The Sunday Mail
In our continuing coverage of kidney ailments, which because of the small numbers of patients involved, is not getting the requisite attention from relevant health authorities, we tracked Malvern Karidozo, a wildlife biologist based in Victoria Falls, who has had a near-Lazarus moment. Through his narration and experiences, kidney ailments, which are killing a number of people around the country every year, are a reversible and manageable condition, if only interventions are made at an early stage. Read on . . .
Garikai Mazara
After reading for his first degree in Environmental Science with Bindura University of Science Education, then doing a Masters in Conservancy Biology with Wits University, life seemed to be on a roll for Malvern Karidozo. He moved from Harare to Victoria Falls, to be in the thick of things as it were, what with the World Heritage Site being the epicentre of ecotourism in the region. Contracts for wildlife consultancy were flying onto his home office desk left, right and centre.
Married to Faith and blessed with Tafara and Mudiwa, the couple started saving to build their own house, after all a family home is what every couple strives for in life. On a Thursday in November last year, he presented some research papers in Kasani, Botswana, on the ever-increasing conflict between human beings and elephants. The following day, though he was not presenting, he wanted to attend the wildlife conference, just to hear what others had to articulate.
“During my presentation in Kasani, I noticed that I had started a cough and my head was aching. So before I went for the workshop on Friday, I thought it better to visit my doctor first because the cough was now persisting,” he narrated at the family home last week. At the hospital, the usual tests were done and nothing wrong was found. But his situation was deteriorating and within hours an ambulance was being arranged for him to be transferred to Bulawayo, over 400 kilometres away. By the time the ambulance arrived at Halfway, which literally is halfway to Bulawayo, Karidozo had passed out.
After a week at Mater Dei Hospital in Bulawayo, after which he was transferred to Parirenyatwa, where he was to spend another week, he was discharged. The initial prognosis was that he had suffered a kidney infection, which the doctors thought could be reversed by the treatment he had been prescribed, hence they asked him for a review in a week’s time. And for sure, in the week that he was away from hospital, his condition vastly improved and he looked forward to his review. But somehow, the night before the review, his situation, without any warning, changed.
“I started feeling some discomfort in my chest, failing to breath and vomiting fluids. I was rushed to hospital and though all the indicators were normal, my saturation rate was terribly low. I remember when I was admitted the rate was 38 when a normal saturation rate is supposed to be above 95.”
Oxygen saturation rate is the amount of oxygen in the blood, compared to the blood’s carrying capacity, of which a normal human being at sea level, should have a reading of above 95 percent. When he was rushed into the high dependency unit at Parirenyatwa, Karidozo’s saturation rate slightly improved to between 60 and 65, which was still well below the required ratios. Then came the near-Lazarus moment. Chipped in Faith, his wife, “Malvern was admitted on Christmas Eve, and you know how the festive season is like with accidents.
There was an immediate need to transfer him from the high dependency unit into the intensive care unit but the ICU was fully packed. You know road traffic accidents around the festive season.”
Though the problem had been diagnosed as an acute kidney problem, of which dialysis machines had been moved to his bedside by the time they secured an opening for him in the ICU, the immediate preoccupation with the medical team was reviving him. “The time that Malvern spent in the ICU helped us get a new perspective of life. There were times when I asked the doctors what they had found wrong on him or what his chances were, and they would simply encourage me to keep on praying.
“That is the worst answer one can get from a doctor, you need that assurance that probably in the next hour or two, a day or two, a week or two, he will be up. Not prayers.”
After admission into hospital on Christmas Eve, Malvern only came to on Boxing Day, a frenetic three days which involved getting some prescription drugs from South Africa. When he finally came to, he was advised that he needed a kidney biopsy, to determine the extent of the damage to his kidneys.
“I was advised that although the biopsy could be done locally, the tissue had to be taken out to South Africa for testing. Because this involved the movement of human tissue, a process which Customs closely monitors given the upsurge in the trafficking of human parts, I was told that the earliest that I could get my results was anything from three weeks to a month.
“But in the event that the tissue got tainted along the way, the South African doctors would not conduct the tests and would instead request for fresh tissue, meaning another three to four weeks. And in the meantime, my condition would be deteriorating. So I was advised to go to South Africa for the biopsy.”
The trip to South Africa was to be a blessing in disguise for him. After the biopsy, which took less than a day to have the results, he was asked if he had heard of continuous ambulatory peritoneal dialysis (CAPD).
“No, I told them. I only knew of haemodialysis, of which I had undergone a number of sessions in Bulawayo and in Harare.
“I have to be thankful for that biopsy trip because the doctor attending to me explained that because I had an acute kidney problem and not a chronic one, I had three options to choose from. CAPD, haemodialysis or a kidney transplant.”
Continuous ambulatory peritoneal dialysis is when a permeable catheter is inserted in the “beer-belly” and dialysis goes on during the day or night as the kidney patient goes on about their daily lives. Into the catheter, a glucose fluid with a positive charge is inserted, which then attracts toxins from the blood because the toxins will be carrying a negative charge.
The extent of damage of the patient’s kidney usually determines how often the fluids are changed. In Karidozo’s case, he has since shifted from six-hour intervals to eight-hour intervals, largely because of the cost involved and partly because the eight-hour regime allows him greater freedom to do his work.
“I change my fluids at six in the morning, at two in the afternoon and at 10 before I retire for the night. Soon after the operation to insert the catheter, the hospital trained me for about four days on how to change the fluids and now it is routine for me, just the same way you go to the toilet.”
Though Karidozo is grateful that he “stumbled” upon CAPD, which is relatively cheaper as compared to haemodialysis, the costs involved are still on the high end.
“I am not sure why local doctors don’t talk about and recommend CAPD to their patients, especially those whose kidneys would not have chronically failed, it maybe a commercial decision but my South African doctor made it clear that CAPD is the first line of defence when it comes to fighting kidney problems.
“Though I am on medical aid, of which one has to have been contributing for at least two years to access kidney treatment cover, it is the cost that is draining.
“Luckily for us, we were saving to build our house and we had to resort to those savings for my treatment, otherwise I would have died the time I was admitted in the ICU. My being alive today is a combination of fate and divine intervention.”
A month’s supply of the glucose fluids and the disposable sundries which he uses comes in at a jaw-dropping gross weight of 500kg.
“My first consignment was a nightmare, we were flying and I had been given two months’ supply, so we thought it better to courier the boxes. The courrier company made money out of us that time. Now we have resorted to using buses that ply Harare-Victoria Falls.
“Someone in Harare gets the supply for me and puts them on the bus. But imagine if something happens to that bus, that means a month’s supply would have gone, and the medical aid would be under no obligation to buy again. And we are talking of $1 300 worth of supply, which means I would have to look for that amount.”
Apart from the logistics of moving his “cargo” between Harare and Victoria Falls, it also means that his travels, meals and social interactions have to be meticulously planned, all in advance.
“I cannot wake up and say I want to attend this or that funeral, especially if it is some area which has rough or dusty roads, because the opening where the catheter is doesn’t need any dusty environments, or else an infection will set in.
“There is also the issue of moving and being with the boxes at the same place, so if your visit is going to be for a number of days, you need space in your travel for the boxes.”
Because of his diet, either he has to have pre-packed meals as he cannot eat food prepared at functions like weddings or funerals.
“But I am grateful to my family support structure, my in-laws know of my condition and they know I don’t eat anywhere and anyhow.”
The Karidozos are of the opinion that some Government regulations do not make sense. Explained the wife, “We are not allowed to import these supplies by ourselves because we don’t have the requisite licences.
Only pharmacies are allowed to, but because the number of kidney patients who use CAPD is still low, it is bad business for the pharmacies so they don’t even bother to stock them. We have to rely on Parirenyatwa Hospital for supplies and given the challenges facing our health sector, at times we have to run across the border to Livingstone to buy, when there is no supply coming from Parirenyatwa.
“The other challenge comes when he is travelling, say to Angola for his wildlife conferences, or Kenya. The paperwork and cost of transporting the boxes is cumbersome. For instance, some airlines insist that the boxes cannot be treated as luggage but can only be carried as cargo, which means they travel in a separate schedule as his.”
Karidozo has been given two years to monitor his kidneys, in which time he has to look for a donor, in readiness for a transplant. “My sister and brother have expressed willingness to donate but it is more than just that. There are a lot of tests that need to be done. But in the long term, a transplant is cheaper, because I am spending about $1 500 per month on treatment. In 20 months I would have spent as much as it would cost me to have a transplant, so I am hoping that by the end of next year, everything should be set for the transplant.”
The good thing about kidney problems, Karidozo mentioned, is that there is virtually no stigma associated with the disease.
“But if I were to be given a basket full of ailments to choose from, I would certainly choose HIV, because it is not only manageable and cheaper but gives one all that latitude to carry on with their life.”
The downside to the disease, he said, is the lack of awareness and support structures.
“If only kidney problems got as much support from the Government as HIV and Aids, many people would not be dying. It is less than a year since I have been diagnosed with this kidney ailment but I have already lost friends that I used to do dialysis with. The cost is very prohibitive.
“In South Africa, for instance, they pay a token R70 for a dialysis session at Government hospitals. In Botswana, it is virtually free at all Government hospitals. But here we pay with an arm-and-leg to have one session.”
