Lest we forget…

2020 comes to an end and as we get ready to welcome the new year, it is time to look back at a most disruptive and tragic year. Time to have a special thought for those we have lost. Lest we forget.

For the local medical community, the most shocking and heartbreaking event was the passing away of Dr Bruno Cheong. Dr SBM Gaya, Consultant in Charge in Internal Medicine at JN Hospital and founding member of the Renal Association, has known Dr Cheong for a long time. Here is his tribute written in June of this year.

Dr Bruno Cheong  proceeded to study medicine at Cardiff University Wales following his secondary education at College du St Esprit. He subsequently specialized in internal and respiratory medicine and then came back to Mauritius. I still remember the day that we both joined the Ministry of Health in July 1989. We both started as medical and health officers and then followed the same pathway from specialist to consultant in charge . His last posting was consultant in charge internal medicine at Flacq Hospital.

Bruno was a very down to earth person, very devoted to his work and dedicated to his patients. He was a very jovial and friendly person and was very appreciated by his peers, all hospital staff and patients alike. We had many fruitful discussions pertaining to health issues in the public service during meetings of the consultants  in charge medicine. He had many bright ideas and he certainly contributed to the improvement of our health service over the years.

Bruno was also a very  good teacher and taught many undergraduate and postgraduate students . His junior doctors, MHOS and specialists must have learnt a lot from his vast experience. As a hobby, he enjoyed playing golf.

Sadly, Bruno was infected with Covid 19 while treating a patient with this disease and he passed away on 27 April 2020. He leaves behind his wife and 2 chidren. He will be missed by his family and all the staff of the Ministry of Health who have had the privilege of knowing him.

Thank you, Bruno, for all that you have done for the country. There is no better tribute and acknowledgement of your contribution to the medical profession than naming Flacq Hospital as the Dr Bruno Cheong Hospital.

May your soul rest in peace

We will also remember Dr Raj Purgus, a great Mauritian nephrology friend. You can read our tribute here.

Finally, we have some special words for Hussein A. Sheashaa, Professor of Internal Medicine (Nephrology), Urology and Nephrology Center, Mansoura University, Mansoura-Egypt. This indefatigable figure never stopped in his clinical, research and especially teaching activities. He organised and personally taught in innumerable tutorials, seminars, webinars and conferences. Four of the Renal Association members were invited by the Egyptian government to attend dialysis conferences in the last 6 years. Professor Sheashaa’s energy and enthusiasm for sharing knowledge (and getting photos taken) with a big smile was infectious. He was still doing a webinar the day before he passed away suddenly on the 30 October 2020. May he rest in peace.

The 40th Anniversary of the First Kidney Transplant in Mauritius

Today is a very special day to commemorate. Forty years ago, on the 17th December, the first kidney transplant was performed in Mauritius.

There are many remarkable aspects to this story. The surgery was performed in the Clinique Mauricienne by Dr Mahen Modun, urologist and Dr Marcello Li Sung Sang, nephrologist, both recently back from training at Dublin’s National Renal Unit. Helped by the paramedical staff, the sequential donor nephrectomy and transplantation took 4 hours.

What a daring feat! Such procedures are usually done by two different surgical teams in hospital settings with full diagnostic and therapeutic backup. The blood samples for cross match had to be sent to South Africa and the immunosuppressive drugs brought from Ireland. Try to imagine the medical scene in Mauritius 40 years ago.

Le Cernéen, 19 December 1980

In 1980, advanced renal failure was a death sentence. Dialysis had not started in Mauritius then. What was the chain of events that allowed the desperate 20 year old man suffering from oedema, breathlessness and high urea to find these two doctors? What led to the patient, the donor (his 18 year old sister) and their family to believe in the surgical intervention?

Since 1992, some 350 transplants have been performed in Mauritian public hospitals. Foreign teams started the transplantation programme and local surgeons took over. Unfortunately, the local transplant surgeons retired four years ago and patients have since been sent abroad for transplantation by the Ministry of Health and Wellness. Behind the scenes, there are serious efforts to restart local kidney transplantation with up to date standards and techniques in the near future.

Le Mauricien, 19 December 1980

One last detail about this great anniversary. The most amazing of all. Both the transplant recipient, now 60 years old, and the donor, 58 years old, are alive and well with the transplant kidney still working every minute…

Mauritius and African Nephrology

Mauritius may be some 2000 km away in the south-west Indian Ocean but Africa is the closest continent to our country. There are also important historical and cultural ties between Mauritius and Africa even though most Mauritians are descendants of immigrants from Asia.

The Renal Association is linking up with overseas nephrology societies. Building relationships with Africa is a priority. In addition to having a representative on the International Society of Nephrology (ISN) African Regional Board, the Renal Association is also joining the Africa Association of Nephrology (AFRAN).

It is therefore fitting to read this recent article in Kidney International – Nephrology in Africa: forgotten no more

Africa, home to 1.34 billion people distributed over 54 countries, has been called the cradle of humanity. Despite being endowed with immense natural and human resources as well as great cultural, ecological, and economic diversity, Africa remains the most underdeveloped of all continents. Africa’s share of global income has been dropping consistently, and African countries occupied 30 of the 32 lowest spots on the 2018 United Nations Human Development Index.

Africa has the youngest (median age, 18 years) and most rapidly growing (annual growth rate, 2.5%) population in the world. Infectious diseases and neonatal and/or maternal deaths are the major causes of death and disability. An overwhelming majority of global deaths attributable to tuberculosis, malaria, and HIV infections occur in Africa. At the same time, the burden of noncommunicable diseases, including kidney diseases, is also rising. According to the Global Burden of Disease Study, apart from a few countries in Central America and Southeast Asia, African countries have the highest age-standardized rates of disability-adjusted life years attributable to chronic kidney disease.

The above article starts with a paragraph with a tribute to the stalwarts of African nephrology that have unfortunately passed this year.

During a time when the world is grappling with the coronavirus disease 2019 pandemic, African nephrology suffered a major setback, with the passing of 3 of its stalwarts: Oladipo Akinkugke (Nigeria), Jacob Plange-Rhule (Ghana)—whose obituaries are featured in this issue—and Mohamed Abdullah (Kenya). These individuals bookend the period during which nephrology took roots in the continent. This editorial discusses the highlights of African nephrology during this development phase and recalls some of the individuals who made them possible.

To this list, we also have to regretfully add Dr. Anthony J.O. Were, President of the African Association of Nephrology (AFRAN), Head of @KNH_hospital Renal Unit, and Deputy Director of the East African Kidney Institute who passed away 3 weeks ago. We have missed an opportunity to collaborate with him.

The Renal Association is now affiliated with the ISN!

This a great moment for Nephrology and for kidney patients in Mauritius. By joining up with the International Society of Nephrology (ISN), we hope to make Nephrology grow into a fully fledged specialty in our country. to the benefits of our patients. We can also now participate in the global effort in education, training and research spearheaded by the ISN against kidney disease.

First Educational Meeting

On Thursday 16 July 2020, the Renal Association had its first educational meeting ever. It should have occurred in early April but the Covid-19 lockdown put paid to that. Dr O Bheekharry presented “The Filter, the Pump and the Pill”, a review of the latest SGLT2 inhibitors trial.

It was an opportunity to invite 2 prospective members of the association Dr Guttee, Dr Purrunsing and Dr A Rughoobur Bheekhee. The latter was able to follow the presentation from 550km away in Rodrigues via a web link. Another innovation was the video recording of the presentation which hopefully will become the norm for our educational meetings.

You can access the abstract, the slides and the video of the talk here.

Tribute to Dr Raj Purgus

It is with great sadness that Renal Association wishes to honour the memory of our colleague and friend Dr Raj Purgus. He passed away on the 21st of April after a year long illness. Born in Fond du Sac in the north of Mauritius, he studied at Royal College Port Louis and then went to read medicine in Marseille.

He practised Nephrology in Assistance Publique-Hôpitaux Universitaires de Marseille initially specialising in dialysis then transplantation. He gave nearly 40 years of loyal service to his hospital and patients.

Dr S Gaya, Consultant in Charge at J Nehru Hospital, got to know him quite well. He makes this heart felt tribute:

” Although he settled down in Marseille, he always had his native country close to his heart. I first met him in the early 1990’s during one of his many visits to Mauritius. He was proposing to donate some dialysis machines to the Ministry of Health. “

“He has always wanted to share his knowledge and experience in Nephrology with the local team. Since 2006, he expressed a wish to organize training for local surgeons in kidney transplantation and for MHOs to have full time training in Nephrology with the help of Aix-Marseille University.”

“He has helped in the upgrading of our dialysis services through his yearly “Renal Week” when he would visit all the dialysis units in the regional hospitals. During that week, he would give lectures and talk patiently to patients and relatives. He would discuss tirelessly with the nephrologists and nursing staff on issues related to dialysis, transplantation and nephrology.”

“He was always very enthusiastic and his advice was appreciated by one and all. He was a very kind hearted person, very devoted to his patients and always ready to help. He was a very good friend and he was a great fan of Manchester United Football club. We would often have lengthy discussions on WhatsApp regarding the team performances in certain games!”

“He is sorely missed by his family both in Mauritius and Marseille as well by all his patients and friends. Thank you Raj for all that you have contributed to Renal services in Mauritius. May your soul rest in peace.”

We have lost a great colleague and friend indeed. May we be able to continue the work he started. He leaves behind his wife and two sons. Our deepest sympathies to them and his family.

Prof John Cunningham at CardioMeet 2020

Renal Association senior members were well represented at the lecture by Professor John Cunningham – University College London, UK on “The kidney as a driver of cardiovascular disease” at CardioMeet 2020 held by the Cardiovascular Society (Mauritius).

The dramatic impact of kidney disease on cardiovascular mortality.

It was an emphatic and eloquent lecture from Prof J Cunningham who was beating the drum for nephrology at the cardiologists dominated conference.

Renal Association President Dr Fagoonee moderating.
Dr Gaya in the front row while RA Secretary Dr Ip asks a question.

It was a nice tantalising taster to the planned Renal Association conference “Let’s Talk Kidneys” in July.

Guy’s Hospital Transplant Team working visit

During the third week of November, the Guy’s Hospital Transplant team came to Mauritius on a work visit to help to get the local kidney transplant programme reactivated. Kidney transplantlation in Mauritius came to a halt in 2016 with the retirement of the two local transplant surgeons.

This visit was organised by the Ministry of Health and Wellness (MOHW). The team consisted of Professor of Transplant Surgery Nizam Mamode of Mauritius parentage and Mauritius born Transplant Research Fellow Mr Benedict Phillips.

The four full working days consisted of meeting the Honourable Minister Dr K Jagutpal and appraising the potential transplant wards, operating theatres and the diagnostic facilities. There were meetings with various stakeholders and last but not least, workshops on legal framework and clinical protocols and pathways with senior MOHW officials and nephrologists (Dr K Fagoonee, Dr S Gaya, Dr D Ip).

The Guy’s Transplant team are also very eager to help with training local doctors, nurses and laboratory technicians. The local team will need to do further groundwork to meet their high standards before they can come over. Their plan is to help for a few years until the local team becomes autonomous.