Photos from the Field

Improving Renal Health in El Salvador

"Friends at Global Links, thanks to your support, 1105 people from Guayaba Abajo are in the process of receiving the benefits of new research,” wrote Dr. Carlos Orantes, National Coordinator of the Renal Health Project that is investigating unusually high incidence of kidney disease in El Salvador.

Men in El Salvador, especially farmers in coastal areas, are especially vulnerable to chronic renal insufficiency (CRI). In this area, traditional causes of kidney disease, such as hypertension and diabetes, do not entirely account for the high numbers of CRI. Initial findings of the research led by Dr. Orantes indicate that extensive use of agrochemicals is also a factor.

Once CRI advances, as it inevitably does, into kidney failure, the only available treatment options are dialysis or kidney transplant. Public health researchers in El Salvador concluded that further studies were needed to explain the high incidence of kidney disease in this population, and take steps to prevent and treat it. Dr. Orantes oversees collecting urine samples from the community.

As a student at the Latin American Medical School in Cuba (ELAM), Dr. Orantes, on the left, studied under Dr. Raúl Herrera, right, the former head of Cuba’s National Institute of Nephrology. Dr. Herrera had collaborated with Global Links on other public health projects, and had recommended that Global Links support a critical study that Dr. Orantes would be undertaking in El Salvador along with the national health authorities there.

Dr. Orantes, shown here with two children from the community, named his project Nefrolempa, a combination of “nephrology” and “Bajo Lempa,” a region in central El Salvador where a high incidence of CRI had been reported.

The Nefrolempa project, which began in August 2009, is a project of the Salvadoran Ministry of Health, and seeks to determine the frequency, distribution, and causes of CRI in the community of Bajo Lempa. The patients’ physical, occupational and social environments are all part of the study. When he visited the project last fall, Global Links Program Officer José Henríquez observed that this approach includes a new understanding of the problem as well as a new emphasis on prevention. After the initial results, the Ministry decided to undertake two more regional studies in order to build a national renal health program: Nefroriente and Nefroccidente.

Nefrolempa and the subsequent studies created regional Renal Health Units where they base their research and prevention initiatives, as well as educational programs for those at high risk of developing CRI. The studies include training technicians at the community level and involving medical students in the study.

Global Links provided financial support to buy diagnostic supplies and lease equipment for lab analysis for the clinical research part of the project.

“Important components of the project are the training of about 100 health workers and community leaders and the restructuring of health services,” writes Dr. Orantes. “In the upcoming days we will be developing the second phase of the Nefrolempa project, Nefrolempa Pediatric. Master Cuban nephrologists are accompanying the process.”

The health initiative, which started with the Nefrolempa project, highlights the potential that lies in collaborative relationships. By collaborating with ELAM graduates and with the Ministry of Health, Global Links is able to support public health projects that will have a long term effect on the wellbeing of the people of El Salvador.