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Syria ER: Aleppo’s Kidney Crisis

Dr. A. Oussama Rifai, an Aleppo-born, U.S.-based nephrologist, speaks from a field hospital in Aleppo, nicknamed M-10 for security purposes.

Written by Karen Leigh Published on Read time Approx. 3 minutes

He’s in the middle of a trip sponsored by the Aleppo City Medical Council, spending his days and nights treating M-10’s patients. “This hospital is mainly for surgery and critical care,” he says. “This is not typical trauma in suburbia.”

Rifai, who specializes in the field of kidney disease, told us about the growing need for dialysis machines and care for patients who have suffered trauma to their internal organs.

I thought I would come to a ghost town, but the economy is hustling and bustling, there is food. Life goes on in an amazing fashion. I’ve been here for two days. I am a nephrologist, so the main focus has been on patients on dialysis. We have visited two dialysis clinics here and both are functional. When I was here in January, there was only one and it was very primitive. Expertise and confidence are growing.

I grew up in Aleppo. Once people start speaking to me, they know I am not foreign. [On this trip] I have not visited parts of Aleppo that have been profoundly damaged. What struck me was the anticipation of reconstruction and rebuild, trucks of concrete and sand and people trying to repair this. Despite the potential of another mortar or battle, people are rebuilding. I only saw the liberated areas, and they are vibrant and full of life and commerce. Security is an issue, but it’s not the regime or the Free Syrian Army, it’s people roaming the streets who could potentially kidnap people for ransom.

Humanity in general goes through two sets of illnesses. Youth illnesses are transient and reversible, and as we age the chronic illnesses occur, like diabetes, hypertension and kidney failure. As kidney failure progresses, patients would end up needing to be on dialysis. It’s a very expensive modality. The cost of each dialysis patient per year in the U.S. is $50,000 or so. The highest Medicare budget is for the dialysis population. It’s trying on the patients as well as their families.

When I was here in January, there were security issues and a lack of funds, and eventually a lot of those patients that were here at the time died. These patients today are a new influx. Unfortunately they are managed with the bare minimum, but they’re doing fairly well. The Syrian Nephrology Kidney Foundation project now has a focus on what we call acute renal failure, which is a reversible transient illness. We can bring patients back to normal.

I am caring for a patient right now in intensive care who has renal failure, crush injuries, massive bleeding relating to gunshot wounds, and the kidneys have gone into arrest. This patient had a gunshot wound (by a sniper) to his thigh. He bled to the point that his blood pressure was zero and he went into cardiac arrest. [Now he’s on dialysis] because low blood pressure leads to acute kidney failure. But we anticipate full recovery with him. He’s 18 years old.

[The need for dialysis] is a lot more frequent and less identifiable because of these patients’ lack of means. Over the past month, there were six unnecessary deaths of young people who could have been saved by acute dialysis in a hospital. Dialysis is a complex medical process needing water treatments with reverse osmosis that are very expensive, about $30,000, and dialysis machines are about $20,000 plus someone to run the machines. Thirty thousand can buy thousands of tools [to treat other] injuries, and there has been a lot of rationing of treatment and care because of the expense of this treatment.

Because of this, one of the modalities we have developed at the project is dirt cheap — it can be used for dialysis and requires very little medical infrastructure. It’s not perfect, but in wartime, we cannot provide an ideal solution. It can be used to save lives and provide dialysis until the patient recovers.

Right now in the intensive care unit, we have a boy who was shot in the leg, an 11-year-old boy who was hit by shrapnel that went through the right side of his chest and settled on the right side of his heart, and a patient who’s been there for 15 days and had a bullet sever his chest so he [can’t eat.]

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