Case Study - Malcolm Lewis and Trish Smith
Taking paediatric renal care
Dr Malcolm Lewis, consultant paediatric nephrologist and Sister
Trish Smith, paediatric renal nurse specialist, have worked at CMFT
for more than 25 years. Over the past decade they have share their
experience in paediatric nephrology with doctors, nurses and
children in Sudan, Kenya, Tanzania and Nigeria.
In March 2014, they were invited to participate in an
'Interventional Nephrology Course - a handson experience' in Port
Harcourt, Nigeria. This was developed by colleagues and friends
Professor Felicia Eke and Professor Ifeoma Anochie from Port
Harcourt and sponsored by The International Society of Nephrology
(ISN), International Paediatric Nephrology Association (IPNA) and
the University of Port Harcourt Teaching Hospital (UPTH).
A histopathologist, experienced lab technician and nephrologist
from Cape Town worked with Malcolm and Trish to deliver a five-day
course attended by 80 paediatric nephrologists from throughout
It focused on enhancing clinical skills: performing renal
biopsies with ultrasound guidance, interpreting the results,
insertion of peritoneal dialysis and haemodialysis catheters and
delivering dialysis treatment to children with acute kidney
"Working in Nigeria poses many clinical challenges due
to limited resources and a health service which is not
subsidised," explained Malcolm. "Staff are frustrated
by problems such as an uninterrupted electricity supply,
access to laboratory tests and the availability of drugs.
Many children need care and treatment which sadly
their families are unable to afford."
He added: "The way we do things in the UK has to be
adapted to the facilities and resources available locally;
this often involves thinking of innovative approaches to
Trish worked with nurses who were keen to learn how to manage
dialysis therapy with very limited resources and no prospect of
providing long term treatment.
She explained: "It's a vast difference to working in
Manchester, where every child has access to treatment
with no added cost and long term dialysis is available
until renal transplantation is possible. The majority of
children in Nigeria do not have this luxury, so sadly
medical and nursing care has to be tailored to their
financial resources, with life-limiting consequences."
Children and families travel long distances on basic public
transport to reach a hospital, often spending four to six hours on
a local bus. And poor, congested roads make journeys with sick
children even more arduous. All the children undergoing treatment
were amazingly resilient especially as there was no topical
anaesthetic cream, no play therapists and minimal access to toys.
Each child was rewarded with a teddy bear which Trish had brought.
Airport staff were curious as to why she had so many bears with her
and whether they were filled with drugs!!
Despite these challenges, the healthcare professionals in
Nigeria are keen to learn and adapt their skills to meet the needs
of their young patients.
Dr Israel Odetunde, one of the participants, said: "The
clinical skills course provided us with valuable
hands-on experience which we can implement into our
own practice. The course team were excellent
facilitators of learning; we are indebted to them for
giving us their time and experience."
Malcolm and Trish have strong links with colleagues within the
African Paediatric Nephrology Association (AFPNA) and The
Paediatric Nephrology Association of Nigeria (PNAN) and are hoping
to return to Port Harcourt in the future to continue this joint
Professor Ifeoma Anochie, will be visiting CMFT later this year
to work with the paediatric nephrology team.
Contact Trish for more details: