ISN Educational Ambassador, Nitin Kolhe, consultant nephrologist at the University of Derby and Burton (UHDB) NHS Foundation Trust in the United Kingdom, spent a week at Mpilo Central Hospital in Bulawayo, Zimbabwe as part of the ISN Educational Ambassadors Program (EAP) in March 2020, before COVID-19 restrictions were in place.

UHDB nurses Sister Carol Rhodes and Sister Claire McGuire accompanied Dr. Kolhe on the visit. The aim was to train local staff in kidney biopsies and peritoneal dialysis services, and how to reduce infections.

According to Dr. Kolhe, patients in Bulawayo tend to present late with advanced kidney disease, and recognition of acute kidney injury and chronic kidney disease in primary care is poor. Patients are unable to receive peritoneal dialysis at Mpilo Hospital, and hemodialysis can be interrupted by frequent electricity loss and machine breakdowns. Patients may have to travel up to 300 kilometers for treatment and buy any equipment for dialysis themselves. 90% of patients are dialyzed on vascular catheters because no vascular surgeon can perform AV Fistula. Kidney biopsies have not been performed in public hospitals in Zimbabwe for more than two decades; they are only done in the private sector in Bulawayo because there is no formal renal biopsy program in government hospitals.

The team from UHDB provided teaching on recognizing acute kidney injury and investigating and managing chronic kidney disease in the community. Dr. Kolhe gave training on all aspects of performing kidney biopsy and setting up a peritoneal dialysis program.

Doctors and nurses received hands-on experience of inserting peritoneal dialysis catheters and scanning kidneys in three patients and one volunteer. Dr. Kajawo, a clinical nephrologist at Mpilo Hospital, performed two kidney biopsies under the guidance of Dr. Kolhe using real-time ultrasound guidance. A diagnosis based on a review of histology slides was made in a public hospital in Zimbabwe for the first time in more than 20 years.

Staff at Mpilo Hospital learned how to deal with potential complications following kidney biopsy in different case scenarios. The aseptic no-touch technique (ANTT) was demonstrated, as well as hand-washing techniques and the correct use of gloves.

The favorable exposure surrounding the visit helped raise awareness of the challenges in local kidney care. The Minister of State for Bulawayo Metropolitan Province, Honorable Judith Ncube, pledged to support kidney health initiatives, promising to help Dr. Kajawo in procuring peritoneal dialysis fluids and kidney biopsy needles.

Dr. Kolhe was impressed with the dedication and goodwill of local doctors and nurses despite the sub-optimal working conditions. He has invited Dr. Kajawo, and his colleague Sister Pat, for a week of training at the Royal Derby Hospital. He comments: “For the Mpilo kidney unit, continuity is important. ISN is doing a wonderful job of educating the developing world. EAP equips local doctors with knowledge which they cannot afford to get.”