An electronic publication from the Australian Indigenous HealthInfoNet
Issue 8, July 2000 - October 2000 : ISSN 1329-3362
Conference abstracts and papers
Aboriginal Health 2000: Cultural partnerships - unified in health
29-30 June 2000, Sheraton Perth Hotel, Perth, Western Australia.
M. Thomas, A. Irish, B. Saker, K. Warr, C. Lim and J. Whishaw
Self-care dialysis and preventative kidney disease treatment for
Aborigines from remote areas of Western Australia.
Aborigines from remote areas of WA have a 5- to 10-fold greater incidence of predominantly diabetic endstage kidney failure (ESRF) than non-Aborigines, but have limited options for ESRF therapy. Cultural and family ties limit the 2500 km relocation for hospital dialysis in Perth; high staff turnover in remote areas and widely-disparate small patient numbers make nurse-assisted satellite dialysis units difficult; and racial tissue typing differences with unpredictable medication compliance retard transplantation.
In 1989, after widespread consultation, a programme of training and support was offered to permit self-care HD/CAPD in remote areas of WA. Live-donor transplantation was performed where feasible, and thrice weekly PD in local hospitals was reserved for dependent patients. Culture/area-specific hurdles included: the primacy of tribal elders in initial selection of potential donors and HD partners, enteric parasitosis, non-English speech or reading, ground temperatures over 50oC, variable power supply and bacterial water contamination, and lack of security for machines and stores. Initial experience with transplantation and intermittent PD was sub-optimal, however, the self-care dialysis programme was more successful than originally anticipated, using intense Perth-based initial training, location of HD machines in the local hospital or home (and a spare machine per area), weekly telephone contact using numbered sequential photographs for trouble-shooting, and regular review, alternating between Perth and home. Aboriginal patients now represent 25% of all 300 RPH dialysis patients, including 20% of the whole Home HD program, and 60% of the CAPD program, achieving acceptable results. Nurse-staffed satellite HD Units have been operating in the Goldfields for five years, and are to open soon in Port Hedland and Broome. RPH provides a 2-3 monthly visiting nephrology service to the regions, often sited in the Aboriginal Medical Service with attendance by Aboriginal Health Workers encouraged. Strict control of hypertension and diabetes with correction of obesity and alcohol excess can markedly slow the progression of kidney failure.
