Resolving CKDu Problem: Let’s not make it a mere academic exercise

A simple rainwater harvesting and storage Facility for a rural household

by Ranjit Mulleriyawa

Talk, talk, endless talk… but very little action. We have had over two decades of research, many ‘talk shops’ - symposia, seminars, public awareness campaigns and several publications in scientific journals and newspaper articles on CKDu. To many, CKDu seems to be a mere academic exercise to be discussed and debated, and no more, until publication of the next research paper or symposium. Since many researchers do not spend adequate time in the field, visiting kidney disease patients in their homes, they fail to capture the depth of human suffering.

Several ‘Presidential Task Forces’ have been set up specifically to resolve the problem of CKDu. The National Academy of Sciences and the Organization of Professionals Association(OPA) has discussed the issue of CKDu on many occasions; the Law and Society Trust held a panel discussion on this subject last year, and has even devoted its latest issue of the ‘LST Review’ entirely to discussing this serious national health issue. This writer was personally requested to address several Rotary clubs on the subject of CKDu since it was considered to be a matter of "high priority" for Rotarians. His talks specifically focused on the importance of providing clean drinking water to CKDu endemic villages through rainwater harvesting. The audiences were most receptive, and there was widespread agreement that the topic deserved to be "followed up". Sadly, no action has resulted to date. As one cynic pointed out, "no action, talk only (N.A.T.O) is fast becoming a way of life in Sri Lanka today."

How can we remain so insensitive to the suffering of CKDu patients and their families? Let us not forget that it is these farmers affected by CKDu who help feed us all with our staple food - rice.

Meanwhile, people in the disease affected areas are becoming increasingly cynical of "do-gooders" who come to their villages to collect water samples from their wells, draw blood from their veins, and collect urine samples, only to depart and fail to provide any feedback thereafter. Clearly, it is high time to kick start some effective action in CKDu endemic villages. This article suggests some concrete actions designed to assist CKDu patients and their families, as well as suitable preventive measures aimed at controlling the disease based on available knowledge.

Civil Society must take the lead

Perhaps, one reason for the slow progress in initiating effective action in the field is due to the fact that resolving the problem of CKDu has been mainly relegated to government departments and universities, which tend to be hampered by various bureaucratic constraints. This writer believes that it is now time for civil society and the private sector to take the lead in initiating meaningful action in the field. His Excellency, President Sirisena has opened the door for such action by his recent call to concerned citizens to help prevent further spread of this kidney disease.

Preventing CKDu

The disease is strongly associated with drinking ground water (obtained from domestic wells). It is believed that there is some hitherto unknown toxic substance in the drinking water that contributes to kidney damage. Then, the obvious solution is to assist people in the endemic areas have access to clean drinking water. What is the most practical way of providing potable water?

Rainwater Harvesting

Harvesting rainwater running off the roofs of houses is the most logical, cheapest (per liter basis), viable and sustainable solution for increasing access to clean drinking water to widely scattered rural households in dry zone villages. It has been estimated that a family of five would need 20 liters of water per day for drinking and cooking purposes, and a storage structure capable of holding 5,000 liters of rain water would be quite adequate to provide the needs of an individual household throughout the year.

Lanka Rainwater Harvesting Forum (a local NGO) has perfected the technique of rainwater harvesting. It has helped a USAID-funded project in Vavuniya establish 750 rainwater harvesting and storage facilities. This project has proven the viability of rainwater harvesting in providing good quality drinking water to rural households at their doorstep at a mere 0.25 cents (Sri Lankan currency) per liter.

Despite such living proof of the viability of this simple, common sense, ‘low tech’ home grown, solution which provides rural households with potable water at their doorstep, some government agencies and vested interests are promoting high cost imported filters (Reverse Osmosis or RO Systems) which cost the beneficiaries (poor villagers) four times more per liter of purified water, besides requiring them to collect their daily water requirements from a central location. Farmers are busy people with little time to waste in making daily expeditions to water distribution points.

Improving Health Education

An effective community health education program designed to inform rural households on the importance of drinking adequate quantities of water (at least three liters/adult/day); refraining from smoking, intake of illicit brews (kassippu), avoiding self medication by rushing to the nearest pharmacy or village ‘Kade’ to purchase strong analgesics (pain killers) for relief of common body aches and pains, and overall improved nutrition is a vital need for residents in CKDu endemic areas. Educating school children on the above issues may help in getting the message across to their parents.

Safe Handling of Fertilizers and Pesticides

Misuse of pesticides (fertilizers, insecticides, weedicides and fungicides) is currently a major problem among small farmers in Sri Lanka. Main reason for this is the Ineffectiveness and impotency of the Agriculture Department’s extension services. Accordingly, there is an urgent need for improving agricultural extension at village level through an innovative approach such as deploying community-based farmer extensionists.

Treatment of CKDu

Treatent of CKDu has been well addressed by clinicians attached to state hospitals. As such this aspect is not dealt with in this article.

Other essential support for patients and their families

1. Counseling and psycho-social support

Professional counselors could help villagers to establish community- based support groups aimed at interacting with CKDu patients and their families who are in urgent need of caring. People willing to listen to their problems and guide them in coping with the disease and its attendant problems are urgently needed. They may provide such services at renal clinics in major hospitals, or better still, in the villages itself.

2. Financial support

Patients needing dialysis require financial assistance to meet traveling expenses to clinics, meet essential laboratory tests (which may not be available at the nearest government hospital). At present, the government has approved payment of Rs. 3,000/- per month to these patients, but this does not seem to be easily accessible in all districts.

3. Social Workers

In many other countries, social workers are employed by health authorities to assist in the follow-up of patients after receiving a kidney transplant, or those receiving dialysis. These personnel visit patients in their homes and help in sorting out their medical and family problems. Clinicians attached to the Center for Education, research and training on kidney diseases, Universiy of Peradeniya, have been requesting the Ministry of Health to establish a cadre of ‘social workers’ to assist in after care of CKD patients, but the response from the ministry appears to have been lukewarm thus far.

An appeal to Banks, Corporate Sector and affluent urban citizens

Awake! All you privileged people. Spare a thought for the suffering farmers affected by Chronic Kidney Disease. They toil through blazing sun and monsoon rains braving marauding herds of wild elephants at night to help feed us all with our staple food. Join us in our effort to control CKDu. Let’s get involved in some meaningful action in the villages. When politicians stumble and bureaucrats fail to deliver, we, civil society must act and make a difference. We have specific projects that you could contribute to. Contact the author via e-mail (rangoviya2013@gmail.com) or telephone (077-2657541) for more information.

*The writer is a farmer, researcher, and rural development activist working with farming communities in the dry zone for almost thirty years. He is currently a member of the Center for Education, Research and Training on Kidney Diseases (CERTKid), University of Peradeniya.
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