Health Officials on Nevis lay down reasons behind delay of dialysis services

NIA CHARLESTOWN NEVIS (June 21, 2013) — Officials of the Ministry of Health on Nevis, have confirmed that dialysis services on Nevis would not be available soon, since a task force put together by the Minister of Health concluded that a number of critical auxiliary measures had to be in place before the service could be made available on the island.

Permanent Secretary in the Ministry of Health Mrs. Nicole Slack-Liburd with support from Acting Medical Chief of Staff at the Alexandra Hospital Dr. John Essien and Chief Medical Officer of St. Kitts and Nevis Dr. Patrick Martin made the disclosure at a press briefing which addressed the status of renal health and focused on dialysis. It was held at the St. Pauls Anglican Church Hall on June 19, 2013.

“As residents are aware, a dialysis was purchased and delivered to Nevis in April, 2013. We are in the middle of June and the unit has not commenced operations. Naturally, residents have continued to express their concerns…

“Let me say at the outset, that dialysis will not start in Nevis in 2013. Certain ingredients and conditions are not in place…Whether we can in 2014 or beyond requires careful analysis, particularly in the area of cost…In the mean time, residents in Nevis are informed that dialysis has been available in St. Kitts since 2004 and a new development is nigh,” she said.

Dr. Essien, spoke to the integration plan and support structures necessary for the forward movement of a dialysis service on Nevis and applauded the recent acquisition of a hemodialyzing machine. He described the move as a significant step toward improved quality of life for persons who suffered from failure of their normal kidney functions but explained why more consideration was necessary before they were commissioned.

“Before these machines could be put to use, obviously, we have to undergo careful thought and analysis to things even as simple and mundane as the comfort of the patient, in terms of where the procedure is being taken place to more significant logistical issues such as what to do if the machine breaks down because this is a process that you cannot tell the patient; ‘Well we cannot do it today because the machine is not working.’

“We have to put certain things in place as to where, when, how do we transfer these patients to other places. Of course, there are other serious issues such as what to do when you have contamination. Remember, we are dealing with blood transfer, essentially and contamination could come from any source throughout that whole process,” he said.

The Medical Chief of Staff noted that hemodialysis was a procedure that could only be conducted in a hospital setting due to the specialised personnel necessary for the administration of treatments.

“Hemodialysis can only be done in a hospital setting. A person undergoing dialysis, usually, would require two or three, on the average, about three sessions per week, that’s every week of the year. It’s a process that cannot be interrupted essentially for the rest of that person’s life, unless the person undergoes a successful renal transplant,” he said.

According to Dr. Essien, there were several necessary hook ups with equipment and patients that had to be in place before the hemodialysis machines could be commissioned.

“We would definitely have to consider that we are dealing with equipment which would need to be maintained. We are dealing with equipment that we cannot suspend the use of. Of course, using modern technology, we would have to ensure these technologies are kept up-to-date by the appropriate personnel… We are dealing with body fluids and body fluids tend to carry the high risk of possible contamination, either to the patient or to those working on the patient.

“As such we would have to consider that we would need a complex and expensive infrastructure that would, essentially, house these units, uninterrupted supply of electricity, adequate stocks of huge amounts of IV fluids and catheters and tubes, intravenous access, medicines that go along with these, not only to treat the patient in that state directly but also emergency supplies of equipment and medication because these patients have a tendency of, essentially crashing, so you would have to provide all these things before the unit is operational,” he explained.

The Medical Chief of Staff further noted that there were other critical needs that would have to be in place for the machine’s functionality.

“We also have to look at the special treatment of water because these units use copious amounts of water. For one session, you might use approximately 30 something gallons of water and this water cannot just be any type of water. It’s specially treated water. You need a water treatment plant just for that.

“You need extremely strict infection control throughout the whole process, before, during and afterwards. We need the proper sewage system to deal with the waste product, the waste water and waste blood elements. We need a fully-functional laboratory. Without the lab to do a lot of the monitoring, in terms of monitoring the electrolytes, in terms of monitoring the bacterial content, for example, it simply would be folly to really go into this without having all those things backed up,” he stated.

Dr. Essien also reminded that with kidney failure came with the failure of other organs and systems and the provision of resuscitative emergency care was critical. It was for that reason he stated that the ICU had to be fully staffed and equipped.

“These patients might also need re-access of the vascular ports. You need operation theatre facilities that would cater for that as well, as well as any other complications that may arise that would need surgical intervention. All these things, all these different units have to be physically integrated, to allow for the easy access from one point to the other,” he said.

Notwithstanding, Dr. Essien noted that the Unit which was acquired was in a containerised enclosure, for use in emergency settings but consideration was being given for its use for chronic patients. However, other infrastructural additions and accessories to the containerised enclosure in which it was shipped would be needed.

“The one that we have, the enclosure that it came with, does not address several issues which, from a medical point of view, to me the access for emergency care and spaces for disposal of used materials etc. Ideally, we would require specially-trained staff and ideally, you would need to have a nephrologist, whether on sight or accessible, vascular surgeon or surgeons with skills in inserting these things and especially dialysis-trained nurses with some degree of experience.

“The bottom line is, even though you set up a centre for dialysis, there are certain guidelines. This centre has to be certified that it can work because we have to realise, we are not going to be working in isolation. We should be and hopefully will be working in conjunction with other centres in the region to facilitate the continuous care of the patients involved,” he concluded.

The Minister of Health in the Nevis Island Administration (NIA) Hon. Mark Brantley, had began discussions with various stake holders including the Nevis Renal Society upon entry into office, after which a Task Force was established to conduct a feasibility study on the establishment of dialysis service on Nevis.

The core members of the Task Force, headed by Permanent Secretary in the Ministry of Health Mrs. Nicole Slack-Liburd, are Chief Medical Officer Dr. Patrick Martin, Medical Chief of Staff at the Alexandra Hospital Dr. John Essien, Medical Officer of Health Dr. Judy Nisbett and Matron Aldris Dias.