We have had over two decades of research, many ‘talk shops’ - symposia, seminars, public awareness campaigns and several publications in scientific journals and newspaper articles on CKDu; we have also had several ‘Presidential Task Forces’; the Organisation of Professionals Association(OPA) has discussed the issue of CKDu on several occasions; this writer has personally addressed several rotary clubs seeking their assistance in providing potable water to CKDu affected villages through rainwater harvesting, but precious little concrete action appears to have been initiated to alleviate the suffering of CKDu patients and their families. The end result of all these efforts has been: No Action, Talk Only (NATO). Meanwhile, people in the diseased affected areas are becoming increasingly cynical of “do gooders” who come to their villages to collect water samples from their wells, draw blood from their veins, and collect urine samples, only to depart and fail to provide any feedback thereafter. Clearly, it is high time to kick start some effective action in CKDu endemic villages. This article suggests some concrete actions designed to assist CKDu patients and their families, as well as suitable preventive measures aimed at controlling the disease based on available knowledge.
Counseling and psycho-social support
Professional counsellors could help villagers to establish community- based support groups aimed at interacting with CKDu patients and their families who are in urgent need of caring. People willing to listen to their problems and guide them in coping with the disease and its attendant problems.
Financial support
Patients needing dialysis require financial assistance to meet travelling expenses to clinics, essential laboratory tests (which may not be available at the nearest government hospital). At present, the government has approved payment of Rs. 3000/- per month to these patients, but this does not seem to be easily accessible in all districts.
Screening to detect early onset of the disease
Nephrologists (kidney specialists) believe in the need for mass screening of all adults (over 20 yrs) in a bid to detect early onset of the disease. Such screening is accomplished through testing urine samples for Albumin and Creatinine. Early detection through such testing can help arrest further kidney damage through effective medication.
Social workers
In many other countries, social workers are employed by health authorities to assist in the follow-up of patients after receiving a kidney transplant, or those receiving dialysis. These personnel visit patients in their homes and help in sorting out their medical problems. Clinicians attached to the Center for Education, Research and Training on Kidney Diseases, University of Peradeniya, have been requesting the Ministry of Health to establish a cadre of ‘social workers’ to assist in after care of CKD patients, but the response from the Ministry appears to have been lukewarm thus far.
CKDu prevention
Available evidence indicates that increasing access to potable water is perhaps the best way of preventing/mitigating CKDu. No less a person than the President has appealed to the International community and the corporate sector to assist in providing potable water, but they lack guidance in terms of “best options”.
U.S.AID has been the only international aid agency to have addressed this water issue through a very pragmatic programme of promoting rainwater harvesting (collecting water running off the roofs of houses and school buildings). They have successfully demonstrated the viability of rainwater harvesting in the Vavunia area where 750 households depend entirely on rainwater for drinking and cooking throughout the year. Several schools in the Kilinochchi and Batticaloa districts have been provided 30,000 liter capacity rainwater storage tanks. Despite such living proof of the viability of this simple, common sense, ‘low tech’ home-grown, solution which provides rural households with potable water at their door step, government agencies and vested interests are promoting high cost imported filters (R.O. systems) which cost the beneficiaries (poor villagers) four times more per liter of purified water, besides requiring them to collect their daily water requirements from a central location. Farmers too are busy people with little time to waste in making daily expeditions to water distribution points.
Improving health education
An effective community health education programme designed to inform rural households on the importance of drinking adequate quantities of water (at least 3 liters/adult/day); refraining from smoking, intake of illicit brews (Kassippu), avoiding self medication by rushing to the nearest pharmacy or village ‘Kade’ to purchase strong analgesics (pain killers) for relief of common body aches and pains, and overall improved nutrition is a vital need for residents in CKDu endemic areas. Educating schoolchildren on the above issues may help in getting the message across to their parents.
Safe handling of fertilizers and pesticides
Misuse of pesticides (fertilizers, insecticides, weedicides and fungicides) is currently a major problem among small farmers in Sri Lanka. Main reason for this is the ineffectiveness and impotency of the Agriculture Department’s extension services. Accordingly, there is an urgent need for improving agricultural extension at village level through an innovative approach such as deploying community-based farmer extensionists.
Effective education of rural communities
The writer’s long experience in rural development programmes has shown that multi-pronged action involving government agencies (Departments), Non Governmental Organisations (NGOs) and Community Based Organisations (CBOs) are essential for successful implementation of community education programmes described above.
An appeal to Banks, Corporate Sector and affluent urban elites
Awake! All you privileged people. Spare a thought for the suffering farmers affected by Chronic Kidney Disease. They toil through blazing sun and monsoon rains braving marauding herds of wild elephants at night to help feed us all with our staple food-rice. Join us in our effort to control CKDu. Let’s get involved in some meaningful action in the villages. When politicians stumble and bureaucrats fail to deliver, we, civil society must act and make a difference. We have specific projects that you could contribute to. Contact the author via e-mail ([email protected]) or telephone (0772657541) for more information.
(The writer is a farmer, researcher, and rural development activist working with farming communities in the dry zone for almost thirty years. He is currently a member of the Center for Education, Research and Training on Kidney Diseases (CERTKid), University of Peradeniya.)
