Dialysis patients in Savaii undergo specialised surgery

A medical team from Samoa’s National Kidney Foundation (N.K.F.) was in Savai'i last week tending to dialysis patients, saving a round trip to Upolu for many from the big island.

According to the Clinical Director of N.K.F., Leituala Dr. Ben Matalavea, the outreach programme was made possible by work previously undertaken by a surgical team from Australia.

"For the last 12 years or so, a charity surgical team from Brisbane called ORCHID (Operating Rooms Call 4 Help in Development) - led by a Samoan Operating Room Specialist Nurse Salailua Naseri-Cotter and a New Zealand vascular surgeon who also works in Australia Dr. Mark Hamilton - has been kindly donating of their time twice or three times a year, doing these operations for us free of charge, saving our Government millions of dollars over the many years," Leituala told the Sunday Samoan.

The arrangement, however, slid to a halt due to the Covid-19 pandemic, but, according to Leituala, the number of patients needing vascular access surgery grew to over 50.

(A vascular access lets large amounts of blood flow continuously during hemodialysis treatments, to filter as much blood as possible per treatment)

"We are now very fortunate that Dr. Sang Dahua from the visiting Chinese medical team - who are here for 6 months - is able to help us do these procedures for now. 

"We have always wanted to have dialysis treatments available for our people in Savaii.  

"It is a treatment that requires the patient to travel to Tuasivi three times a week taking 4 to 5 hours each time. 

"The Savai'i N.K.F. dialysis facility was opened in 2012 and 16 patients are currently dialysed here. 

"So it makes a lot of sense to have the necessary vascular access surgery done in Tuasivi, utilizing its modern facilities and the expert personnel who operate the operating theater here. 

"This is convenient for Savaii residents and saves our people the costs of traveling to Upolu for something that can be done in Savaii."

When asked to explain the importance of carrying out such an operation, Leituala said: "Patients with kidney failure will need an artificial filter to clean their blood, a process called dialysis treatment. 

"For this to happen the patient's 'dirty' blood needs to be taken out of the patient, who is connected to a machine that has a filter to clean the blood, and have the cleaned blood returned to the patient. 

"The current practice in Samoa, when dialysis is initiated and usually done on an urgent basis, a double-lumen big central venous catheter is inserted into a big vein either in the groin or neck area.

"These are not permanent and are fraught with problems, mainly bad infections, because they are foreign objects placed into blood vessels. 

"Ideally, patients' own blood vessels should be used but these vessels ought to be 'formed' by an operation.

“Two big needles are then used by inserting them into these new, and sufficiently big, blood vessels for the process of dialysis. Without vascular access, dialysis will not be possible. 

"Creating these big enough vessels called fistulas a patient's own vein is connected to the side of an artery, usually in the arm [and] is a specialized procedure done by a vascular surgeon. 

"Once this connection is 'matured' in 6 to 8 weeks then the big needles are inserted into it without it collapsing, and the 'filtering’ of dirty blood can be done like washing dirty laundry, and clean blood returned to the patient safely. 

"This access becomes permanent and the patient's lifeline for life. The plastic catheters can then be removed and the patient is free to do whatever activities they wish to do once these foreign bits are removed."

Leituala acknowledged the kind assistance of Hospital staff at the Ministry of Health and the Malietoa Tanumafili II Hospital at Tuasivi, in making the venture possible for residents of Savai'i. 

“‘What’s good for Upolu is also good for Savaii’ is a theme our Government has been championing so I guess this kind of fits in with that.

“The beauty of having Dr. Sang Dahua here for 6 months is that he is able to train one of our local doctors on how to do this specialized procedure. It is the only option we have due to the restrictions of travel forced upon us by the Covid-19 pandemic.

“I wish to acknowledge once again the tremendous help, over many years, of Salailua Naseri-Cotter and the ORCHID team, and that of Dr. Mark Hamilton who did this for us free of charge.

“The ORCHID team is a multi-disciplinary team and over the years highly specialized surgeons like Dr. John Bingley, Dr. Nick Boyne, Dr. Juanita Muller, Dr. Peter Hansen, and many others were able to come at their own expense.

“The many experiences and specialized OR [Operating Room] nurses, as well as anaesthetists, are included in these teams.

“Not only availing of themselves, but the necessary equipment and materials for the surgeries. Dr. Nick Boyne also donated a brand new ultrasound machine for the pre-op assessment of patients’ blood vessels and the proper place to operate.

“May our Good Lord bless these Good Samaritans and take care of them during these difficult times.”


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