Thursday, 12 November 2015

2 can share a kidney


Gabriel with his younger brother, who donated a kidney to him.
 
JACK ZIMBA      
WHEN Gabriel Phiri was diagnosed with kidney failure in 2006, he felt like it was the end of the world for him.
“It was a fright. It was a question of am I going to live or maybe this is the end of it all,” says the 55-year-old.
Today, however, Mr Phiri lives a fairly healthy life, thanks to a donated kidney he received from his younger brother.
Mr Phiri discovered that both his kidneys had collapsed after a freaky incident. While waiting for a friend in a car park, a tiny particle entered his eye and he ended up at the hospital to have it removed.
However, after routine tests, it was discovered that Mr Phiri had high blood pressure, a shocking diagnosis, as he was not a known hypertensive. Prior to this episode, however, Mr Phiri had for a long time suffered loss of appetite, which he could not understand.
But it was the second diagnosis that scared him the most.
Further tests revealed that Mr Phiri had abnormal levels of urea and creatinine (a chemical waste which is a by-product of normal muscle contractions) in his blood. This led doctors to check his kidneys and confirm the worst - both organs had collapsed.
DIALYSIS VS TRANSPLANT
After the diagnosis, Mr Phiri was put on dialysis treatment, which he received three times a week at a private hospital.
But even for an established businessman like him, meeting the cost of dialysis at the private hospital soon became unbearable. At the time, treatment cost K800 per session, and a patient needs three sessions per week.
Today, the cost of dialysis ranges between K1,200 and K1,700 per session at private medical facilities.
Under a government scheme, however, the treatment can be accessed at highly subsidized fees. There are three categories of payments, with the highest being K400, while the least is K50 per session. There are others still, who get the service for free under the scheme, including children and pregnant women.
But although he was able to access cheaper dialysis at UTH, life on the machine was beginning to take a toll on Mr Phiri and his business, as he had to spend many hours out of the office.
“Four hours on the machine drains you,” says Mr Phiri, who runs a printing company.
After three years on dialysis, doctors recommended kidney transplant as a long term solution for Mr Phiri.
Although he was scared to undergo a transplant, he took the offer.
“When you are in a situation where it’s a question of life or death, you take anything that is offered to you as an option,” he says.
Two of Mr Phiri’s brothers offered themselves as possible donors of the bean-like organ, but it was Vincent, his youngest brother, who had a matching blood group.
“I did it out of love,” says Vincent, who was 33 years old at the time.
The Zambian law does not allow harvesting of organs from dead people; hence the only source of body parts is a living person, preferably a blood relative.
On March 29, 2009, Mr Phiri underwent the transplant operation at Apollo Hospital in India, making full recovery within two month.
As for Vincent, he leads a normal life just like before.
“People ask me if I feel like there is something missing in me…but I don’t feel anything,” he says.
“I think I have become more attached to him,” says Mr Phiri about his younger brother.
“Of course there is that feeling that if it wasn’t for him, I would probably not be here. There are people I spent time with at UTH who died because, in some cases, they never had the privilege that I had,” he says.
He says the transplant gave him “a second chance at life”.
It is a second chance that others long for.
Maganizo Mabengwa is a young man in his late 20s. He has a catheter permanently inserted in his abdomen and thrice a week he visits the renal department at UTH for dialysis.
He complains about life on dialysis and his face beams when asked if he would consider a transplant. 
“I wouldn’t refuse that…I wouldn’t,” he says.
Maganizo discovered he had kidney failure in October last year after visiting the hospital with symptoms that included swollen legs, vomiting and night sweats, and although he never suspected anything very serious, he was diagnosed with kidney failure.
Hypertension was given as the reason for Maganizo’s condition. But just like Mr Phiri, he, too, was not a known hypertensive.
According to Dr Charles Mutemba, a nephrologist or kidney specialist working at the University Teaching Hospital (UTH), many people will not know they have kidney failure until the condition becomes advanced, usually resulting in swollen legs.
Dr Mutemba says many people who are diagnosed with kidney failure are “crash-landers”, people who, like Mr Phiri, go to seek medical attention for something different.
He, however, says symptoms of kidney failure usually mimic the original disease, making screening difficult.
There are two types of kidney failure - chronic and acute kidney failure. Acute kidney failure, which is reversible, is usually caused by sudden occurrences such as accident, poisoning and diseases such as malaria.
Chronic kidney failure, which is a result of permanent damage to the kidneys, is caused by three major factors, according to Dr Michael Mbambiko, a UK-trained kidney transplant surgeon.
“If someone is hypertensive and the blood pressure is not properly controlled, one of the organs that gets damaged is the kidney and it is damaged irreversibly,” says Dr Mbambiko.
Diabetes is also listed among the major causes of kidney failure, while ethnicity is also a factor, with black people being more susceptible to the condition, according to Dr Mutemba.
He says Truvada, which is one of the first-line treatments for HIV/AIDS, has also been known to cause damage to kidneys, so has the prolonged use of certain painkillers.
PREVALENCE
Although UTH does not have records to show the prevalence of kidney failure, Dr Mbambiko thinks the number is “quite high”.
Dr Mutemba blames non-availability of statistics on kidney failure on lack of proper screening of patients.
Every year, the Zambian government sponsors 10 patients to undergo kidney transplants in India, spending about US$25,000 for each transplant. In South Africa, kidney transplants cost as high as US$65,000.
However, Dr Mutemba says some patients have failed to undergo the transplant because they failed to find a matching donor.
He says many relatives of kidney patients are afraid to donate a kidney even with assurance that they can live normally on one.
In fact Zambia’s celebrated football commentator Dennis Liwewe, who died last year at the age of 78, was born with one kidney.
“We still have a lot of work to sensitise our population that kidney donation is safe,” says Dr Mbambiko, who has performed many successful kidney transplants in Britain.
“We can’t perpetually be dialyzing patients,” he says.
Besides, access to dialysis machines is still very limited in Zambia. Currently, only two government hospitals have Hemodialysis machines – Kitwe Central Hospital and UTH.
Patients who are in places where they cannot access Hemodialysis are put on peritoneal dialysis, which can be administered at home. But peritoneal dialysis does not come cheap, either.
Dr Mutemba says the cost of dialysis cannot become cheaper with time, it can only getter worse, making transplant the best solution.
Transplant Links Community, a UK charity has offered to conduct the first-ever kidney transplants on a number of patients in Zambia, as well as to equip local doctors with skills in renal transplants.
Dr Mbambiko says although the initial cost of establishing a facility that would conduct kidney transplants in Zambia has not be determined, the country would save a lot of money in the long run.
“We have enough expertise to carry out kidney transplants,” Dr Mbambiko says.

Thursday, 5 November 2015

Recycle-mad Sweden now moves towards circular economy

Solar panels at an apartment block in Husby.

 

 
Henrik Norlin explains to journalists how old clothes are turned into new fabric.
 

Bicycles at a new residential in the Stockholm Royal Seaport.
 

THE 1985 sci-fi movie, Back to the Future, predicted what the future would look like 30 years later - with flying cars, video phones, robots, self-lacing shoes and levitating skate boards. Most ideas remain a dream.

The movie is partly set to the date October 21, 2015 which, three decades ago, seemed a really distant future. Yet on this very date, I found myself standing in a small science laboratory at the Royal Institute of Technology in Stockholm, Sweden, listening to a lively young man explaining how his small company called Re:newcell is able to turn old clothes into snow-white fluffy cotton that can then be used to make brand new garments.

The concept seems extremely futuristic and I can imagine what such an innovation could contribute to recycling and the manufacturing sectors.

The company is very secretive about the chemical formula or chemicals used in its processes, but insists it doesn’t use any dangerous chemicals.

Henrik Norlin, who is one of the founders of Re:newcell, says cotton material produced in the laboratory will cost “more or less” the same as the one made from harvested cotton.

The company is currently awaiting more financial investment to take the idea from the laboratory to a factory.

Re:newcell is just one of many companies in Sweden that are trying to promote sustainable living through recycling and re-using of various products and materials.

The Swedes are generally obsessed with the environment and sustainable living, and are investing a lot of research into technologies and concepts that can reduce the carbon footprint, thereby reversing the negative effects of climate change.

The Swedish Institute invited six journalists from Africa, Asia and Europe to look at some of the concepts being developed to encourage sustainable living in this technologically-advanced Nordic country.

One of the concepts being espoused by Swedish companies is circular economy, which entails that a product never really ends up in the trash can as waste, as the case is in a linear economy, where there is an industry on one end and a landfill or refuse dump on the other.

Actually, in a circular economy, garbage does smell like money and all waste that ends in a landfill is considered as lost profit.

Stuart Pledger, who is one of the strongest proponents of circular economy, reckons that there is US$4.4 trillion to be made out of rubbish. Although what he really preaches is re-using material as opposed to recycling them.

According to Mr Pledger, who heads a consultancy firm called Circulareconomy.se, circular economy is modelled on the ecosystem, which he describes as a “super-efficient system” able to rejuvenate itself.

“The circular economy is really interested in a mindset where you borrow materials from the ecosystem, use them and then you return,” he says.

And when it comes to recycling, Sweden is really a shining example. The country recycles 99 percent of its household waste.

In Stockholm, for instance, about 993,000 kilogrammes of food waste is collected every month and is turned into biofuel to power buses and taxis. The city is working to become fossil fuel-free by 2040.

In Back to the Future, Doc Brown powers his time-travel machine with banana peels, leftover beer, and Pepsi scavenged from garbage.

So efficient is Sweden’s waste management that the country now imports huge amounts of garbage from other countries to generate energy for domestic heating.

Some 800,000 tonnes was imported in 2014 from countries including Britain, according to statistics from Avfall Sverige, Sweden’s national waste-management association. And up to 260,000 homes in the Nordic country are powered by trash, making Sweden a world leader in energy generated from garbage.

Re-using old computers

Although circular economy is little heard of in Zambia, Erik Pettersson, describes it as a “revolution” and predicts that the concept will gain momentum.

Mr Pettersson runs a company called Inrego, which buys old laptop and desktop computers, wipes the hard drives, restores them to pristine condition, and then sells them to second users.

The idea is to reduce the amount of e-waste, already a huge problem in countries like Nigeria, as well as to cut down on the carbon dioxide that is produced during the manufacturing of new computers.

It is said that every Swede has five kilogrammes of electronic products in their homes that they do not use, but are still useable.

According to Mr Pettersson, about 600,000 laptops are thrown away in Sweden every year and end up at recycling plants where they are shredded before certain metals are extracted.

Inrego buys back about a third of the laptops that would, otherwise, end up at recycling plants. Last year, the company bought 260,000 laptops from companies and individuals. Of those, only eight percent were not reusable and sent to the reprocessing factories.

The company’s warehouse has tens of thousands of laptops that will end up in 70 countries across the globe.

Actually, about 40 percent of the computers find their way back into the Swedish market.

Car sharing

One of the major sources of carbon emissions, especially in densely-populated cities is automobiles, and the lesser vehicles on the road, the better for the environment.

And so Flexidrive, a small company founded in 2011, has a solution: car owners can rent out their vehicles when they are not using them. The concept is called car sharing, and is also meant to promote social interaction among citizens.

Through car sharing, Flexidrive hopes to reduce car emissions by one percent.

“It’s a waste to have a car just sitting the whole day when you are at work,” says Magnus Engervall, who co-owns Flexidrive.

Mr Engervall, himself, does not own a car, but rents one whenever he needs to drive somewhere.

Of course the concept requires a lot of trust, and Swedes are said to be among the most trustworthy people in the world.

Flexidrive now has about 800 car owners registered as members, with a pool of 1,600 vehicles. Last month, the company announced a take-over by one of Europe’s largest car sharing company, SnappCar.

Mr Pledger says: “In a circular economy, leasing is better than buying.”

Green housing

But the grand project in as far as sustainable living is concerned is a green housing development at the Stockholm Royal Seaport, a large piece of land reclaimed from old industries.

The new urban district, which will have 12,000 flats, is located a few kilometres from the heart of Stockholm, and is set to become one of the greenest residential areas in the world once completed.

Designers of the new complex have completely done away with refuse bins, instead, there is a network of underground vacuum pipes that, by suction, take the garbage to a central place for sorting, before recycling takes place.

Trees are sacred in the new residential and even frogs have a special channel to prevent them from being run over. Now that is eco-conscious.

And there are more slots for bicycles in the new residential development than for cars. Actually there is one car parking slot for every two houses and two bicycle slots per home. The idea is to discourage people from using cars.

And because not everyone is expected to own a car, there are pool cars which residents can use at a fee.

The green plan is to build not only energy efficient houses, but also an energy efficient transportation system, with buses and taxis that will run on biofuel.

In another location, north of Stockholm, called Husby, which is home to poor, mostly migrant communities, the municipality is refurbishing entire blocks of residential flats, and the houses are not just getting a new coat of paint, but are being made energy efficient.

About 10,000 square metres of solar panels have been installed in the refurbished blocks.

This makes Husby one of the most solar dense areas in Sweden. 

In Husby, too, there is more emphasis on cycling, with bicycle lanes incorporated into the road network.

The local authority is even offering cycling lessons to residents who do not know how to cycle.

The Stockholm Royal Seaport gives one a glimpse into what future housing developments will look like, and what sustainable living really is.

As we start to consider the effects of climate change and the efficient use of resources and management of waste, Zambia should also begin to seek innovations to help make money from trash and turn old things into new ones.