The Presidential Task Force on Chronic Kidney Disease prevention in Sri LankaD

The Presidential Task Force on Chronic Kidney Disease prevention in Sri Lanka.D. N. D. Dolage (199191477/1)NUR 207 (Research Method)BSC. Nursing – 10th BatchICBT Campus – ColomboUniversity of Sunderland2019-12-28Word Count - I declare that this is my own work and it has not been submitted for another assignment.Signed: Dated: 28-12-2019 Chronic Kidney Disease Prevention in Sri Lanka Renal failure is a situation in which the kidneys fail to function adequately. It describes as a decrease in the glomerular filtration rate. Biochemically, it is typically detected by an elevated serum creatinine levels. Renal failure can be divided into two categories; acute renal failure (ARF) and chronic renal failure (CRF) also known as Chronic Kidney Disease (CKD). ARF is a rapidly progressive loss of renal function, whereas CRF is a slowly worsening loss of the ability of the kidneys to remove wastes, concentrate urine, and conserve electrolytes. People with kidney problems often suffer from a lack of physical strength, tiredness and muscle wasting, which reduce their capacity for physical activity and these situations are much worse with CRF . The main causes of this condition are the accumulation of toxins in the body due to kidney failure, and the anemia situation that the kidney failure patients often suffer from, resulting in tiredness and the difficult to breathe. However, as stated by the World Health Organization (WHO), among both types of kidney diseases, CRF or CKD is becoming a pandemic and creating a global burden (WHO Bulletin, 2018) Considering CKD it is defined as kidney damage or glomerular filtration rate (GFR) 30 mg/g in two of three spot urine specimens (WHO, 2019). Although there are many causes for chronic kidney disease present; Diabetes mellitus, hypertension, heart attack or stroke, obesity, family history, heavy tobacco consumption, and being over the age of 60 are the most common causes. (About Chronic Kidney Disease, NATIONAL KIDNEY FOUNDATION, 2019). According to the WHO (2018), Global Burden of disease assessed 5-10 million people die yearly from kidney disease. According to Rajapakse, Shivanthan and Selvarajah (2016) considering Sri Lanka, even if there is no exact statistics reported on CKD incidents in the whole country, as the prevalence of CKD is about 15.1% -22.9% in some selected districts of the country. However in the recent years it has noticed that the reporting incidents of CKD are rising up in the country comparing to the past. Sri Lanka with a population of approximately 20 million, agriculture is an integral part of the lively-hood of the country. Mostly farmers are tending to use fertilizers with various chemicals. From a recent research study done by a group of University professors revealed that these chemical fertilizers are being identified as contributed to develop CKD among people in rural areas. ( Wimalawansa, 2014 ) From this study it has also identified that excessive usage of agro- chemicals, rich with heavy metals collecting not only within the plants but also adding to fresh water reservoirs. This water, rich with accumulated heavy metals which are consuming by the people is dangerously effects on their kidney cells. Not only that Bandara et al., (2008) pointed out drinking contaminated water is the main cause of CKD. In this way CKD has unusually started to spread an epidemic situation in the country and it harmfully affected the patient as well as their families in the aspect of the socio-economic dimensions, community and the country. Moreover, the increased incidents of CKD raise the number of hospital admissions which require renal therapies such as dialysis and increase the work load of hospital staff. Hence, the staff would not be able provide complete individual care for all the patients in general. The most pathetic situation is the increased number of deaths because of inadequate dialysis unit in hospitals in related to the number of patients. Here as a result the Government needs a large sum of money for providing facilities and treatment for the patients, staff salaries and infrastructure. Therefore, it needs to increase the budget more than annually estimated. And also there are so many problems occurred socially and economically in the patients’ families because of suffering from CKD. It directly affects for the education of school children as well. Since CKD has become a serious health problem and often creates a radical disruption in the individual’s life and activities. . There are so many disruptions in patients with CKD, and they become more tremors challenge with the decrease of income, unemployment, family issues, fluid and dietary restrictions, limitation of activities, physical and mental changes, loss of social integrations, as well as inability to fulfill long-term life plans (Heiwe et al., 2003). In short, it is a truth that if a person gets CKD once he or she will ruin not only due to the disease but also due to its bad effects. CKD is a disease which is varying from person to person and it is prognosis is very poor and unpredictable, the symptoms also differ from person to persons and it may be mild or life threating. Therefore CKD should have a complex regimes of treatment (Jacobs, 2006). Although the disease is irreversible, the main aim of the care given when treating to the patient or slow the loss of renal function and to prevent complications (Manuel, 2002). The most important thing is to prevent CKD is adapting for a healthy lifestyle and it will reduce risk and progression of kidney disease (Renee & Lynn, 2000). The condition may get worse because of not having appropriable long-term treatment, and it directly affects for the social interactions and economic capabilities of human (Lancaster, 1988).Understanding this as a future problem of the sustainable development of the country, the MOH has taken immediate actions to control and prevent this dreadful disease condition. For this, the presidential Task Force (PTF) on Chronic Kidney Disease was founded under the guidance of the former president in order to prevent CKD which has become a national health hazard. This task force works for the prevention of CKD, provides the provision for treating the victims and facilitate the welfare of families of the victims. The PTF official web site was launched on the 16th September 2015 to make people aware on the prevention of kidney disease and buildup a campaign for the kidney pts. Here the president stated that the Government could not fight against CKD alone. And also asked for the support of the general public to accomplish this task against CKD. (www. Presidentialtaskforce.gov.lk).  Considering the functions of this task force, the vision of the PTF is to control CKD and ensure welfare of patients and their families whereas the mission is to enhance and sharing knowledge applying correct methodologies prevent and treatment of patients and assuring the welfare of victims. The roles and responsibilities of PTF on prevention of CKD are: Preparation of a National plan or policy for eradicating CKD; Inter Ministerial, departmental and institutional coordination with regard to CKD; Intervention in legal and policy matters with regard to CKD; Act as a facilitator with regard to CKD and Supervision and Guidance, Feedback and project review With the involvement of the Sri Lankan President it was constructed a special unit with modern facilities for CKD Patients. In the North-West province .The PTF established new kidney centers in the Kandy teaching hospital and Colombo NHSL. Also PTF renewed the former units of Maligawatta. The Health Minister installed 30 dialysis machines at the NHSL. In 2015, there were 450 dialysis machines in Sri Lanka. Evan though the minister of health promised to increase the number of dialysis machines up to 1000. There were 3000 trained nurses by the year 2017. But since the number of kidney patients has increased the hospitals need to recruit 6000 trained nurses. Further through this program it was taken measures to provide purified water supply services for the people living in the affected areas as a preventive measure. Hence government should provide clean water to all people living in and around CKD affected areas. However still PTF has failed to implement and affective program to supply good water for those people. Many problems were aroused when implementing the plans, because of the disturbances occurred in applying PTF proposals. At first it had been introduced research proposals for consider regarding the reasons of rapid spreading the disease. But they were delay because of inability to allocate grants and difficult to find researchers. At finally it comes to the conclusion that the usage of chemical fertilizers is directly affect for the disease. But these findings were suppressed by the involvement of multinational co-operations and political issues. And also, the health sectors had to do a great effort for make people understand regarding prevention of disease as these patients were in poor awareness about the disease condition. . The kidney transplant support foundation was established in 2007. After that then Health minister started the national organ the Donor program in 2009 with the help of national kidney foundation of Sri Lanka. The objective was to support the large number of kidney disease patients who were dying due to lack of donors. The kidney protection society raises funds to financially help needy patient. Farmers generally belong to low income group and are not bothered about environmental benefits of hazards. They are interested in maximizing their crop yields and profits. They never use and personal protective equipment like gloves and masks, when they handle fertilizers and agrochemical. Further the government is not strong enough to control the power of Multi National Fertilizer Companies which do not like to stop selling harmful fertilizers. In addition, the government should provide harmless organic manure for the farmers and provide clean water for the affected people. It is very important to provide clean water to all inhabitants of CKD affected and surrounding villages. Hence the PTF needs to have an effective program to supply good, quality water to those in the CKD affected areas. But there appear to be no effective plan to supply good quality water to the affected areas. To achieve this objective it is necessary to know the number of affected people in the different divisions. Further the patients who have under gone kidney transplant surgeries should be financially supported. The government has to spend more and more fund for that. So it directly affected to the economy of the country which is still developing. Even though the government has established PTF and a kidney transplant unit to fight against CKD still the government has failed to control the situation. The reasons for this failure are; poverty of the patients, lack of awareness and education on the dangerous of the disease not attending clinics regularly as they are busy with life. Also they do not have enough awareness regarding regular clinical follow up as well as they do not follow correct dietary pattern which is suitable for the disease. Not only that, there are not enough medicine and other health care facilities in related to the increasing number of patients. There are low number of health care workers and nephrologists is also affect for the controlling the disease. . Rising the number of hospital admissions which require renal therapies such as dialysis increases the work load of hospital staff Hence the staff would not be able provide individual care for all the patients in general. In conclusion, according to my point of view the government must take more stern and effective actions to curb the CKD. The government can employ PHIS and use media like TV channels to educate school children and people living in the affected areas about the health hazards of CKD. When treating for CKD, they should have to dialysis the patients or kidney transplant to live. Many people live long lives while on dialysis or after having a kidney transplant. So that government has to do a great expender. As well as they have to spend more expenses for the medicines used in treating those patients. There are many reasons to interrupt for the disease control programs such as, not having enough health education and no specific training programs for health care workers. We must improve our knowledge regarding this. For that awareness programs are needed. Then only we will be able to give correct guidelines preventing this. Some countries have developed public health programs for early identification and treatment of CKD and complications. The effectiveness of these program is being evaluated. (Definition and classification of CKD, 2013). As nurses our responsibility in eradicating the deadly disease can be implemented in hospitals, clinics and in the society. We should take the responsibility of ensuring health maintains and awareness education of Chronic Kidney disease patients and asses diagnose, educate and treat patients who have developed or a risk of developing kidney related problems. Further they should support the patients in the later stage of kidney diseases, to follow required treatment procedures in order to prolong their life span. However PTF is trying hard to successes. Up to some extend they become successful. REFERRANCES

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