Chronic renal failure: Thousands are affected

By Dr. C.S. Weeraratna

E mail: (csweera@sltnet.lk)

A Chronic Kidney Disease is causing untold hardships to thousands of people in North Central, Uva and North Western Provinces . A large number of people affected by this disease are dying. What are the authorities doing?

Since the year 2000, a kidney disease called Chronic Kidney Disease of unknown etiology (CKDU) , also called Chronic Renal Failure (CRF) has been reported to occur in several areas of Sri Lanka . The total number of affected individuals is unknown, but it is thought that around 10,000 people, most of them in North Central Province (NCP), are currently undergoing treatment for this disease.

A seminar on CKDU, organized by the Faculty of Graduate Studies of the University of Sri Jayewardena pura, was held on 12 Dec. 2011. According to the deliberations at this seminar, CKDU is more prevalent among men , typically around the age of 40-60 years, engaged in agriculture. The patients affected by CKDU are mostly in NCP in addition to some parts of North Western and Uva provinces. It is a major health problem in a number of DS Divisions such as Medawachchiya, Kahatagasdigiliya in North Central Province. Around 1500 people in NCP have reached the end stage of CKDU. The only treatment for them is dialysis which has to be carried out atleast once a week and there are not enough dialysis machines in the hospitals in the affected districts. It costs around Rs.6,000-10,000 for a dialysis, and most of the affected people cannot afford this. As a result , a large number of CKDU patients and their families are in a desperate situation.

According to separate studies carried out by a number of scientists, CKDU is attributed to a toxic element/s or compound/s in drinking water. Among these constituents are cadmium, fluoride, aluminum, toxins released by Blue Green Algae, pesticides etc. A draft research proposal to determine the causal factor/s of CKDU was prepared by a team of experts and a research programme is supposed to have been initiated by the Ministry of Health, in October 2008. The final report of this study was expected to be submitted in Dec. 2009. Two years have passed but this report is not yet released. The exact causal factor of CKDU is not known and scientists are continuing studies to find what causes CKDU.

While the scientists are carrying out their "studies" to determine the causal factor of CKDU , it is extremely important that action is taken to reduce the occurrence of this lethal renal disease which is causing untold hardships to the thousands of poor people in three provinces of the country. The most important issue, not addressed effectively up to now by the relevant authorities is the fact that thousands of people, mainly from the Dry Zone have died/become disabled as a result of CKDU. The national Ministry of Health and their counterparts including the Chief Ministers in the affected provinces appear to be inactive on the issue of CKDU. There is a need for a comprehensive public health effort to effectively address the problem. The provincial political authorities with the relevant officers need to take more effective actions to implement an integrated programme in association with other responsible authorities, to prevent/control the occurrence of CKDU.

One way of reducing the incidences of CKDU is implementing a programme to supply good quality water to those in the affected areas. People in the city of Anuradhapura who are supplied with water from Thuruwila by the Water Board are not affected by CKDU. Those who can afford, use bottled water as they are aware that it is the water which causes CKDU. Those who cannot afford to spend a lot on bottled water tend to drink less water which may exacerbate the problem. Promoting use of rainwater wherever possible is also another alternative. Rainwater is relatively the most pure form of water. It is almost free of toxic elements/compounds. A considerable portion of the rainwater that falls on the roofs of buildings can be collected in tanks in the premises itself. Water that falls on a roof of 1,000 sq m in an area where the annual rainfall is 1,500 mm (the annual rainfall in NCP is around 1500 mm) would be around 1500 cubic meters (i.e app. 1.5 million liters or app. 300,000 gallons). Water thus collected could be used for numerous domestic purposes including drinking. For centuries the world has relied upon rainwater harvesting to supply water for households. Before city water systems were developed rainwater was collected (mostly from roofs) and stored in cisterns or storage tanks and used for drinking and other domestic purposes.

It is disheartening to note that the relevant authorities have not taken adequate measures to control/prevent CKDU, which is affecting thousands of people medically, financially and socially. A concreted effort need to be taken by the responsible authorities before we will loose a large number of our people in the Dry Zone.

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