A harangue of proportions

The call comes in from the referral centre.

It is similar to the thousands that have passed through the switchboard over the last three and a quarter years. A terse, monotonous dialogue ensues. Some haggling, a few grunts of approval, then the line goes dead.

The “client” shows up later — anything from a couple of minutes to hours afterwards: often middle-aged, sometimes younger. Penurious. Swollen with gross edema — known in medical parlance as anasarca. In some obvious discomfort. Barely ambulant. Vital signs (pulse, blood pressure, breathing) reveal considerable cardio-respiratory compromise. Initial labs show severe kidney compromise, bordering on frank failure. (S)he needs haemodialysis asap. There’s an initial lull, almost a stupefying pause. And then… absolute bedlam ensues.

Most patients don’t make it past the 2-week mark. Most go meekly. Others fight valiantly for every millisecond with the very essence of their beings. A privileged few make it to see their next birthday — I personally pay for a birthday cake in acknowledgement of that seemingly pyrrhic victory. You have to admire their doggedness. Their tenacity. The lucky breaks they get in the life game of roulette they play everyday.

Oh, but what does it matter? Death is the antagonist that always wins the battle. It’s like the script was written even before the macabre scene played itself out.

Kidney failure has reached levels of frightening proportion worldwide. In Sub-Saharan and indeed other developing parts of the world the actual number of persons who pass away with kidney disease is unknown. In Nigeria, conservative estimates put a number of End-Stage Renal Disease (ESRD) cases at 15000 every year ( as at 2012). Most causes of kidney failure include Diabetes, Hypertension, Infections (Glomerulonephritis, Hepatitis B +/- C, HIV etc.), Genetic causes (e.g Polycystic Kidney Disease), chronic ingestion of prescription medication (antibiotics, painkillers), unsafe/unregulated herbal concoctions, to mention a few.

In a country with a near-comatose health sector, a non-existent emergency response system, an absolute disregard for the sanctity of human life, an ill-equipped, unmotivated & apathetic workforce and the lack of a safety net in the form of health insurance, the ills just seem to keep on piling. Throw in the hydra-headed monsters of brain-drain, the quick-fix-syndrome, the lack of political will and corruption (gasp!)… these condiments are the perfect complement to a hideous, revolting and gagging mixture of lunacy. But i digress; let us leave the charlatans for another day.

In my close to four years working as an independent GP (or PCP) in an outpatient haemodialysis company, i have personally managed almost 1000 cases. I am tired; bedraggled by weariness — physically, mentally, emotionally. All i hold on to is hope. Even that wears thin every single moment that passes. Am i asking for help? Absolutely! For these fantastic humans who have no one else to turn to. Advocacy. Financial support for patients, their caregivers and the people who cater to them. Technical support for training more health professionals to improve early diagnosis, adequate planning and proper management. Education. Improving literacy. The list is endless.

Today is #WorldHypertensionDay. High blood pressure is the most predominant cause of kidney failure in Nigeria, and the 2nd commonest cause globally, accounting for close to 30% of all newly diagnosed cases of kidney failure.

#KnowYourNumbers. Get your blood pressure checked by a competent medical professional. Have a chat with your doctor on what those numbers mean and how to deal with it.

Be well.