The Pediatric Nephrologist

On the schedule this week, we have been working in the pediatrics ward. Specifically, we have been rounding with the clinical team in the pediatric intensive care unit. The PICU holds nine beds and overall feels much calmer than the crowded internal medicine wards we were in last week. Common disease states encountered include acute renal failure, complications of malnutrition, and severe septic infections. The consultant this week was a specialist in pediatric nephrology, which worked out in our favour as almost all the patients in the ICU this week have had kidney problems. After completing a renal rotation at Moses Cone Memorial Hospital, I was intrigued to draw comparisons between care in Zambia versus in the United States. One of the patients was a fourteen-year boy on hemodialysis due to end stage renal disease secondary to steroid-resistant nephrotic syndrome. One of the greatest barriers to his long-term care was the fact that there are only four hemodialysis centers in the whole country of Zambia. (There are at least that many dialysis centers in Greensboro alone, if not more!) Each of the centers is located in a major city in Zambia; however, this child lived in a village far from the city. His family did not have the money to pay for the transportation into Lusaka three days a week. The only true solution to solve his kidney problem is a transplant but there is not any hospital in Zambia that does transplants. The consultant stated that if someone can pay, they will send them to India for a transplant. This was terribly saddening to me because I knew that that also would never be an option for this child.

My next thought was, if hemodialysis is not an option, how about the use of peritoneal dialysis in Zambia. We do not seem to use peritoneal dialysis as frequently in the United States as hemodialysis but I have heard that peritoneal dialysis is quite common in the European countries. Peritoneal dialysis is nice because it allows the patient to have more flexibility as they do not have to come in multiple times a week for treatment, which would be especially optimal in Zambia when hemodialysis centers are not conveniently located in the rural villages. The consultant informed me that the limiting factor to PD is hygienic conditions. Many patients’ living environments, specifically those in the villages, do not meet sanitation standards to accommodate the resources needed for peritoneal dialysis. For example, many do not have access to clean water at their homes. It’s an extremely tough situation and one that I was very saddened to hear about. It makes you extremely humbled for all the resources that we have available to us at home. Don’t forget to be thankful.