Thursday 3 March 2016

A moment that changed me: carrying out kidney transplants in Gaza

It is only a 20-minute walk, but crossing no-man’s-land at the Erez border control changes everything. Entering Gaza feels like gaining access to a state penitentiary; there are guards, automatic weapons, dogs, gates and the infamous wall, designed to keep the 1.85 million Gazans in, and everything else out. Israel is an advanced country, with fantastic infrastructure and a healthcare system to rival any of those in the western world. Just a few miles down the road though, you see a different story. As an NHS doctor, working in a busy tertiary centre in Liverpool, I am used to working long hours, coping with staffing shortages, and the constant pressure. Despite this I am proud that we provide quality healthcare for our patients at any time of the day or night, seven days a week. That’s why I wanted to help those not so lucky to have such a healthcare system.
My journey to Gaza began with a charity, the Liverpool International Transplant Initiative (LITI). LITI was responsible for the first kidney transplants in Gaza, and has performed 25 successful transplants there now. As we made our way from the border to the al-Shifa hospital, the largest in Gaza, I couldn’t help but notice the buildings lying half-demolished and derelict along the way. The 2014 war had a colossal impact on the infrastructure of Gaza, and many people are still trying to recover. Al-Shifa hospital itself is little more than a large apartment block with no resemblance to the hospitals we know so well in the UK.
Our aim on this mission was to carry out four kidney transplants, all live donors, from relatives of the patients. Living with kidney failure in the UK is a struggle, even with advanced support, three to four weekly dialysis sessions, regular follow-ups, dietitian input, specialist nurses, anaemia management and hospital transport. In Gaza it is almost impossible. Suffering from kidney failure here means almost certain premature death. Dialysis centres are few and far between, and cater for numbers that are unheard of in the UK. This means that patients may only be able to dialyse once or twice per week, which puts an enormous strain on the body and leaves them with a substandard quality of life.
Our first patient was a 27-year-old woman, due to receive a kidney from her brother. She had been admitted to hospital three days previously with pneumonia, and even while talking to us at rest was extremely breathless. It became painfully obvious that this young lady was not fit for a transplant on this mission, her body was still fighting off the pneumonia, and to put her through a huge surgery and immunosuppression would not be right. In Liverpool this patient would receive antibiotics, her anaemia corrected and in six weeks’ time would be in the best shape possible to have her transplant. Unfortunately this is not the case in Gaza, and I suspect this woman may not be alive by the time we next fly out.

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