Monday, 11 May 2015

A new dialysis patient every 5 hours

Kidney failure rates on the rise as S'poreans get more obese, don't keep diabetes in check
By Salma Khalik, Senior Health Correspondent, The Sunday Times, 10 May 2015

Kidney failure rates here continue to rise. Every five hours, one person in Singapore needs a transplant or has to start dialysis.

Last year, about 1,730 people lost the use of their kidneys, up from 1,657 in 2013, latest figures from the Renal Registry show.

The reason? Singaporeans are getting more obese and more are suffering from diabetes, the main cause of kidney failure when not kept in check.

Professor A. Vathsala, head of nephrology at the National University Hospital, said that so long as diabetics are not doing their best to control the progression of the disease, the number of kidney failures will keep rising - a trend that has persisted for more than a decade.

In 2002, 728 people had end-stage kidney disease - about 1,000 fewer than last year. Today, in spite of medication, only 40 per cent of diabetics are able to keep their blood sugar levels in check. "This means six in 10 don't meet their target," Prof Vathsala said.

Dr Chionh Chang Yin, head of renal medicine at Changi General Hospital (CGH), calls diabetes an epidemic that needs a concerted approach at multiple levels.

"It begins with health policies and movements against poor dietary habits, obesity and sedentary lifestyle, which contribute to the diabetes epidemic," he said.

Early detection and control of the condition are key to preventing complications such as kidney failure, he noted.

The Renal Registry's interim report for 1999-2014 said a total of 5,912 people were receiving dialysis at the end of last year - about 500 more than in 2013.

To deal with the rising numbers, at least one new dialysis centre had to be set up every year for the past few years. It noted that most who turned to dialysis were Chinese (67 per cent) but "the proportion had increased among Malays (from 16.6 per cent in 1999 to 24.5 per cent last year) and Indians (from 6.2 per cent in 1999 to 8.8 per cent last year)".

Dr Adrian Liew, head of renal medicine at Tan Tock Seng Hospital, said that compared with the Chinese, Malays had a 42 per cent higher risk of kidney failure and Indians had 14 per cent lower risk.

Lifestyle differences could account for this. For example, smoking in Singapore is lowest among Indians and highest among Malays. Similarly, Indians do the most exercise and Malays the least.

As a result, Malays, especially Malay women, are more obese - a major risk factor in getting diabetes. What is worse, Malay diabetics tend to seek treatment later. By this time, a lot of damage has already been done.

Prof Vathsala advocated treating obesity aggressively, as one in nine people here is obese.

A study of more than 57,000 diabetic patients at the nine National Healthcare Group (NHG) polyclinics from 2006 to 2009 found that half had diabetic kidney disease, the precursor of kidney failure. This is higher than in most other countries, including the United States, where the proportion is 32 per cent.

The NHG polyclinics have been proactive in "optimising therapy" for diabetics and those at risk earlier, Prof Vathsala said. This includes getting them to lose weight by eating properly and exercising regularly. "Food cannot be the centre of our existence," she said.

Many still hesitant about organ harvesting
By Salma Khalik, Senior Health Correspondent, The Sunday Times, 10 May 2015

Too many families here are unwilling to have organs taken from their loved ones after they die, resulting in fewer organs available for life-saving transplants.

Since 2004, the Human Organ Transplant Act (HOTA) was changed to allow the kidney, liver, heart and corneas to be retrieved from anyone who dies, unless the person has opted out. But grieving families often delay the process and the organs become unusable.

People dying older and fewer fatal traffic accidents have also contributed to the shrinking pool.

Dr Adrian Liew, head of renal medicine at Tan Tock Seng Hospital, said the fall in cadaveric organs for transplant "is due to the reduced number of suitable brain-dead donors", because such donors are getting older and often have several medical problems, making their organs unsuitable.

"At the same time, due to our strict traffic and seat belt laws, the number of road traffic accidents have also decreased substantially," he added.

"In the past, that had contributed a significant pool of potential deceased donors who are younger, with more suitable kidneys for transplantation."

The heart has to be taken from a brain-dead patient whose heart is still beating.

The kidney and liver from a person whose heart has stopped can be used so long as the heart is restarted within 30 minutes of death.

But some families refuse or delay this procedure.

Retiree Chin Kee Thou, 65, wrote a letter in The Straits Times Forum Page to explain why people might object to organ harvesting, even if the dead person had not opted out.

"Many still subscribe to the belief that even when one is dead, that entity may not have dispersed immediately, and thus they have a wake period of three to five days before disposing of the body," he said.

Mr Chin, a Buddhist, told The Sunday Times that he is not sure when the soul leaves the body and will not donate his organs for fear "they are still alive" even though he is medically dead.

Only 17 people received a cadaveric kidney transplant last year, half the number compared with 2013. Similarly, there were 13 cadaveric liver transplants, down from 19 the previous year, and no heart transplants at all, against four in 2013.

The 17 cadaveric kidney transplants last year is the lowest number in more than a decade, and a far cry from the high of 56 done in 2006, two years after the HOTA was changed.

At the end of last year, there were 353 patients waiting for a kidney, 23 for a heart and 60 for a liver. Kidney transplants can more than double a receiver's remaining years after diagnosis of someone whose kidney has failed, compared with dialysis.

Said Professor A. Vathsala, head of nephrology at the National University Hospital: "All studies show that transplants give many years of good quality life.

"Transplant patients can return to work, bear children and have a quality of life far superior to patients on dialysis."

Despite the potential to save lives, many people here resist having organs removed from a dead relative, she said.

In countries like Spain where there is almost universal buy-in, restarting the heart of a dead person is done as a matter of course, even when deaths occur outside of a hospital, she highlighted.


Catholic priest gets stem cell transplant from man in US
By Melody Zaccheus, The Sunday Times, 10 May 2015

Hospital pharmacy manager Peter Mui walks around the Chicago suburb of Glenview wearing a watch engraved with the words "the gift of time for time given".

It was a present from Singaporean priest Luke Fong - a complete stranger 15,000km away whose life he saved by donating his stem cells.

The 50-year-old Catholic priest, a fitness enthusiast, was diagnosed with a potentially fatal strain of leukaemia in 2013. Six months after his diagnosis, the Bone Marrow Donor Programme, which is linked to an international registry, found a match in Mr Mui.

Dropping everything, Mr Mui underwent a relatively painless process. There are two ways to extract stem cells: a bone marrow harvest, and peripheral blood stem cell harvest, which is more common.

Mr Mui underwent the second procedure, which included five injections over several days and being hooked up to a machine for five hours to extract his stem cells, in a process similar to blood donation. He experienced aches and fatigue and had to rest for a few days.

"I didn't know who the recipient was but I thought about his family and the people who love him," Mr Mui, now 48, told The Sunday Times by telephone. "How can anyone say no to saving a life?"

Father Luke, who is still recovering from the July 2013 transplant, flew to Chicago two weeks ago to say thank you to Mr Mui. Their meeting was reported by American media, including the Chicago Tribune and NBC's evening news.

Father Luke, who got home last Wednesday, said Mr Mui's selfless act was "unfathomable". He was was flooded with a "gamut of emotions" when he first saw him at O'Hare International Airport.

"He didn't owe me anything yet he went out of his way to save someone he didn't know. I flew over to thank a stranger who has now become a friend and a blood brother.

"I hope Peter wears the watch proudly and that his children can carry on their father's legacy of giving hope to others."

The assistant parish priest from the Church of the Immaculate Heart of Mary near Kovan had been on a break from graduate theology studies in Washington, DC when fever and fatigue overcame him while on a trip to New York.

Thinking he had iron deficiency, American doctors prescribed him iron tablets. "I was very sick for a month and could hardly walk. I was losing a lot of weight and missing classes," said Father Luke. He flew back to Singapore for medical treatment and was given the bad news. He underwent chemotherapy and was told he needed a transplant.

Bone Marrow Donor Programme data shows that every day, about six Singaporeans are diagnosed with a blood-related disease.

Father Luke's 5,000-strong parish was shocked to hear the news, said Mr Michael Vong, 52, the co-chairman of the church's pastoral council: "All of us were devastated. We are so used to seeing him fit and strong. He used to wake up, pray and then do 10km runs."

Rallying behind him, hundreds from the Catholic community had their DNAs registered as part of the Bone Marrow Donor Programme's database.

On a few occasions, Catholic Archbishop William Goh visited Father Luke in hospital and met his parents to pray with them. Father Luke took to his blog to share his journey with worshippers and others stricken by chronic illnesses.

Last month, doctors gave him the green light to travel to the United States. He stayed with Mr Mui, his wife and two children aged nine and 12, for about a week.

He cooked breakfast for the family and met Mr Mui's parents. They also visited the room where Mr Mui's stem cells were extracted.

Mr Muilost a childhood friend to leukaemia in 1984, when they were 16. Jon Grebin was diagnosed at the end of the school year and died in three months. "I didn't even have the time to say goodbye to him properly," he said. "Leukaemia is so hard on the body and the spirit. It is a crushing way to die."

On June 20, 2001, Mr Mui had his cheek swabbed for his DNA at achurch drive to do his "small part" for someone in need.

It was the same day Father Luke, who used to work in the hotel industry, was ordained in Singapore.

Father Luke is still being treated at Singapore General Hospital where his blood cell count is taken every six weeks. He suffers aches in his joints and water retention and can barely run 500m.

But the disease has given him new direction. He is now an advocate for the Bone Marrow Donor Programme. He speaks in schools and organisations, encouraging people to join the local bone marrow register. As of last year, it had 48,000 potential donors, up from 38,000 in 2013. The aim is to double the pool to 100,000 by the end of 2018. The programme's chief executive Jane Prior said: "We're battling to get through to people that a bone marrow or a blood stem cell donation is a simple and straightforward procedure with no long-term side effects."

Mr Mui did not expect the recipient of his stem cells to be a priest. "I wear the watch every day, as a reminder of Father Luke. I'm happy to see he's doing better and now has more time to bless others."

Sign up to be a donor here at

Buddhist monk glad kidney recipient has second shot in life
By Aw Cheng Wei, The Sunday Times, 10 May 2015

He was the headliner for the once-popular Ren Ci Charity Show with his death-defying stunts, but these days, Venerable Ming Yi lives a far more quiet existence.

Every morning, the 53-year-old abbot of Foo Hai Ch'an Monastery begins with prayers and exercise, then dives into paperwork, meetings and religious classes.

Occasionally, he takes short work trips to Hong Kong, Thailand and Taiwan to spread the teachings of Buddha.

Even when it was revealed last month that he had donated his left kidney to a stranger, he tried to stay out of the spotlight.

He only relented to holding a press conference last week - one which he organised himself as he does not have a personal assistant or secretary these days - because "reporters really wanted to know".

"They came to me in the hospital and visited the temple daily," he said. He said he never saw the point of publicising what he had regarded as a personal decision to help kidney patients. "I'm not trying to get people to donate," he said.

He has not shut the door on performing stunts for charity ever again. He said: "If it is really for a good cause, why not?"

But before committing to anything, he would want to "weigh the whole situation" - a lesson learnt from six years ago, when he was convicted of charges involving an unauthorised $50,000 loan from Ren Ci Hospital's coffers to his personal assistant Raymond Yeung.

"In the past, I was more naive and I really wanted to help people. I easily believed whatever they told me," said Ven Ming Yi.

He has a system in place to make sure there is no repeat of such an incident, and it includes having a group of people at the temple to evaluate requests for help.

"If you tell me you cannot afford to pay your water and electricity bills, I will ask you to bring me your bill and I will make the payment for you.

"I would rather do that than give you the cash. I don't know what you will do with the money," he told The Sunday Times at his temple's office, which has few adornments except for his wooden table with an Apple iMac, a rack for his robes, and a row of Buddhist figurines.

"Rules and regulations have to be set. It's not so much to deter people from seeking help but to make sure that we can find the best way to help them."

Ven Ming Yi was born Goh Kah Heng, the son of a bank officer and housewife. He attended Raffles Institution and has a doctorate in philosophy. He helped to raise more than $33 million for Ren Ci Hospital.

He rose to fame in 2003 by abseiling down Suntec City Tower 2. The following year, he was chest-deep in 1,000kg of ice cubes for almost 23 minutes.

His most notable stunt was a walk across beams suspended outside the 66th floor of Republic Plaza in 2006.

But in 2007, the Health Ministry found gaps in Ren Ci's corporate governance. The next year, Ven Ming Yi was charged and he stepped down as chief executive officer. After an eight-month trial, he was sentenced to 10 months' jail while his former assistant was jailed for nine months.

An appeal reduced the monk's sentence to six months, after Justice Tay Yong Kwang took his work for the poor and sick into account. He served four months before being released early because of his good behaviour in prison.

He came out in October 2010 and resumed his duties as abbot, although a year later, the Public Service Medal he had been awarded in 1996 was forfeited. "The number of devotees remained more or less the same," he said.

He has had little to do with Mr Yeung since, but bears no hard feelings. "I know where he is. There's nothing wrong with that. Why have so many enemies in these short decades of life? Everyone's been punished."

During the trial, it was revealed that he bought a multi-million-dollar condominium here, properties in Australia and Seattle, a luxury car and even a racehorse - raising concerns about his lavish spending.

Asked how his lifestyle now compares with the past, he said: "There's no need to talk about that. Whatever's in the past, just let it be. If I keep harping on it, I will never move forward.

"If I keep worrying that someone is looking at me differently, I'm the one who is suffering."

As for his decision to donate a kidney, which came after he read about the shortage of donors, he said he does not need to know more than that the recipient, a young woman whose identity remains unknown, no longer suffers.

"I'll be more than happy to know that the person is recovering well and has a second shot in life," he said.

For now, he is focused on making a complete recovery after the surgery on April 27. "I haven't fully returned to work yet. I do some paperwork here and there, but have not taken part in religious activities... But I'm a restless person."

He believes he will be well-rested by the end of the month.

"The temple will celebrate Buddha's birthday then. It's a big festival, and my first major activity since the surgery. I cannot wait."

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