Yesterday we visited the Madras Medical Mission where we met Dr. Georgi Abraham, the founder of Tamilnad Kidney Research Foundation (TANKER), an organization that focuses on detection, awareness, research of CKD and providing dialysis for the underprivileged. He spoke to us about the rising burden of CKD in India given the increased prevalence of chronic health issues like diabetes and hypertension. The statistics were alarming — 48% of patients presenting with CKD are already stage V and 63% of people with ESRD are on conservative treatment and not on renal replacement therapy.
Although the numbers are disheartening, the work that TANKER is focused on with awareness and screening may hopefully turn those numbers around. The Awareness and Prevention Program at TANKER is spearheaded by Rajalakshmi Ravi. Under her direction, the Awareness Program has reached nearly 120,000 people and screened over 22,000 people for kidney disease. Through her work, she has identified many significant risk factors that predispose individuals to CKD, including acceptance and understanding of their underlying disease states, such as HTN and DM.
Are physicians partly to blame for patients not understanding their disease, health, and treatments they require? After seeing the outpatient clinic at Sri Ramachandra University and reading Das’ paper on healthcare delivery in urban and rural populations in India, it is clear that patients have limited face time with physicians (3.6 to five minutes per encounter). The time to explain diagnoses, treatments, and promote adherence to medications for chronic illness is scarce and from my limited exposure it seems to be non-existent. Even at BMC and at my own clinic at South End Community Health Center, patients struggle with treatment adherence despite my best efforts with educating them about their disease and importance of taking their medicines. Despite this, Mrs. Ravi highlights that peer educators can play a major role, if not an even more important role, in helping people understand their disease, promote healthy lifestyle, and encourage adherence to treatment. She is truly a “Boss Lady” as I like to say, and it is inspiring to see the work that she has accomplished.