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A Qualitative Feasibility Study Examining Barriers and Enablers to Establishing an Adult Peritoneal Dialysis Programme in Malawi
World Journal of Nursing Research
| Vol 5, Issue 1
Table 2. Perceived barriers and enablers to implantation for an AVGservice in Lilongwe
| Potential benefits of PD Home therapy (cost savings and life-style benefits over HD) “Treatment is done at home” (Patient) “There are a number of benefits. The first one is no breakdown of machines or lack of spare parts because we don’t use machines. The second one is that it is done at home so it reduces transport costs. The third one is that you dialyze in your own free-time which allows you to travel long distance because it can be done anywhere.” (Patient) “You are not forced to come to the hospital. You can wake up early, do PD and then proceed to do other things. You would have enough time. Also it reduces the costs of transport meaning you can save a lot of money we use for coming here” (Patient) “The beauty about PD is that it can be done anywhere. PD gives freedom of movement that one is able to go to school and work even in areas where they don’t have haemodialysis machines. PD makes one productive as you are able to go to school and work” (Patient) “PD reduces transport costs because it is done at home. With PD you save money but you put your life at risk due to infections” (Patient) Additional dialysis space/ life-saving “One, it will overcome congestion in our unit” (Patient) “I believe it can help a lot of people especially those who stay very far away. Also time management since you are doing it at home.” (Patient) “You can also save many lives since, here in Malawi, haemodialysis space is an issue.” (Patient) “It could help the people who need dialysis but who cannot be enrolled onto chronic haemodialysis (hospital haemodialysis) due to lack of machines, thereby saving lives. A lot of people are dying because they don’t have access to haemodialysis.” (Patient) “We have to try PD as there are so many dying without (haemodialysis) space.” (HCP 3) More “natural”/ perceived less restrictions “Little to no restriction on food choices as one does dialysis four times or more per day” (Patient) “PD can improve quality of life since it is done a number of times a day.” (Patient) “Since it is done every day, it is like the kidney is working normally.” (Patient) “While with HD you are required to get calcium. You do not need calcium because you do not get bone problems.” (Patient) Autonomy/ ownership “Secondly, because you give the person authority over their condition, they understand it better” (Patient) Variety of choice “Patients can have varied treatment options which is good” (Patient) “PD might be a good option for those with no veins or who have lots of line problems” (HCP 2) Safe “She was on PD for two years with no complications” (HCP 6) |
| Barriers to implementation of an PD service in Lilongwe Education “Challenges could be there for those who can’t understand what PD is about properly. Patients need to be trained properly” (Patient) “I have issues with if we would have enough resources for everyone” (Patient) “Most patients are not well educated hence it is difficult to comprehend what you are being told” (Patient) Infection “Infection could be a problem” (Patient) “As much as PD is needed in Malawi, hygiene will be a very big challenge because of the rooms (houses) we use. It is very hard to maintain good hygiene in most homes due to poor economic status” (Patient) “For me, I am in construction, and I deal a lot with dust (there might be problems). But at KCH, it is depending on the person, how he or she can understand since when the hospital is starting something they equip people with knowledge” (Patient) Infrastructure in hospital “Prolonged hospitalization (at the time of catheter insertion)” (Patient) “Availability and variety of antibiotics. In the past they used gentamycin” (Patient) “I have issues with if we would have enough resources for everyone” (Patient) “Lack of/ shortage of staff as it needs more time for someone to grasp the concept” (Patient) “The PD fluid comes from South Africa. It would be transferred to a patient’s home once per month by ambulance. That costs is included in the cost of care so patients wouldn’t have to pay for that” (HCP 1) Infrastructure and service at home “It’d have to be CAPD. There’s no good option for APD- not everyone has reliable access to electricity to run the equipment etc.” (HCP 4) “Many use water from the wells. But we’d just need to find ways around that. Perhaps if we provide better sanitation; and basins and soaps and water from pumps rather than the wells it’d be better” (HCP 3) “It’d have to be CAPD….always” (HCP 1) “Running water and electricity? (laugh) Not even in parts of Lilongwe. They’d need to use a well. It’s not well developed yet.” (HCP 5) “There’s regular power cuts” (HCP 7) |
| Enablers and critical issues for establishing an PD service in Lilongwe Education and training “What is required is proper training” (Patient) “Patients should have a guardian (“buddy”) with whom they are trained together so that they can adhere to standard procedures” (Patient) “(The) patient could come to the hospital at least once per month for continued learning on PD” (Patient) “I feel like having educational sessions (for patients) since it is something that everyone does on their own” (Patient) “There’s need for proper training of clients on PD and it’s care” (Patient) “There’s need for intensive education. Once information is clear, this is my number one modality to use.” (Patient) “There is need for thorough education on how to do PD and support for PD clients” (Patient) “We’d need a community nurse to oversee the process. They would need upskilled. But we could do that” (HCP 6) Infection “There needs to be availability of other resources e.g. soap for cleaning” (Patient) “We need to ensure availability of antibiotics.” (Patient) “Need to ensue good personal hygiene to avoid infections” (Patient) Physical infrastructure “Increase the funding to the hospital so that the patient should not lack anything when they start treatment” (Patient) “Needs a special ward with special bathroom and toilet which is currently not available” (Patient) “Assurance on the sustainability of resources” (Patient) “We’ve got PD fluid. We’ve got loads of PD fluid! We’ve got the 2.8 and the 4.2 (percentage). It’s in the basement going out of date! We can’t get the catheters though. It’s the catheters that we desperately need.” (HCP 1) “A urologist used to put them in for us. Surgically. Under GA mainly, but LA sometimes. It went OK.” (HCP 3) Resourcefulness/ innovation “We even made our own PD fluid from saline and 5% dextrose when we couldn’t access the manufactured stuff” (HCP 1) “We need to be resilient and creative and innovative and try things. For example, when our dialysis lines got broken we went to the basement and routed around in boxes” (HCP 2) “(We could use) the mini-solar power (lots of families who don’t have mains electricity have a mini-solar panel to provide small amounts of electricity e.g. to charge mobile phone etc.)” (HCP 4) |