, since they are prone to infections and a gamut of complications that can lead to their premature demise.
There is no cure for renal failure, which in simple terms occurs when the kidneys become damaged and fail to perform their designated functions to filter the blood, remove waste, control the body’s fluid balance, and keep the right level of electrolytes. Once a patient develops chronic renal failure, one of their first options for survival is dialysis, which, Dr. Gangji asserted, is only a short-term renal replacement therapy.
The form of dialysis that is common in this part of the world is haemodialysis, where the blood is pumped out of the patient’s body into a machine, which is essentially an artificial kidney, through which it is filtered and returned to the body. Another form of dialysis, which Dr. Gangji said the DMRC is hoping to soon introduce, is peritoneal dialysis, which allows a patient’s abdomen to act as a natural filter. But, according to the physician, given the fact that dialysis cannot fully replace the functions of the kidneys, the best possible option for a renal failure patient is a transplant.
It is for this reason, DMRC has reached out to the Ministry of Public Health and the GPHC to introduce what Dr. Gangji has described as a safe method of kidney transplant.
Human beings are born with two kidneys and medical experts have found that persons can survive normally with a single working kidney. Moreover, a kidney transplant is a surgical procedure whereby a kidney is removed from a suitably matched donor and placed into a renal failure patient.
Kidney transplants are nothing new to Guyana, as a number of these have been done over the years. However, the safe method referenced by the physician is a kidney transplant done laparoscopically. This procedure is touted as one that caters to swifter recovery of both recipient and donor, and entails the surgeon making three or four small incisions in the lower abdomen to remove and insert the kidney. “In Canada, we do things laparoscopically, and this allows the donors and recipients to recover much faster…so that’s the goal, but if we are not allowed to do that here, we will use other ways of doing the transplant,” said Dr. Gangji.
SYSTEMS IN PLACE
Discussions with Brigadier George Lewis, Chief Executive Officer of the GPHC, have reportedly been favourable, as were interactions with Public Health Minister, Ms. Volda Lawrence, who Dr. Gangji said has been supportive in promising access to medication for patients. This is particularly important, since this service is expected to be offered at no cost to patients.
To facilitate the transplants, Dr. Gangji said that “we will bring our own team down” whose efforts will be complemented by a number of doctors from the GPHC who were long in training at McMaster University to aid the process. These trained and certified doctors, Dr. Gangji said, will support the follow-up care of patients, which, he explained, is especially crucial. “We have a very strong clinic structure developed at DMRC, so we have the technology and strong follow-up that mimics the way we do things back in Canada,” he added.
While the transplants are not slated to occur for another few months, plans for its initiation have been set in motion, since the cross-matching process for nine patients have commenced, in what Dr. Gangji described as a sophisticated lab, that has been added at the DMRC.
Cross matching is a process of testing the blood and tissues of the donors and recipients to ensure their compatibility for transplantation. The samples, he disclosed, will be sent to Canada where they will be scrutinised by a Committee, which after careful analysis, will determine which pairs are compatible enough for surgery.
Turning his attention to the importance of having in place a local lab, Dr. Gangji said, “it allows us to do a number of specialised lab tests, and you need that specialised lab testing to be able to actually do transplants, because we need to know the drugs levels [of patients]…because if you have under-dosing, it can lead to rejection, if you overdose, it can lead to drug toxicity and those drugs levels have to be measured quite often,” said Dr. Gangji.
MEASURING SUCCESS
He noted too that while some people are convinced that the surgery is the most difficult part of transplantation, this might not be the case, since it is the immunosuppressant that is the most difficult part for patients over time. Immunosuppressants are anti-rejection drugs that forced the immune system to not view the new organ as an intruder.
But even with the recovery of patients, complete with suppressed immune system, this does not mean that a transplantation team can boast of success.
“You cannot say you are successful if you lose your patient within 10 years… we haven’t been successful in that case. If a person dies within two years, we have failed. If the kidney is maintained beyond 10 years then it is a win, and if it is maintained for 15 years, then we can say we have hit the standard,” Dr. Gangji further underscored.
He added, “It is a tricky process, because there is need for expensive drugs and we have to make sure the patients are taking theirs. So patients have to be educated to know that they take their medication at the right time, and we have to follow drugs levels to make sure that we don’t cause any harm,” the physician further explained.
Even as he stressed the importance of closely monitoring post-transplant patients, Dr. Gangji noted that they are still very much at risk of increased infections. He, moreover, added, “we have to constantly monitor…this means we have to have a system that can actually handle that…so simply doing a transplant and walking away isn’t the answer; you are going to need a close collaborative system with a lot of professionals who have experience in this area and a working lab…it is a big team effort to provide patients optimal care, and we can offer that.”
Even as reactive measures are being advanced to combat renal failure, Dr. Gangji shared his conviction that prevention through awareness must continually be emphasised. He has been enforcing that here by educating both patients and medical practitioners, even as he supports the DMRC’s vision to expand its live-saving drive.

 

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