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President Maithripala Sirisena appointing Sanjeev Gardiner as Ambassador for Prevnetion of Kidney Diseases

The Gardiner Foundation (GF) of Sri Lanka, headed by Sanjeev Gardiner, Chairman of the iconic 150-year-old Galle Face Hotel in Colombo, has tied up with the Brussels-based International Society of Nephrology (ISN), to help rid Sri Lanka and the rest of the world of the scourge of Chronic Kidney Disease (CKDu), which claims an estimated 5,000 lives per year in Sri Lanka alone.

On December 19, President Maithripala Sirisena will be formally launching the International Society of Nephrology (ISN)-Gardiner CKDu Fund here, in the presence of a distinguished international gathering of experts and diplomats including ISN Secretary General Adeera Levin, and the renowned Indian nephrologist and doughty campaigner against CKDu, Prof.Georgi Abraham, who was the South Asian representative in the Governing Council of ISN between 2005 and 2011.

The 46-year-old Sanjeev Gardiner had already set up the Gardiner Foundation to help CKDu patients in Sri Lanka with a personal contribution of Rs.30 million. The Gardiner Foundation is already up and running in the North Central Province (NCP) which has the greatest incidence of CKDu in the island. Gardiner was moved to start the Foundation seeing the plight of kidney disease sufferers in NCP.

Watching his dedication and commitment to the cause, President Mithripala Sirisena, who hails from the NCP and is deeply concerned about the CKDu menace there, appointed Gardiner as the Ambassador for the national campaign against CKDu last year.

Extent of CKDu
Estimates of CKDu in Sri Lanka vary. Some experts say that as many as 400,000 people in NCP alone may be afflicted by CKDu, with five or six out of 100 persons afflicted. According to some medical experts, 300 to 600 CKDu-related deaths occur in Sri Lankan hospitals annually. Some put the number of deaths due to CKDu at around 5,000 per annum, and say that many deaths due to CKDu are not recorded as such, as they occur at home in remote rural areas, says Chandra Mohotti,  a livewire in the Gardiner Foundation who is also Senior Vice President of Galle Face Hotel.

According to Dr. Asoka Bandarage, about 20,000 people have died of CKDu over the past two decades in the NCP alone, with 80 percent of the deaths occurring within two years of diagnosis because of a variety of factors, such as late reporting and diagnosis; lack of dialysis machines; non-availability of pure drinking water; expensiveness of the drugs; and poverty.

CKDu is not commonly found in other rural areas of Sri Lanka though they have rice cultivation practices and lifestyles similar to those prevailing in the NCP. Some researchers consider the “unique hydrochemistry of the drinking water” in the NCP to be the reason for the prevalence of CKDu  there. Others consider the “hardness of ground water” and the “heavy metal retention capacity” of the soil in the region to be the causative factors.
Fertilizers and pesticides are also blamed. A study published in January 2010 by a team of Sri Lankan and Japanese scientists hypothesized that “the unique hydro-geo-chemistry of the drinking water,” (with high levels of fluoride), is a decisive factor in the emergence of CKDu in NCP. The rising temperature in NCP has also caused the problem with people having to drink large quantities of chemically polluted water, the Japanese say.

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CKDu spreading fast
According to the Gardiner Foundation, CKDu is “spreading in Sri Lanka at an unprecedented rate over the past two decades.” It says that this is a relatively new phenomenon that the government and the people of Sri Lanka are facing. While the government is doing its bit, it is time the private sector also helped, the Gardiner Foundations feels.

Sri Lanka has a relatively comprehensive and free public state health care system. And yet it finds it difficult to keep pace with the alarming rate of growth of CKDu. Only about 5 percent of the government’s annual health budget is earmarked for the management of CKDu. Private treatment is extremely costly.

According to Dr. Bandarage, in 2005, a kidney patient had to spend approximately Rs.  10,000 (US$ 79) for dialysis and LKR 800,000 (approximately US$ 6,320) for a kidney transplant. Each tablet now costs about Rs 350 and that has to be taken without fail and on time.

Kidney donors are extremely difficult to find in Sri Lanka, as kidney sales are illegal here. Until September 2010, kidney donations were accepted only from relatives and members of the clergy. The desperate need for kidneys led to a change in government policy which now allows non-relatives to donate.

CKDu in Sri Lanka, Nicaragua, and India have common features cross national studies reveal: The victims are farm workers; all suffer from “a rare form of kidney damage known as tubule-interstitial disease, consistent with severe dehydration and toxic poisoning”; and a few suffer from diabetes and hypertension.”

In these countries CKDu goes undiagnosed as it is insidious disease. It can manifest itself as just a swelling in the ankle or as gastritis. Therefore, it tends to be neglected or incorrectly treated.

Sensing the urgency of the matter, Sanjeev Gardiner, tied up his Gardiner Foundation (GF) with the International Society of Nephrology (ISN) to start, not just a Sri Lankan, but a global mission, to initiate and ensure the sustainability of the multi-faceted activities for the prevention and treatment of CKDu.

Ambassador for CKDu prevention
Last year, President Sirisena had appointed Gardiner  as  the  “Ambassador  for the Prevention of Kidney Diseases.” Since CKDu is a social and economic problem, and not just a medical one to be tackled only by doctors and the government, the President wanted a private sector person to be the Ambassador and Gardiner was the natural choice.

Maithripala Sirisena’s coming to power has made a great difference to the Gardiner Foundation’s anti-CKDu campaign. Sirisena has taken various initiatives to prevent, cure, and assist afflicted persons and their families and also aid research. The President has a clear grasp of the situation and its gravity and has decided to broad base activities in relation to CKDu. He is keen on involving global players in this campaign, as many other countries share Sri Lanka’s socio-economic characteristics. Countries could help each other with funds, equipment, medicines and expertise.

The President had no hesitation in making Gardiner and his foundation the nodal point for his nation-wide campaign. He was looking for a man of integrity and capacity and Sanjeev Gardiner fitted the bill admirably. Gardiner heads a conglomerate of successful business ventures in Sri Lanka and overseas besides the historic 150-year-old Galle Face Hotel.

Having made initial enquiries, Gardiner was convinced that global awareness and international support is indispensable if any worthwhile contribution for this cause is to be made. Hence the need to obtain the support and concurrence of prestigious international organizations such as the International Society of Nephrology. He also saw the need to rope in foreign governments.

Funding, donors and donations will be required, but the present need is to set up a mechanism and work out programmes and projects which will function in a transparent manner so that people in Sri Lanka and elsewhere are convinced that the ISN-Gardiner Foundation is working along credible lines.

According to Mr. Chandra Mohotti, the driving force behind the ISN-Gardiner Foundation, more than funds, equipment and accessories are required .Disposable material used in treatment  like syringes will have to be replaced. Various countries and organizations across the world could help in one way or the other. Medicines will have to be imported and made available at an affordable price. For this the government could reduce the customs duty on CKDu drugs and equipment and accessories.

The Gardiner Foundation’s motto is: “ To create and maintain an independent and international Fund to support, care and do research towards the prevention, provision of relief and treatment to patients suffering from Chronic Kidney Diseases worldwide.” In other words, the Foundation will help promote education and research in CKDu. It will offer fellowships and grants for research. It will fund training programs for health workers and professionals.

Given the tie with the ISN, the ISN will be involved in the formulation of policy and the structure and functioning of the ISN-Gardiner Fund. The nature of the ISN’s involvement will be discussed in-depth when ISN officials come to Sri Lanka for the launch of the ISN-Gardiner Fund. However, it has already been decided that the accountants for the fund will be KPMG Worldwide.

Prof. Dr. Georgi Abraham
Most significantly, Gardiner has secured the help of the Indian nephrologist Prof. Georgi Abraham of the Pondicherry Institute of Medical Sciences, who is also Consultant and Director of Nephrology at the Madras Medical Mission (MMM) Hospital in Chennai. Known among his patients as a “saint” for his missionary zeal, Prof. Abraham is involved in the prevention and treatment of CKDu both in India and internationally. He was a member of the Governing Council of the ISN between 2005 and 2011.

Prof. Abraham got his MRCP UK 1982. He is also FRCP (London), and FRCP (Glasgow). He is the Founder President of the Peritoneal Dialysis Society of India (1997-99). He is part of the Global Outreach Programme in Nephrology runs by the International Society of Nephrology. He is an Advisory Committee Member – International Society of Nephrology for Access to Dialysis in Developing Countries. He is Editor in Chief – Indian Journal of Peritoneal Dialysis.

Dr. Abraham runs the TANKER Foundation in India. Though based in Chennai the foundation works all over India. Recently it set up modern treatment facilities in Manipur, a state in the extreme North East of India. When he was on a visit to Manipur he found that out of eight North Eastern States, only seven nephrologists were available and five of them were located in Guwahati in the state of Assam. It was found that the care given for CKDu patients was at the lowest possible level. Many of them suffered either due to inadequate facilities or due to the non-affordability of treatment.

This prompted Dr. Abraham and TANKER Foundation to raise funds to set up a dialysis unit at Manipur. Dr. Sharath Kumar,  Prof. in Nephrology, Manipur, agreed to support the underprivileged suffering from CKDu. The TANKER Foundation with the support of donors mobilized funds for four dialysis machines, a Reverse Osmosis Plant, and other required equipment for the dialysis centre to the tune of INR 33 lakh. A Christian priest, Fr. Lijo, deputed a team of his committed staff to get trained in dialysis in Chennai. Training was given by Dr. Abraham and his team at MMM Hospital and by Ms. Padma of TANKER Foundation, at the Ambattur Rotary Hospital Unit.

President Maithripala Sirisena, Health Minister Dr. Rajitha Senaratne and Deputy Minister Harsha de Silva at the Kidney Fund  launching ceremony
President Maithripala Sirisena, Health Minister Dr. Rajitha Senaratne and Deputy Minister Harsha de Silva at the Kidney Fund launching ceremony