By Anna Jerram (Past-Committee Rep for SVT)

Clinical Vascular Scientist

Manchester Royal Infirmary

Gambia Experience May 2017

In March, 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 there.

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 11 months 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 commissioned a 14-bed haemodialysis centre in 2015 at the Edward Francis Small Teaching Hospital in Gambia’s capital Banjul, with dialysis machines donated by UK hospitals.

Most of the patients on the unit dialyse via temporary lines which are prone to infection. The alternative to dialysis via a catheter is for the patient to have an arteriovenous fistula created in their arm, through a surgical procedure. For those not familiar with the 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 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 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. 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.

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 at the dialysis centre.

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 afford to pay for the operation privately, currently the only option for them.

Our trip to the Gambia was well received by the doctors and surgeons at the hospital we visited. They had the opportunity to learn 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.

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 www.ibkf.org.uk for more information or to donate to the charity.

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

CASE Newsletter Article, December 2017