Dr Eddie Tan1, Dr Amrish Krishnan2, Ms Sarita Goundar2, Dr Gerald Waters1
1Waikato Hospital, Hamilton, New Zealand, 2Fiji Kidney Hub, Suva, Fiji
End-stage kidney disease is a huge problem in Fiji. Haemodialysis is not free and prohibitively expensive, so promoting the cheaper (but under-developed) alternative, Peritoneal Dialysis (PD), is the only viable cost-effective dialysis option. The growth of a PD program relies heavily on developing physician-led PD Catheter (PDC) Insertion (PDCI) skills.
We looked at how PD developed in Fiji over time: 2015-2019 (present), coinciding with overseas interventional nephrologists visits. There were PD-related lectures (e.g. PD prescription, acute PD, PDCI techniques) and PDCI demonstrations with hands-on sessions using models/phantoms incorporating pork bellies. This culminated in 2019 with a 1-day PD workshop (lectures and practice PDCI sessions) and 2-day supervised PDCIs in live patients. The work involved preparing talks, assembling teaching materials, arranging paperwork (e.g. local medical council registration and indemnity cover), seeking sponsorship and liaising with local teams (physicians, surgeons and nurses).
Initially there were no PD patients and very little PD skill-sets locally. Interest in PD has since increased with enhanced PD skill-sets (via overseas secondments of local doctors/nurses and training visits by PD teams from abroad) and newly-sourced government-sponsored infrastructure to develop PD (premises, equipment and personnel). Local feedback for the mentoring/sessions is extremely positive with reported increased confidence in PD knowledge and PDCIs. 2 local physicians received direct supervision in PDCIs on local patients.
Enthusiasm and knowledge in PD has mushroomed in Fiji. Further supervised PDCIs could help establish independent PDCIs locally; helping develop PD as a cheaper, viable dialysis alternative to save more lives.
Ms. Sarita Goundar is a dialysis nurse in the Fiji Kidney Hub.