MANILA, Philippines — Sheila Cuerdo, an 18-year-old Business Administration major living in Infanta, Quezon rarely got sick – in fact, her relatively good health and strong body was something that her mother Menchie often remarked to others. In November of 2011, however, Sheila began to experience symptoms that puzzled her family.
Without a prior history of hypertension, diabetes, or heart disease, Sheila nevertheless had a higher than normal blood pressure, accompanied by bouts of nausea. Eventually Menchie brought Sheila to the National Kidney and Transplant Institute (NKTI).
First option: dialysis
Menchie didn’t know anything about kidney disease in 2011, especially not in November and December when she and Sheila struggled with the latter’s symptoms. All she knew was that she didn’t want her daughter to die. That’s why when the doctors at NKTI recommended that Sheila be put on dialysis, she readily agreed.
Knowing that Sheila could die if she didn’t undergo dialysis, Menchie did her best to give emotional support to Sheila, who was very resistant of the process.
“Siyempre, hindi naman niya gusto yung nagda-dialysis dahil mahirap nga naman ang titiisin. Masakit daw. Kaya lang, ako naman, sinasabi ko sa kanya na kahit mahirap ay kailangan niya tiisin dahil gusto pa namin siyang makasama nang matagal-tagal,” said Menchie. (Of course, she never liked going through dialysis because of all the discomfort she has to endure. She said it was painful. But I kept encouraging her, telling her that she has to hold on and be strong, because we still want her to be with us for a longer time.)
It is best for a kidney transplant patient to get a kidney from a living relative. Since a transplanted kidney is considered a foreign body by the patient’s immune system, there’s always the chance that the patient’s antibodies will attack the transplanted kidney and try to destroy it. This process is called “transplant rejection.”
The adverse effects of transplant rejection may be reduced by 1) The patient’s use of immune system suppressing drugs and 2) Finding the best organ (in this case, the kidney) match between donor and recipient.
As mother and daughter, Menchie and Sheila have one of the best donor-recipient matches possible. Still, Sheila would have to take immune system suppressing drugs to prevent rejection of Menchie’s donated kidney. When Menchie passed all her tests and work-ups and the doctors gave her their approval to donate her kidney, she was so relieved.
“Kahit buhay ko, ibibigay ko para sa anak ko. Tiwala rin naman ako sa mga doctor namin. Kaya lang, hindi naman natin masasabi, di ba? Pwede namang halibawa, habang inooperahan ka, hindi ka na magising, di ba? “Kaya ipinasa-Diyos ko na lang. Nagdasal ako na sana naman po, Diyos ko, wag po muna akong mamamatay dahil ang dami ko pang obligasyon sa mga anak ko,” said Menchie, who has two other kids besides Sheila. (I’m willing to lay down even my life for my daughter’s sake. I trust our doctors, but we can never be sure, right? You can go to sleep on the operating table and never wake up. That’s why I really prayed and asked God to not let me die because I still have to take care of my children.)
A new life, new challenges
Menchie and Sheila had their transplant surgery on May 22. At the time of this interview, which was mid-June, Sheila is recovering well. She has to take a strict regimen of antibiotics, immuno-suppressant drugs, and vitamins for four months. She’ll be under careful observation for six months. And she won’t be able to go back to school for at least a year.
The transplant procedure has given a new life to Sheila and her family. Menchie is just thankful that her daughter has a chance to live normally, without having to go through daily dialysis.
Menchie and Sheila do not come from a rich family. Their only means of livelihood are farming and fishing, and most of their resources were already used up for Sheila’s medical expenses. Fortunately, they were chosen by PCSO to be a Donee under the PCSO KT Sponsored Case.
Leading kidney center in Asia
Sheila and Menchie are lucky to have been treated at The National Kidney and Transplant Institute (NKTI), which is one of the leading kidney transplant centers in Asia. For the past 30 years it has been the foremost kidney transplant center in the Philippines, and is recognized in the Asia-Pacific region for its successes in renal organ transplantation.
It marked its 2,000th kidney transplant operation in February 2002. It has the busiest organ transplantation program in the country not only for kidney transplantation but also for pancreas, liver, bone marrow, islet cell and stem cell.
The NKTI is also the first transplant center in Asia to perform double transplants like liver-and-kidney, and pancreas-and-kidney transplant operations. These were performed at NKTI long before any other transplant centers in Asia would do it.
The NKTI is the first government hospital to be ISO-9001:2008 certified and is in the process of getting international accreditation. It uses the most modern diagnostic techniques in kidney and other related diseases, all modes of dialysis, minimally invasive surgery (Laparoscopy) and surgical procedures, most notably, organ transplantation.
It is designated by the Department of Health as the reference hospital for all other hospitals in the country when it comes to the diagnosis, treatment, care and management of renal disease. This means that the NKTI sets the benchmarks for other hospitals to follow when it comes to identifying, treating and managing kidney disease.
In order to reduce the number of end-stage renal disease among Filipinos, NKTI has always been involved in educating the public on how to prevent kidney diseases. The NKTI does this mainly through its public health arm, the Renal Disease Control Program (Redcop). Redcop implements various projects such as researches, training and advocacy for the prevention and control of kidney diseases on a national scale. Other Redcop activities include giving support to establishing a national organ donation program and other outreach activities.
The National Kidney and Transplant Institute started out with its forerunner, the National Kidney Foundation of the Philippines (NKFP). It was formally created by Presidential Decree under the administration of President Ferdinand Marcos on Jan. 16, 1981. At the time, the NKFP did not have its own building and operated in Wing A3 and A4 of the Lung Center of the Philippines.
As the NKFP’s operations and scope grew over the years, it went through two more changes in its name. In Nov. 12, 1986, the NKFP was renamed as the National Kidney Institute (NKI). In May 25, 1995, the NKI was renamed as the National Kidney and Transplant Institute. It was then designated as the Philippines lead medical facility for organ transplantation.
The need for more organ donors spurred the NKI to lead in establishing an organ retrieval program. This was begun as the Cadaver Organ Retrieval Effort (CORE), later renamed Human Organ Preservation Effort (HOPE) in 1990. Today, HOPE is the leading organ procurement office in the country and has pioneered advocacies in organ retrieval from cadaveric donors. The main beneficiaries of this program are patients who have no living related donors and would have organs harvested from deceased donors.
As the NKFP grew to become the NKI, and later, the NKTI, it expanded from a smaller, specialty medical facility into a full-fledged tertiary hospital. While its resources still make it the premier facility of renal disease in the Philippines, it now treats various conditions through its departments including: Adult Nephrology, Pediatric Nephrology, Urology, Radiology, Internal Medicine, Anesthesiology, General Surgery, Laboratory Medicine, Hematology and Stem Cell Transplantation, Nuclear Medicine, Cardiovascular Medicine, Pulmonary Medicine, Neuro-Physiology, Physical Medicine and Rehabilitation, Dialysis Center, and Vascular Surgery.
The NKTI has several specialty centers, including the Organ Transplantation Center which provides transplantations of kidneys, pancreas, liver, bone marrow and stem cells. Its Nephrology Center caters to both adult and pediatric nephrology patients, while its Dialysis Center provides both hemodialysis and peritoneal dialysis 24 hours a day, 7 days a week (24/7).
It also has a Chemotherapy, Transfusion and Pain Management Section, which serves outpatients dealing with cancer, cancer pain and anemia.
The needs of transplant patients are most effectively addressed by using the best diagnostics facility possible. Knowing this, the NKTI Diagnostic Center uses state-of-the-art equipment and the most competent personnel to address all diagnostic questions and dilemmas. It is the benchmark in the Philippines for providing medical imaging and diagnostic services, and is at par with the best in the world.
The NKTI Diagnostic Center offers Computed Radiography, fluoroscopy, picture archiving and communication systems (PACS), ultrasound, vascular ultrasound, digital mammography, computed tomography (CT) scan, Magnetic Resonance Imaging (MRI), and radio frequency ablation (RFA).
The NKTI also has a highly-advanced Vascular Laboratory attached to its Vascular Surgery Division. Using highly advanced imaging and diagnostic equipment such as Plethysmography, Doppler Ultrasound, Duplex Ultrasound, and Laser Doppler waveform and imaging, the Vascular Laboratory provides crucial information on how to treat various vascular diseases.
According to Dr. Dator, the NKTI is building the Center for Urology and Men’s Health (CUMH) which is the first in the country. This facility, which will be housed within the NKTI complex, will focus on the field of Urology and Andrology, which is a specialty that deals with male health problems, particularly those affecting the male reproductive and urological tracts. It is the counterpart of gynecology.
“Men have unique diseases and these are what the CUMH seeks to address. If women have, for example, breast cancers, then men have prostate cancer. Worldwide, one out of six to one out of eight men develops prostate cancer. As average age of the male population increases, the number also increases. The most number of cases occur in Western countries while the Asia has lesser cases.
“However, the Philippines does not have the same prostate cancer rate as Asia. Our prostate cancer incidence is either mid-way or moving closer to that of Western countries. A factor in this is our adoption of a more Westernized diet and lifestyle” said Dr. Dator.
Mandate from the people
According to Dr. Dator, indigent patients like Sheila are the ones that the NKTI is mandated to help.
Dr. Dator added that financially-challenged patients like Sheila receive the same quality of treatment at NKTI as paying patients. He said that there’s no separate area for patients like Sheila and those who are able to pay. Their tests are conducted in the same world-class diagnostics lab and they get treated by the same expert physicians and specialists.
He said that one of the challenges of NKTI was to increase the number of transplants for Filipino kidney patients. “There is a huge discrepancy in the number of Filipinos with end-stage renal disease who need kidney transplants and the actual number of those who get transplants. In 2012, there are 15,000 people registered with the Philippine Renal Disease Registry (PRDR) who require transplant. However, an average of 350 transplants is done per year.
This discrepancy is something that NKTI seeks to address. “The quality of life of someone with a transplanted kidney is so much better than that of someone who undergoes dialysis,” he said.
There is no cure for kidney failure. When it fails, the only options are dialysis or kidney transplantation. Fortunately, early detection of kidney disease can help in the prevention of kidney failure. It is important to detect and manage acute kidney disease so it does not progress to chronic kidney disease.
“Prevention and early management of kidney disease is part of the mandate of NKTI. We are fulfilling that mandate by maintaining excellence in patient care, service, training and research. These four aspects of our mission are also the four key principles that guide our work and our policies,” said Dator.
In the same report, Ona also said that, “For as long as there is one Filipino sick and uncared for, our job is not done.”
With the NKTI determined to fulfill its mandate from the Filipino people in the best way possible, more patients like Sheila Cuerdo will have the chance to live and enjoy that life with their loved ones. (advt)
(Some of our more generous, compassionate readers might like to extend financial aid to Sheila, and they are encouraged to call (632) 981-0300 local 1078 to get information on how to extend assistance).
[Photos courtesy of HealthSolutions Enterprises]