FEATURED: Dr. Momina brings kidney care expertise to King Faisal Hospital

Dr. Momina Muhammed Ahmed, a nephrologist – specialist in the treatment of kidney diseases and related conditions, including kidney transplant which has not been done in Rwanda thus far –, joined King Faisal Hospital (KFH) in January 2021. She is of Ethiopian nationality and she is one of the pioneers of kidney transplant in Sub-Saharan Africa. She played a key role in Ethiopia’s first kidney transplant centre, a practice which is done in only a few Sub-Saharan African countries. Before the kidney transplant centre was established in Ethiopia, patients used to get the transplant service abroad. But, Dr. Momina said that thanks to the medical development, she followed close to 400 kidney transplant patients back home, with her team. The Doctor’s joining KFH team represents a big milestone as the hospital strives to become a centre of excellence catering to regional healthcare needs, and is also aligned with Rwanda’s vision of being a centre for medical tourism, according to the Hospital. The New Times’ Emmanuel Ntirenganya had an interview with Dr. Momina from KFH on Thursday, February 11, in which she talked about the expertise she is bringing to the Hospital and what it means to advance kidney care in Rwanda. Here are the excerpts: What motivated you to get into kidney disease treatment specialisation? There were few nephrologists in Ethiopia, and an exponentially growing number of kidney disease patients. So, the main motivation was to end the suffering of people suffering from kidney disease, and the lack of doctors to take care of them. I wanted to get trained [abroad where there was advanced kidney disease treatment] and come back and train more doctors. I trained in South Africa and also received kidney super-specialty training in the United States. Later, I got back home [and] I started my kidney disease specialty and super-specialty programme supported by partners from the United States. I managed to work with my colleagues to produce at least 12 nephrologists. What is the experience and expertise in kidney disease treatment that you are bringing to King Faisal hospital and that could save the lives of patients who come to the Hospital? I have acquired experience in managing almost all kidney diseases. I am here to share my expertise in advancing kidney care, to assist the Rwandan physicians in developing the skills for treating kidney diseases, and setting up a kidney transplant programme in Rwanda. Those are the two main jobs or responsibilities given to me. What is the burden of kidney disease in Rwanda? As any other organ of our body, the kidney can be affected by several pathologies. And, diabetes, hypertension and obesity are the main reasons for kidney failure. There are two forms of kidney failure [acute and chronic]. [In case of] acute kidney failure, there is rapid dysfunction of the kidney because of many reasons. So, [in this condition] if the patient is supported with dialysis, the kidney can recover (most of this kind of problem recovers within six weeks). But, there are kidneys [that are] irreversibly damaged – [in the case of chronic kidney failure]. With private insurance or the Rwanda Social Security insurance which covers like 85 per cent, it is less expensive as out of pocket expense (the part of medical bill that the patient has to cover with their own money) is like $15 for the dialysis (for one treatment). Not only do we need laboratory work but we also need to buy some medicines, so it increases the cost of the treatment. There are currently seven dialysis centres in Rwanda, and almost all of them are functioning at their full capacity. So, we have close to 50 patients on dialysis, and close to 100 patients who got [kidney] transplants abroad. This is not a small number. And, these are patients who get the chance to get diagnosed, and also have the capacity to get the dialysis and the transplant. So, we can say this is just the tip of the iceberg. Most of the cases are undiagnosed because the patients do not have the means to get the diagnosis. The access of dialysis is limited for several reasons including financial limitations and poor diagnosis in the countryside caused by the constraints of facility and trained human resources. Given the issue, what can be done to help patients, especially the vulnerable, access this lifesaving treatment? This is a very big public health problem. And, it’s not only in Rwanda. Rwanda is lucky because your population numbers are not huge, and the Government is covering for [the cost of] at least acute [renal failure] dialysis (for six weeks under the community-based health insurance scheme), and sponsoring kidney transplant to be done abroad. In Sub-Saharan Africa, there are only a few countries where the Government sponsors dialysis because it is very expensive, and the number [of patients who need the treatment] is huge, and we don’t have a lot schemes established to support this segment of the population. What I would strongly advise is to work on prevention. That’s the most cost-effective way to do for low resource and developing nations: preventing those risk factors like obesity, hypertension, and diabetes from coming into the picture. What is kidney transplant, and why does it matter? Kidney transplantation is the best treatment option for most patients suffering from end-stage renal failure. So, to have a kidney transplant, the patient should be in acceptable health condition, there is a need for enabling [medical] infrastructure. To do a kidney transplant, there should also be a kidney donor in good health condition. So, we check the details on the health of the donor, and the health status of the recipient as well. This (donated kidney) is a foreign part [to the recipient body]. So when we put this foreign organ into someone’s body, the body will not keep quiet; rather it will fight, and the kidney will get damaged. In order to reduce that fight, we give medications so that the body won’t fight the new kidney. We call them immunosuppressants – drugs that lower the body’s ability to reject a transplanted organ. They (those medicines) are also expensive and they have to be taken properly for as long as the new kidney is functioning. Keeping patients on dialysis is also very expensive. The best way to advocate is to have them get kidney transplants. When you compare it with dialysis, kidney transplant has got several advantages in prolonging patient survival, and after they get the transplant they come back and they become productive and contribute to the community. Their lifestyle will be like returning to normal than the patients staying on dialysis. And, also, financially, in the long-run, transplant is cheaper than staying on dialysis. So, for a country like Rwanda, working on prevention, and kidney transplant [in the event of some kidney failure], should be the way to go. You said there is a plan to set up a kidney transplant at King Faisal Hospital; what does it entail and when is it expected? We want to do the setup. This needs the mobilisation of resources, to strengthen the lab, the radiology, the pathology, finance and staff and ICU among other things. And, the most important [part] is the legal policy, and framework because kidney donation is a very sensitive issue; it should be done in an ethical manner. So, the [required] law and policy should be in place. We should first work on those tasks. Hopefully the next step will be recruiting all the proposed staff including those to be trained as nephrologists, and later offer kidney transplant services at KFH.

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FEATURED: Dr. Momina brings kidney care expertise to King Faisal Hospital