I failed kidney-donor test

2011-02-01
THE SUN Newspaper- Alban Opara

David is eight years. He was diagnosed with chronic kidney disease, caused by urinary blockage. He was born with it. His situation attracted much concern both in my family and many other people were touched of this problem.

He was managed from 2007 to October 2010 at Lagos University Teaching Hospital (LUTH) Idiaraba Lagos. He passed through corrective surgery, which is supposed to open the blocked urinary tract. In India, we learnt that the surgery was not well done, because they did not see evidence of the corrective surgery. They believed that if the surgery was properly done his case would not have developed to chronic kidney disease (CKD).

In LUTH, he was admitted and placed on dialysis thrice a week. Each dialysis costs between N35, 000 and N50,000. The dialysis was always a nightmare to us, because for each dialysis, he would be canulated on his lap, an exercise that is very truamatic. Paediatricians’ nephrology doctors who were not used to children going through dialysis used him to practise. He would cry and get tired. The doctors would come one after another to try to get his vein. David waited for an answer to his illness, but could not get it at LUTH. In India, especially Fortis Hospital, where we went for kidney transplant, the dialysis was a pleasure and very cheap. It costs only $65 or Rs 2,800, equivalent N9,880.

David suffered at LUTH. Death daily knocked at his door, but God, the Almighty, was on his side. We were told by his doctors that he needed to go to USA or India for kidney transplant, which they said was the only solution to his situation, and the transplant would take between N5 million and N10 million.
I am neither a contractor nor trader. I never had an income of that amount before in my life. I imagine as a journalist, poorly paid, how many years I would work to save N10 million.
However, God answered us. The management of The Sun Publishing Limited helped us on fund raising campaign. Vanguard Newspaper was also involved in the campaign. I sent out many appeal letters. To my surprise, when Nigerians saw the picture of my son on dialysis machine as published by Saturday Sun and Vanguard Newspaper, they were touched and they responded.

With that experience, despite several weaknesses of Nigerians, I agreed with Professor Dora Akunyili, former Minister of Information and Communications that Nigerians are, “good people.” Nigerians (inclusive of some corporate bodies) donated to us, and we travelled to Delhi, Indian capital on November 4, 2010 for the transplant.

We had several experiences. I was surprised at the Indian High Commission in Lagos, because the doctor, who endorsed every medical visa collected N8,000 un-receipted for every visa outside N12,000 official fees. After interviewing me, he said, “you pay N8,000 here, then go down, the cashier would give you slip to pay N12,000 visa fee.” He would not collect the money directly from you, instead, he would raise the file on his table and ask you to drop the money there. It was only when you drop the money that he would endorse your visa form.

Again, the experience with Qatar Airways on October 29, 2010 devastated us. Our flight to Doha and connection to Delhi were confirmed, but we were not allowed to fly because the airways officials said we did not fill Medical Information Form (MEDIF).

The form they said was required for the airways to know the state of health of the patient, the nature of incapacitation, if he needs a medial practitioner accompanying escort, if any special in-flight arrangements needed, like meals and oxygen, wheelchair, and ambulance (at origin and destination). The form to be endorsed by the attending physician were processed at the Airways’ headquarters in Doha and it takes a minimum of 48 hours and maximum of 72 hours to get response of either approval or rejection.

So, we were turned back with the form, which we were expected to return whenever our doctor endorsed it. Getting approval was made hard for us because our doctors endorsed the form with condition “to the fact the flight will be in the next 24 hours. If his flight will be after 30 0ctober 2010, we will give him another session of dialysis done preferable 24 hours or less before his intended flight.” With this condition, it was difficult for us to get flight schedule because the information has need to get to Doha for approval. By this, David’s health was getting worse, and we were afraid. Every move to reschedule the flight was hard because the flights to India because of the Commonwealth Games. So, flights were fully booked. For us to fly, we upgraded our tickets to Business Class.

However, we travelled on November 4, 2010. The flight was sweet, but it was clear to my wife and I that the journey was not a pleasure trip. Our hearts were occupied with thoughts of what would happen.
On November 5, 2010, the nation of India was on fun, joviality and celebrations mode. The nationals world over especially in the country remembered what they called Diwali, festivals of the lights. They celebrated it for five days with enthusiasm. They started on Wednesday, November 3, for what they called Dhanteras. Each day, they said had significance and legends, but very few knew about the legends and reasons. The five days national public holidays involved even hospitals workers. The hospital (Fortis Hospital) staff who received us at the Indira Ghandi International (IGI) Airport did not take us to the hospital, instead, took us to a rented apartment where we paid to stay for about three months.

However, on Monday, November 8, we were taken to the Hospital and the doctor, Dr. (Prof.) Anant Kumar seeing David said: “He is very sick and there is need to do some investigation and observation on him for three days.” He immediately gave him. We all thought it was few days admission. But the admission lasted one month, complications upon complications. He even spent 12 days in Intensive Care Unit (ICU). He went through three surgeries before the transplant. All these were efforts to put him in a stable health prior to the transplant session. He was on regular dialysis three times a week and at a time, he did dialysis everyday.
Dialysis in Fortis Hospital was without stress, because patients come on weekly fixed appointments. Before they come, beds are made ready. They just come and would be shown the bed. This situation makes them to programme their lives without worries over the illness. I saw renal patients coming to the dialysis centre looking healthy. I observed some who transact businesses on phone while on dialysis bed, and some after dialysis, go back to office. When you see them, unless one tells you, you may not know they have renal disease.

But at, LUTH for example, where my son was doing his dialysis, it was a nightmare and painful session. You go early in the morning, official protocol and doctors indifference will make one spend the whole day.
Besides, the dialysis done here with what happened to David, was like infusion of infection into his body. There, it was discovered that his kidney were inflamed with abscess (puss). They tried to drain it as a way of clearing the infection we went with, but the effect of infection was still on him. So, they ended up doing kidney laparoscopical nephrectomy. That is removing the inflamed kidney to save his life before transplant. The infection in him caused fever that seems difficult for them to control, until they stop administering antibiotics.

We went to India, thinking that kidney transplant is a surgery one undertakes as a sick person, but I was proved wrong. I was made to know the kidney recipient must be put on medical healthy state. He must be free from infection, the temperature must be normal, heart state must be normal. The patient must have normal feeling and thinking like a normal person, that is. The psychiatric doctor must clear him. The patient must pass Neurologist test. Kidney recipients I saw were treated before the transplant.
David spent 28 days before he was admitted for the transplant.
Kidney transplant surgery is very complicated. It involves medical, legal, political procedures and family consent.

Medical procedure
Medically procedure requires going about 29 tests for both the donor and recipient. The tests under biochemistry, they are: CBC, KFT LFT, Blood sugar (F,PP), HbA1c,Ca, Po4,PSA, 24 hour urine protein; under Clinical pathology is urine R/E, M/E. Under microbiology are CMV-IgG,and urine culture; Under blood bank are HBsAg, HCV RNA, HIV1&11, Blood group; under Radiology are untrasound (whole abdomen) including PV1, chest X-ray, DTPA Scan, and transplant surgeon review.
Besides these tests, you must undergo cardiac clearance with ECG and Echo unoflometry.
The second stage of the tests involved radiology which requires CT (Angio) for renal vessels, PSA prostate (male) above 50 years, psychiatry check-up, gynecological and pap smear (female) and HLA typing and cross matcha.

The documents that are also required for kidney transplant include either passport, or driving licence, or work permit or any other government identity, affidavit of patient with photograph from his country or India, affidavit of donor with photograph, affidavit of a responsible senior member of the family with photos from donor and recipient country, Birth certificate or school leaving certificate, marriage certificate with photographs.

In the political procedure involved, we were given “Certificate of No Objection” by the Nigerian High Commission in India, which we presented to the hospital before the transplant could be carried out.
On a letter dated November 25, 2010, Nigeria’s Acting High Commissioner in New Delhi, A.M Mongouno, wrote to Dr. Kumar, “The High Commission has also been informed that Mrs. Ifeyinwa G. Opara wants to donate one of her kidneys to her son, Master. David I P. Opara, who needs a kidney transplant. The document reads: 1. Without any undue pressure and coercion; 2. Out of sheer love and affection; and 3. Without any monetary consideration. The High Commission has ‘No Objection’ to the kidney transplant.”
We faced also Indian government kidney transplant panel. The panel’s function is to ensure that the donor is not doing it for financial rewards. I tried to know the reason for the panel, and I was told by a source in the hospital that the government was doing that to protect their citizens. Indians, I learnt in the past, would line up in hospitals in search of those who need kidney for financial reward.

On November 15, 2010, a day we ought to be celebrating our 24th wedding anniversary, instead, my wife and I in twin-room 124 received a shocking news. I left Nigeria with a plan to donate one of my kidneys to my son, David, but I was told that I was not medical fit and qualified to donate, because the blood sugar test was higher than the normal. I learnt that this was caused by stress and depression, few days later without, drug, my blood sugar level went low to 77 point. We were confused. We did not know what next to do. I never wanted my wife or any of my children to be the donor. We sat down. I looked at my son lying on the bed in need of life, and gazed at my wife, tears dropped from my eyes.

Dr.( Prof.) Anant Kumar, the director of Urology and Kidney Transplant Team, Fortis Hospital, told me to look for another donor. He said, “your wife could donate.” He minuted on the case-note directing my wife to begin the first stage of the donor’s test.

I was afraid that my wife may not scale the first stage of the test, but fortunately for us she survived first, second and final stages. She was found medically fit to donate her kidney to our eight-year old son. The title of kidney donor (KD), I wished to earn, she earned. What I could not do to make our son live, my wife did it. Today, David is living with her mother’s kidney. He is very healthy, strong, eats well, drinks almost two litres of water daily and has started playing football, his favourite sport. This sacrifice by my wife has made me to love her more.

I wondered what would have happened if she did not travel with us? Or if she was not found fit. Just imagine what would have been the fate of my son. The money we went with would have been wasted on mere treatment and dialysis.

We faced financial challenge. We went with $33,300. The hospital package for the transplant that involves spending between 8 and 10 days in admission, is $15,000 or $16,000. It could be more if there is a rejection of kidney by the body of recipient or other complications.
Prior to our transplant, we had spent $29,000 on the effort to stablise David, and we fell short of fund. God was on our side, Dr. (Prof.) Anant Kumar and Dr. (Prof.) Sanjeev Gulati, (Nephrologist and dialysis expert) stopped collecting consultation fee from us. Prof. Kumar promised to talk to the Hospital management to give us discount. He actually did.

The hospital policy is that you must deposit the whole money before treatment could commence, but in our case, they gave us reasonable discount, and we were allowed to make only a deposit of $7,000 and remaining $3,500 before discharge from the hospital. Fortis Flt. Lt Rajan Dhall Hospital, it was said is a manifestation of the founder’s vision of medical care. It is an environment where some best medical professionals – doctors, nurses and technicians with a profound sensitivity to the needs of patients are found. The care, they give to patients give confidence to the sick.

The hospital I learnt focused on high –incidence health problems in India such as heart, kidney, respiratory and diabetic conditions, which it was said is common malady that hampers great number of the senior citizens.

“Our medical faculty comprises some of the most renowned doctors in the key specialties, allowing you to access medical knowledge of an exceptional high order. Because critical care is so crucial to a patient’s recovery, we have set up dedicated closed ICU’ for each specific super-specialty with dedicated, trained and experienced personnel of the key specialties.”

Prof. Kumar who is director of the Urology and kidney transplant team said, “transplant varies. There are some patients whose bodies reject the kidneys and injections are given to stablise them. Such patients are placed under close watch. In a year, we could do between 870 to 1000 transplantations. Sometimes we don’t do transplant surgeries if there is no patient. We could do up to three in a day. Last week, we did five transplantations.

Dr. Kumar told me that David my son was not the only child he has done his transplant. “I have transplanted a three years old child and have done transplant on over 100 children ranging between three to 12 years in 25 years.

Kumar who has over 25 years of experience in urology and renal transplantation as a teacher and clinician told me he has done over 2,000 transplantations and has retrieved all kidneys laparoscopically, did over 500 lap donor nephrectomy.

In a child like David, we are very careful because blood pressure level to protect the kidney from bursting.” Again, Kumar confirmed that, “a child dialysis is a challenge.”
He disclosed that in the past four years he has handled transplantation of kidney of over 100 African patients from Nigeria, Congo, Tunisia, Tanzania, Ethiopia, Kenya. Last year, 2010 he said Nigerians were not less than 15 and not more than 20, saying that he has not taken time to keep the statistics.
In November 2010, I met two Nigerians who were transplanted, a man and a woman. Mr. Mohammed Saidu, was transplanted in late December. Mallam Tijani transplantation could go on, because of failure on cross-matcha test. He was asked to wait for some time, but he chose to come back without transplantation, says he would go back as soon he recoups himself financially.

Kumar disclosed that the hospital has never had experience of a patient dying in the process of transplant surgery but confirmed that, “we had difficult cases of patients who were rejected in other hospitals, which we handled successfully. Patients die after transplant because of infection or heart or brain shock.”
He explained that some patients die after between two and 20 years when they fail to take their drugs or when they contact infection or fail to keep appointment with their doctors. A good number survive if they take care of themselves. There are some who lost their graphic in 50 years, he said.
Kumar disclosed that, “we will soon have artificial kidneys. In ten years, we will adopt that, and the challenges of the transplantation will be a thing of the past.”

Kumar advised kidney transplant patients to be drinking boil water, eat good food, take their transplant drugs regularly as advised by their doctors, maintain their blood pressure, have regular check up, regular check up tests, consult with their doctors when due, and do regular exercise and keep personal hygiene.

 

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