Patchwork solutions won’t fix CKDu crisis
Pix and Text by Darshana Ashoka Kumara
It is a matter of fact that the two bean-shaped organs in our body called kidneys are part and parcel of our life as they clean and filter blood to remove wastes and nitrogen; the process keeps the human body healthy. Your life will surely be in a dicey situation in case of kidney failure. From 1990s, a chronic renal failure called Chronic Kidney Disease of Unknown aetiology (CKDu) has widely been reported in Sri Lanka and it is on the rise in an alarming rate. According to experts, although chronic renal failures are generally reported due to hypertension, diabetes, or other known aetiologies, the CKDu is slowly progressive, irreversible, and asymptomatic until the late stages.
Around 5,000 deaths are being reported in the country due to the CKDu annually; there are more than 400,000 affected people, the number could be bigger as it is extremely difficult to calculate the rate of spread. The disease is widely witnessed in the North-Central Province; but it has been recorded in other areas such as Ampara, Badulla, Kurunegala, Matale, Mullaitive, Trincomalee, Kandy and Vavuniya Districts.
We undertook a tour in Padaviya, which is a place in the north-eastern part of the North-Central Province, to investigate the plight of the people who have been struggling with the menace for many years, rather who are fighting for their life. Special bus services operate in Padaviya and many other places in the North-Central Province to transport hundreds of kidney patients who receive treatment at hospitals.
B.G. Karunawathie (42) is a resident of Koonketiya, a village 15 kilometres away from Padaviya. She is living with CKDu since 2004.
"In 2004, the doctors diagnosed that I have the kidney disease. It was identified by sending a tiny part of my kidney to the laboratories. Everyone in my family is suffering from this dangerous disease. My father and mother died because of this disease. We had eight children in our family. Five out of them died of the disease. Other three are also receiving treatments," Karunawathie told Ceylon Today.
She and her family are in dire poverty where her husband, the breadwinner of the family, does not have a permanent employment. He is doing masonry and other daily wage work on casual basis. They need a considerable amount of money to run the family and take care of their kids.
"I have three kids. My husband does not have a permanent employment. He takes care of all of us. But this situation has made our lives unbearable," she added.
Kapuruhami (78) is a villager at Senasiligama, Padaviya. He said the disease is a mysterious thing. Kapuruhami noted that they heard about the disease only very recently.
The Green Revolution which came into effect in the 1960s increased production with high-yielding varieties of cereal grains. Chemical fertilizers and pesticides played a crucial role in the Green Revolution, particularly when it comes to increasing the production. Farmers like Kapuruhami turned to agrochemicals a few decades ago to yield more crops as they were given instructions to do so by the officials. But, he suspects, it is the agrochemicals that caused the disease.
"I have a severe pain in my body. They vaccinate me four times a week. In addition, I need to go for dialysis every month. No other member in my family suffered from this kidney disease. We need to pay one rupee per litre of filtered water. So, we need to pay a lot to purchase water. We also pay money to trishaws every week. Some days we have to buy medicine ourselves. More than Rs 700 is needed to buy medicine. It is unbearable. Everything is money," Kapuruhami lamented.
Various hypotheses are being debated among the academia and the practitioners about the origin of the disease. But, the reported cases of the CKDu have doubled every year. As per the expert views, if the issue is not tackled sooner, around 40% of the population will be victimized in the future.
P.L. Ranasinghe (71), a villager of Senasiligama, has been a victim of this disease since 2005. He said that a large number of people are living with kidney disease, in his area.
"My registration number is 1072. But, this registration number was given in 2005. The situation is terrible, the disease is spreading," Ranasinghe pointed out.
According to the National Kidney Foundation of the US, 10% of the global population is living with chronic kidney disease; even people in their tender ages are vulnerable to it.
R.A. Sampath of Buddangala who had come to receive dialysis treatment at Padaviya Base Hospital was in his early twenties.
"I was working as a helper of a lorry. My work is basically loading the paddy sacks into the lorry. While I was engaged in the work, I experienced cough and later I found blood with my saliva. Now, I am in a very difficult situation. We don't have purified water. Though there are a few filters fixed by the authorities, it has not been a successful remedy. A large number of people still rely on well water that is not treated."
There was a rash like complication on the face of Sampath's face because of his disease.
Diabetes and high blood pressure
Diabetes and high blood pressure are also linked with chronic kidney disease. U. Indrani (47) said she is suffering from five non-communicable diseases, which includes diabetes.
"I had a severe pain in my stomach five years ago. Then I consulted a doctor. Then they diagnosed that I have the kidney disease. Now I am very weak. They say I have a total of five diseases including cholesterol abnormalities and diabetes."
Though government has carried out a programme to provide a monthly allowance of Rs 5,000 to the kidney patients, some have not been paid that amount. W. Malini ( 55) of Padaviya said she was only able to obtain the monthly allowance two times. Now, she doesn't get any money from the government.
"I am receiving treatments at the Anuradhapura Hospital. I need to travel all the way from Padaviya to Anuradhapura. I asked them to make arrangements to visit the clinic in Padaviya. But they wanted me to visit there. We have two buses to transport kidney patients to Anuradhapura. But, these buses depart very early like 3:30 a.m. and that time is not practical to the patients. So, patients tend to find their own means of transportation," Malini added.
Ajith Lakmal (27) of Sri Pura, Padaviya who was diagnosed with CKDu in 2012 said that in his village there are kidney patients in every single house.
Divisional Medical Officer and the Head of the Padaviya Base Hospital, Dr. Pubudu Ranaweera said patients from various areas including Welioya, Siripura, Horawpathana, Padaviya come to his hospital to receive treatment.
With the advancements in medical science, it's possible to slow or stop the progression of kidney disease with early diagnosis. Hence, medical intervention can avert the development of CKDu towards end-stage renal disease.
"Early detection of the disease helps increase the lifetime of the patients. But, most of the patients come to know about the disease at 4th or 5th stage of it as symptoms appear in that period." Dr. Ranaweera said.
Screening of inhabitants in high risk areas where CKDu is spreading happens under the direction of the Ministry of Health. The government intends to detect asymptomatic individuals in the early stages of CKDu.
"Our staff goes from door to door for screening. More than 90 per cent of the detected patients are engaged in agriculture. The males are highly vulnerable to the disease," Dr. Ranaweera added.
Excessive use of agrochemicals, hardness of water, high levels of chemical elements like Calcium and Fluoride in water, dehydration due to inadequate drinking of water, and heat are among the causative factors; but, no specific cause has been confirmed so far.
"Agrochemicals, consumption of alcohol and cigarettes, exposure to the sunlight, not drinking enough water and genetic background are identified as the causes of the disease. This is a multi-factorial chronic disease," Dr. Ranweera highlighted.
Professor Hemanthi Ranasinghe, Dean of the Faculty of Graduate Studies of the University of Sri Jayewardenepura, who led a fresh research on CKDu in Padaviya told Ceylon Today that basically the hardness of water in the vulnerable areas has resulted in the creation of poisonous elements. She pointed out that Cadmium, Lead and some other heavy metal toxicity were also witnessed in the drinking water of the area. Even, Nitrogen and Phosphorus have concentrated in soil due to the application of chemical fertilizer by the farmers to gain a better yield. Such chemical elements get mixed up with the waterways and ground water.
"People now cultivate even at the vicinity of tanks (Wewa). Even some people cultivate inside the tank area during the dry season, for example in Mahakanadarawa. Since ancient times, the area called 'Wew Thavulla' was abandoned and left as the forest. Such forests easily absorb the toxics. But there is no natural mechanism in many places to purify the water," Prof. Ranasinghe pointed out.
Through Reverse Osmosis, a water purification technology that uses a semipermeable membrane to remove ions, molecules, and larger particles from drinking water, has been tested in Sri Lanka, they are not widely available in the disease hit areas. Professor Ranasinghe also suggested rainwater harvesting that is free from poisonous elements. The International Expert Consultation on CKDu, which was held in Colombo last year, has given a set of recommendations to counter the bad effects of the menace. But, the people who visit the affected areas will surely see how the authorities have turned a blind eye on the recommendations.
The recommendations include prioritizing the provision of safe drinking water and food in the affected areas and ensuring sustainable agricultural practices. Providing social support at three levels – patient, family and community is another point. Building the capacity of the existing community-level workers, appointing trained paramedical personnel and social workers in appropriate locations, and strengthening social support services and resources for the benefits of the kidney patients is another recommendation of the experts. Last but not least, ensuring psychosocial support to the patients and families is of paramount importance.
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