Fistula formation in Gambia

Volunteering in Gambia by Anna Jerram

Anna Jerram remembers her time in Gambia where she travelled as part of a group of volunteer health professionals and the support of SonoSite and the Ida Bass Kidney Foundation (IBKF) in order to provide the local community with much needed vascular access services. 

In March 2017, I was invited by Consultant Renal Transplant surgeon, Mr Afshin Tavakoli, to accompany him and a team of two others on a trip to the Gambia. He had heard about the work of the Ida Bass Kidney Foundation (IBKF) charity through a colleague, and that the founder of the charity, Sailey Fladsrud, was looking for a surgeon who would be willing to perform Vascular Access (fistula) surgery in the Gambia.

Our team at the Manchester Royal Infirmary, UK

The current provision of haemodialysis services in the Gambia is extremely limited; Sailey and her family learned this first hand after their mother sadly passed away only 3 years after receiving her diagnosis of Chronic Kidney Failure. The IBKF was set up with the vision of improving these services, to give patients like Ida a better outlook. Through her hard work and dedication, Sailey and her team were able to open a 14 bed haemodialysis centre at the Edward Francis Small Teaching Hospital in Gambia’s capital Banjul, with dialysis machines and consumables donated by overseas companies and UK hospitals.

Most of the patients on the unit dialyse via temporary lines which are prone to infections. The alternative to dialysis via a catheter is for the patient to have an arteriovenous fistula created in their arm, through a surgical procedure. This involves the joining together of an artery and vein at a suitable site, to create a high volume reservoir of blood flow through which dialysis is achieved by the insertion of inflow and outflow needles. Infection rates are much lower using this method, as no indwelling catheter is required, and dialysis efficiency is improved.

So the challenge put to Mr Tavakoli and his right hand man, Renal Transplant surgeon Mr Omar Masood, was to create Vascular Access fistulae in a group of patients dialysing at the centre, to give them better dialysis, and an improved quality of life.

I was honoured to be asked to join the team, as the Clinical Vascular Scientist (a specialist Vascular Sonographer) who would perform the pre-operative duplex ultrasound venous and arterial mapping required to guide the surgeons in their decision making. My role also included post-operative duplex assessment of the fistulae which were created.

Scanning a fistula post -op on the dialysis unit, whilst the patient dialyses via their temporary line.

I was able to accept this exciting invitation thanks to the kind donation of an M-Turbo portable ultrasound system by SonoSite, for the duration of the trip. I’d already had experience of using the M-Turbo in the one stop Vascular Access clinic that I support at Manchester Royal Infirmary; the base of myself and the other members of the team going to The Gambia. To have a system I was already so comfortable and confident using in a completely new environment was great.

The fourth member of our team was Vascular Access Specialist Nurse, Sister Alayne Gagen, who had an integral role in post-operative care and planning for the patients. She also provided training and information for the nurses on the dialysis centre.

Mr Tavakoli and Mr Omar Masood in theatre, teaching the Gambian surgeons to make a fistula.

The fistula surgery performed during our stay had a 100% success rate. The patients who had the surgery were very grateful, as they would not have been able to pay for the operation privately, currently the only option for them.

Me, looking extremely serious, in the pre-op vein mapping clinic at the Edward Francis Small Hospital, Banjul.

Our trip to the Gambia was well received by the doctors and surgeons at the hospital we visited. They had the opportunity to learn the surgical techniques from Mr Tavakoli and Mr Masood; and the theory behind fistula ultrasound, vein mapping, creation and aftercare through lectures given by myself and the team.

Our team with Sailey Fladsrud, IBKF founder (far left) and some of the surgeons and hospital directors.

All in all, our week in the Gambia was a wonderful and eye opening experience, including an unexpected appearance on the Gambian TV channel to talk about the project! We all hope to stay in touch with our new colleagues in the Gambia, with a possibility of a return visit in the future.

Please visit the Ida Bass Kidney Foundation website  for more information or to make a donation to the charity.

By Anna Jerram

Clinical Vascular Scientist, Manchester Royal Infirmary, UK

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