Revolutionizing Nephrology Care in Antigua & Barbuda: A Success Story
Discover how Dr. Ian Thomas, alongside a dedicated team at Mount St. John's Medical Centre, has transformed renal care in Antigua & Barbuda. With cutting-edge facilities, a dedicated staff, and strong community support, the journey from humble beginnings to a thriving nephrology center showcases the power of commitment and innovation in healthcare delivery.
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ESRD IN ANTIGUA & BARBUDA 2018 Ian Thomas, MBBS (Hons.), ABIM (Neph.) Mount St. John s Medical Centre, Antigua Caribbean Institute of Nephrology 11thAnnual International Conference on Nephrology and Hypertension January 2019
Background 442 sq. km (171 sq. miles) Pop. 104,000 (UN estimates) GDP per capita - $15,022 (World Bank 2017) USA GDP per capita - $59,532 (World Bank 2017) Independent from UK November 1981 Ethnicity 91% Black, 4.4% Mixed, 1.7% White Single government supported hospital Medical Benefits Scheme
Dialysis Services 185 bed public hospital Sole haemodialysis (HD) unit at the Mount St. John s Medical Centre (MSJMC). No PD program 17 Stations with 1 portable unit for ICU Staffed predominantly by RNs with a few nurse assistants/dialysis technicians
Background First haemodialysis unit started at Holberton Hospital in 1997 Prof. George Nicholson (Barbados/Guyana) technical advice and first consultant Dr. Leslie Roberts (Trinidad) visiting nephrology consultant
Background contd 1stresident nephrologist in 2008 Dialysis services transferred to Mount St. John s Medical Centre in 2009 Last Dialysis Unit Expansion 2018
Current Structure 3 Nephrologists 2 inpatient, 1 outpatient Outpatient CKD Care Private, Health Centres, Public Hospital Dialysis services/ESAs/IV Iron/VDRAs provided without patient fees Funded by Medical Benefits Scheme Support by Antigua and Barbuda Renal Society
PROGRESSION OF PATIENTS Year Census at End of Year 1997 2 2003 13 2006 24 2008 43 2012 61 2017 89 2018 89
Demographics 2017 Incident rate ESRD 274 per million Prevalent rate ESRD 872 per million 2018 Incident rate ESRD 242 per million Prevalent rate ESRD 867 per million
Cause of Kidney Failure in Antigua and Barbuda 2018 Other 5% ADPKD 2% GN 9% Diabetes 54% Hypertension 31%
Gender Distribution of Prevalent Patients Females 38% Males 62%
Age (Yrs.) Distribution of Prevalent Patients 2% 15% < 30 30 - 44 45 - 59 42% 60 - 74 37%
Frequency of Haemodialysis Twice weekly, 46% Thrice weekly, 54%
Vascular Access Type Catheters 37% Fistulae 57% Grafts 6%
Vascular Access Care Among greatest challenges for our HD program Resident access surgeon emigrated Most surgeries done by visiting vascular access team from USA Occasional patients have travelled to Jamaica and Barbados for access creation or percutaneous procedures
Challenges Facing HD Unit Cost of care Limited HD machines Physical space restrictions Nursing Staff limitations Difficulties with early detection/management of renal bone disease
Challenges contd Reliable access to medications (costs) Vascular access supplies and care Care for patients with Hepatitis B (and HIV) Few living kidney donors
Initiation of Living Donor Renal Transplant Program External Support by visiting surgical team from University of Toledo, Ohio 1stcase performed in 2017 6 performed to date Financed by Medical Benefits Scheme with support from Antigua and Barbuda Renal Society All Donors and Recipients remain well
Special Thanks Dr. Frances Workman (Nephrology House Officer) Dr. George Mansoor (Consultant Nephrologist) Sister Debra Lewis Haemodialysis Unit Manager MSJMC
