Dialysis therapy in the Caribbean - abstract

ABSTRACT

Long-term haemodialysis at the University Hospital of the West Indies, Jamaica, started in 1971 with the training of patients with end-stage renal failure for self-treatment in their own homes. There was no Government Health Insurance or other third party funding for this treatment and, regrettably, patients whose financial and social circumstances did not allow home-dialysis treatment perished from terminal uraemia. Elsewhere in the Caribbean, notably in San Fernando and Port-of-Spain in Trinidad and Tobago, attempts were also being made to introduce dialysis therapy. Again, there was little encouragement in the way of funding from traditional health care sources. The majority of Jamaicans coming to end-stage renal failure did so as the result of benign or malignant nephrosclerosis and the majority of these were from the lower socioeconomic strata of the society. To overcome their relative disadvantagement, dialysis programmes were initiated, first at the Kingston Public Hospital (circa 1972) and subsequently at the University Hospital (1974), to prepare patients with end-stage renal failure for renal transplantation. By September 1980 twenty-five cadaver renal transplants had been performed on patients from these two sources. All patients transplanted in Jamaica have received cadaver transplants. On June 14, 1987 the first successful living-related donor renal transplant in the Commonwealth Caribbean was performed in Barbados. A few months later four similar operations were performed in San Fernando. Dialysis facilities now exist in the Bahamas, Barbados, Bermuda, Jamaica and Trinidad and Tobago. The future holds the prospect of co-operation between these centres and the provision of renal transplantation services for a greater number of West Indian nationals (AU)