At-home Chronic Kidney Disease Treatment in Rural Sri Lanka: A Case Study of Intervention Barriers and Program Viability

Sri Lankan man walking in field

Students

2019
College

Faculty

Project Summary

Sri Lanka’s fertile soil and tropical climate make it an ideal environment for growing many crops—and the country does just that. Unfortunately, in the past three decades the island’s farmers and other rural citizens have seen a growing incidence of Chronic Kidney Disease of Unknown origin (CKDU). The cause of CKDU remains unclear despite over twenty years of scientific and sociological research. While public health scholars typically much prefer proactive, preventative measures to reactive, treatment measures, in the case of CKDU the former presents much difficulty given the community and experts alike cannot agree on a cause. CKDU symptoms often don’t appear until later stages, when it quickly becomes debilitating. Patients are left with compromised economic livelihoods resulting from the high costs of treatment, mostly associated with cost of travel to tertiary care centers, coupled with their inability to work.

I came to Sri Lanka to study a new health intervention for CKDU called Continuous Ambulatory Peritoneal Dialysis (CAPD). CAPD can be done at home, saving rural patients the time and high cost of travel the alternative treatment, hemodialysis, requires. After speaking with CKDU patients both using and not using CAPD in the small village of Wilgamuwa, as well as health and government administrators at the local and national level, I put together a case study report on the successes and barriers in Wilgamuwa’s pilot CAPD program. Ultimately, I found CAPD offers a significant advantage over other treatment options; the power patient’s personal experiences with CAPD carry great weight when they are deciding whether or not to use the new technology; home infrastructure is regarded as the greatest barrier to CAPD adoption, but it may be able to be temporarily mitigated; and government-constituent miscommunication regarding CKDU entitlements needs to be better managed.

From a professional standpoint, this research challenged my ethnographic skills in interviewing and observation. I’ve witnessed what sociological research looks like on the ground, and my case study report demanded a sociological writing style less familiar to me. Personally, I’ve loved being able to see different parts of Sri Lanka. I’ve learned from two different host families about their day-to-day lives, oceans away from my own home, and I’ve reveled in the abundance of flavorful curry, fresh mangoes, avocados, pineapple, and passionfruit. I’m incredibly grateful for Mr. Gelfman and his generosity in funding valuable experiences like this for Penn undergraduates.