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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 Nigeria.

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 injury.

"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 care."

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 working.

Professor Ifeoma Anochie, will be visiting CMFT later this year to work with the paediatric nephrology team.

Contact Trish for more details: