In times of the COVID-19 crisis, BKF has been constantly working to support people needing dialysis and associated care. Kartik Sriram, Trustee and Dr Veerabhadra Gupta, Chief Nephrologist, Bangalore Kidney Foundation explain how they do what they do in an exclusive interview with Akanki Sharma
Share a brief about Bangalore Kidney Foundation (BKF).
Sriram: BKF is a charitable non-profit trust established in 1979. We pioneered the treatment of renal disease in Karnataka. The foundation is focused on high-quality dialysis at affordable costs to the economically disadvantaged. It is our objective to make all our dialysis patients productive, economically contributing and independent members of society.
BKF is run by a board of trustees and a team of directors, all of whom are volunteers and don’t receive a salary. We have a small admin staff of five people. In addition, we have two consulting nephrologists, two full-time doctors, 35 medical workers and 15 support staff. Except for a couple of dialysis technicians who are stuck in their hometowns and unable to return to Bengaluru, all our medical workers have risen to the occasion and are working during the lockdown.
How many dialysis centres do you run in the city? Are these pan-India?
Sriram: BKF built the first nephrology centre in Bengaluru, which is under management now. We then partnered with the Sringeri Math to build the Rangadore Memorial Hospital (RMH). Due to the increasing demand of dialysis, we built a dedicated dialysis centre attached to the RMH which we operate – it’s the only dialysis centre run by us. We support other dialysis centres with medical-technical-commercial assistance at arm’s length. Further, as of now, we are only active in Bengaluru.
How huge is your team and how many medical workers are working currently in the times of lockdown due to the ongoing COVID-19 crisis?
Sriram: In the first few days of the lockdown, there were challenges of absenteeism due to conveyance and a modicum of fear in the family. Both were promptly addressed putting our patients as our primary responsibility. Our head technician, along with two of our doctors, spoke to the staff to determine what the reasons for absenteeism were. If it was conveyance and transport-related, we sought passes for their travel from where they were stuck – invariably their hometown. Where there was family pressure to stay home, the director operations spoke to the family over phone and set the members at ease by telling them the precautions we have taken. In the initial days when there was a shortage, we had to increase the number of beds a technician would oversee. However, with the steps taken, we now have enough medical workers to run the centre without any problems. Only two of the technicians are stuck near Mysore.
How many patients do you generally attend on a normal day and how has lockdown affected this number? Besides, how cost-effective is the dialysis process?
Sriram and Dr Gupta: BKF has an active list of approximately 270 patients. Most of our patients are daily-wage earners or very poor. Typically, we perform 120-125 dialysis every day. During the first few days of the lockdown, we saw a dramatic fall to about 80-90 dialysis per day. We formed a core team of admins, fund raising and medical staff to ensure that we do whatever was required to bring the dialysis back to 100 per cent. Every dialysis patient is immune-compromised and most of them have underlying diabetes or hypertension. This makes them prone to COVID-19 infection. In order to arrest the spread and flatten the curve, it was imperative that our patients received their prescribed number of dialysis to preserve their basic immunity.
Dialysis is expensive. In Bengaluru, most hospitals charge between Rs 2,500-Rs 5,000 per dialysis. A dialysis patient typically requires three dialysis per week for basic sustenance and immunity. BKF charges a maximum of Rs 750 per dialysis to our needy patients. It costs us approximately Rs 1,100/ dialysis and we subsidise the difference by raising funds.
Apart from the dialysis facility, are you also providing any other essential services to patients in the lockdown times, especially daily-wage workers? If yes, kindly elaborate on these. Also, do you have enough beds for the patients?
Sriram: The first problem we had to solve was funds. The lockdown meant daily-wage earners like autorickshaw drivers, fruit vendors, kirana shop owners, household help, etc., had no income. Other costs were going up and there was a real risk that our patients would get off dialysis. This would have disastrous personal and societal consequences for the spread of COVID-19. We set up a funding campaign titled ‘Arrest the Spread-Support Dialysis Patients.’ We approached our regular donors, corporate supporters and partnered with GiveIndia for crowdsourcing. Our target was to raise Rs 35 lakhs assuming that the lockdown would be lifted. This will be used to support comprehensive renal care when they are faced with the decision to stop dialysis. Given the extension of the lockdown, we now plan to revise it to Rs 1 crore.
The tangible problem for a few was something as basic as transport. We collected data of the patients who were unable to come for dialysis because of no public transport and other problems of lockdown. We then arranged them into locational clusters and figured out how to schedule their dialysis. We spoke to one of our patrons, Sundaresh who runs Arpana Seva Samasthe. He readily placed his van and driver with us. We organised milk runs to ensure that all our patients who faced the transport challenge availed dialysis.
In addition to dialysis, our patients require balanced nutrition conditioned to their specific case. We partnered with social institutions like Arpana Seva Samasthe and Lions Club to provide food rations to our patients so that they can sustain nutrition.
We have enough beds for the patients that we currently service. We have plans to buy another 20 dialysis machines which will give us enough capacity to service additional post-COVID-19 requirements.
What all necessary precautions is BKF taking to protect their patients, medical workforce and partners from community transmission of COVID-19? How are you managing to abide by the ‘social distancing’ norm, which is of utmost importance at the moment?
Dr Gupta: We formed a team of admin and medical staff to determine the protocol for COVID-19 response. The team has both consulting nephrologists, two full-time doctors and the head technician along with admin staff.
First, we set up a strong screening process for patients, medical workers and other staff. They are tested for temperature and symptoms daily. Second, we screened all patients and their attenders for any history of contact and travel. Anybody with a history of contact with someone who had travelled was under strict observation. Third, we restricted the admission of attenders from entering the dialysis centre. Fourth, we made it mandatory for every patient to wear surgical masks. Bed-to-bed distancing was not a problem since we already met the requirement. Fifth, we introduced sanitation and cleaning schedules for the dialysis machines, beds, rails and surrounding areas after every dialysis by trained staff. Sixth, we made it mandatory for the medical and support staff to follow PPE guidelines issued by the Government of Karnataka. Rotary Club Bangalore South West is assisting with this.
We also set up an isolation ward on a separate floor for dialysis of patients under observation.
So far, we have had to refer only one patient to the Nationa Institute of Virology (NIV) for testing. The patient was tested negative and has resumed regular dialysis.
While we are able to ensure social distancing within our centre, our patients have to come out of their homes three times a week for dialysis.
How is BKF funded? Any financial aid from the Government of Karnataka, the Centre or corporate companies?
Sriram: BKF is entirely funded by the generosity of several individual donors, like-minded trusts, corporate foundations and corporate bodies. We are a non-profit trust entitled and donations are 80G exempt for Income Tax. Our major donors include Texas Instruments International Foundation, IQVIA, Timken, Cognizant, Microfocus, etc.
Any important precautionary message for those who are dependent on dialysis in the current COVID-19 hit scenario?
Dr Gupta: Ensure that patients continue with their prescribed frequency for dialysis. It is very important for society to support this under-supported cause. It is estimated that after ventilators, dialysis machines may be the next highest shortage in hospitals. However, there is no awareness or reporting around this. There should be a much greater awareness and support of this cause.
akanki.sharma@expressindia.com