In my wanderings around Singapore, I came across what can only be a medical miracle, the NKF dialysis centres under unassuming public housing flats! Singapore's first haemodialysis was conducted in 1961, long after I stopped practicing, and I was excited to see how the procedure is carried out.
I stepped into one of these Centres in Marsiling. NKF Senior Nurse Manager, Lucy Lu, greeted me. When she found out I was a medical doctor, she told me about a recent dialysis-related advancement that she thought I might be interested in.
The SGH-NKF Catheter Flow Restoration with Lytic Dwell at Community Dialysis Centre (CLEAR) service emerged because SGH doctors realised that haemodialysis catheter dysfunction was a common reason for patients being admitted to hospitals.
The solution was simple: train the nurses at dialysis centres to perform the clot-busting procedure via the catheter. Patients could then resume dialysis the same day.
"This project has demonstrated that community nurses can do much more, when empowered and supported. Since we have the model for this procedure to be done, we are in the midst of supporting other community organisations, such as the Kidney Dialysis Foundation, to do the same," said Lucy, with pride in her voice.
In Singapore, 500,000 people suffer from chronic kidney disease and are at a higher risk of progressing towards kidney failure. Nationwide, more than 8,800 kidney failure patients are on dialysis, with six new patients diagnosed every day.
Petite Mesum binte Reswat, 72, is a dialysis patient who has undergone the procedure successfully five times. She understands that going to the emergency department may be necessary at times, but she prefers not to. "When I have a blockage, it's uncomfortable. Now, the nurses can unblock the catheter for me," said Mesum.
"With the right-siting of care, patients can receive treatment at the dialysis centre without having to make their way to the hospital. Our partnership with NKF has also enabled SGH to focus on complex cases requiring immediate attention," said Dr Tan Ru Yu, Senior Consultant, Department of Renal Medicine, SGH and the project's co-lead.
"Care delivery models should be reviewed constantly to be safer, more timely and more effective," said Lucy, revealing her diligence and determination in providing the best care possible to her patients.
