Puggy Hunter was the driving force behind the push for kidney dialysis services in the Kimberley region. Always a clear thinker and passionate advocate, he saw the misery of Kimberley Aboriginal people stranded in Perth on dialysis treatment, lonely, lost and homesick. As always, his colourful use of language helped make the plight of those in the Autumn Centre hostel real to others. “You go and drive past – they’re like crows on a fence down there on Guildford Road” he would say.

Starting from meetings in 1995 with Dr Mark Thomas from the Royal Perth Hospital, Puggy pressed for a satellite dialysis unit for the Kimberley. This would be the ‘hub’ that would provide dialysis services to people locally, as well as support those able to manage home dialysis in their own communities (the ‘spokes’).

When the state government indicated that it was planning to commit resources for regional dialysis, it was Puggy who, by negotiating matched Commonwealth government funding, managed to ensure that the Kimberley unit would be a fully functioning community based unit – not only with nurses and machines, but with transport, Aboriginal Health Worker support and accommodation. He put in extraordinary efforts to ensure that the Aboriginal community got a say – through participation in regional Aboriginal health planning, Norhealth 2020 planning, a regional dialysis summit, by lobbying members of parliament, and tirelessly working with specialists, Royal Perth Hospital management and government bureaucrats.

But he never forgot the people on Guildford road in Perth. On the Friday before he passed on, Puggy sat with the dialysis patients at the Autumn Centre (as he had done so often) and made sure they knew what was happening. He had ensured that the Guildford road mob not only understood and were given hope, but that they were able to have a say in the Kimberley dialysis unit design, into the artwork and into the vision.

Sadly Puggy did not live to see his vision in bricks and mortar – but he knew what had been achieved. His commitment and dedication was finally realised with the opening of the Kimberley Satellite Dialysis Centre on 21st October 2002.
(Dr Richard Murray)

 

The Kimberley Satellite Dialysis Centre (KSDC) opened its doors on the 21st October 2002, providing those Guildford Rd mob in Perth the opportunity to return home or closer to home, as Puggy had promised, it was to be a momentous occasion.

The KSDC is the first Australian dialysis unit to be managed by an ACCHS. The Broome Regional Aboriginal Medical Service (BRAMS) manages the KSDC which is funded by the Western Australian Department of Health (WADoH).

The Guildford Rd mob and other Aboriginal representatives of the Kimberley had a say in the building design, colours, artwork and the vision. What resulted was a purpose built building that reflects the Kimberley colours and Broome architecture. The interior layout allows for cultural avoidance's and is decorated with local Aboriginal artwork. A unique feature is the 66 metre long mythical "rainbow serpent" laser cut into the vinyl floor. This all makes for a very culturally appropriate homely environment.

The KSDC has 10 dialysis Fresenius S & H machines and cares for 42 haemodialysis clients. The operating hours are Monday through to Saturday 7.00am - 8.30pm dialysing two client shifts per day. Where possible the KSDC provides respite care for the Kimberley Home Haemodialysis clients in the attempt to avoid the transfer patients to Perth, removing them away from family, community and country.

Renal-trained Aboriginal Health Workers (AHW) and Registered Nurses staff the KSDC. Administrative and driver support positions are filled by Aboriginal people with strong cultural connections to the local community. The KSDC also has a full time Social Worker and part time Medical Officer who in conjunction with the consulting Nephrologist from Royal Perth Hospital who visits every 6-8 weeks provides medical care.

The KSDC has been running at full capacity since 2004 resulting again in the dislocation of Kimberley Aboriginal dialysis clients away from family, community and country down to Perth. Today a new group of Guildford Rd mob exist,

“You go and drive past – they’re like crows on a fence down there on Guildford Road” he would say (Puggy Hunter). However the vision of the “hub and spokes model” lives on.

 

KAMSC and the regional ACCHS have spent the last four years pushing both the State and Commonwealth Government for further funding to develop the hub and spokes model known as the Kimberley Renal Support Services (KRSS).

The KRSS marries Renal Primary Health Care – Kidney disease awareness, prevention and screening with Tertiary Dialysis services – Haemodialysis, Home Haemodialysis, Peritoneal Dialysis and Transplantation. This provides Kimberley ACCHS the opportunity to manage, in a culturally appropriate way, the care of people on the kidney disease pathway from stage1 Proteinuria through to dialysis therapy.

KRSS Kidney Disease pathway (pdf)

The aim of the model is to; increase kidney disease awareness, prevention and screening in order to slow the progression of the disease, and to increase access to dialysis therapies regionally, to reduce the 3000km dislocation from family, community and country – to be able to dialyse as close to home as possible.

Although funding for the KRSS is still to be secured the Kimberley ACCHS have been able to achieve small steps in improving renal services to its Kimberley people.

 

The Gelganyem Trust a North East Kimberley traditional owner Trust, set up from the Argyle Diamond mine participation agreement, in the East Kimberley have provided funding for a Renal Support Nurse position over the last two years. The position is based at the Ord Valley Aboriginal Health Service (OVAHS) in Kununurra. This position has been involved in all things renal particularly kidney disease awareness, prevention and screening from school children through to adults. Support for local dialysis clients and health staff is a large part of the role also.

 

In 2006 KAMSC were fortunate enough to receive grant funding for a project looking at integrating the palliative approach into the kidney disease pathway. It is now recognised world wide that people with a life limiting illness are on an incurable pathway and will benefit greatly through a palliative approach to care. The KRSS is integrating this palliative approach into each of the new KRSS positions.

The palliative approach is a holistic model that focus’s strongly on the client and family having a say in the care they want. Family meetings are encouraged early on in the disease process. This gives the opportunity for both the client and family to receive kidney disease education and information on dialysis therapy so decisions can be made in a timely, culturally appropriate manner. The KRSS aims to collaborate with the palliative care team as necessary, so end of life care is managed in a culturally appropriate and timely manner through advanced care planning.

 

WADoH provides funding for a Pre Dialysis Coordinator whose role is to educate ESKD clients on dialysis options and prepare them for access to commence dialysis therapy. Currently the KRSS in partnership with Broome Hospital and a visiting Royal Perth Hospital surgeon and anaesthetist is trialling the insertion of PD tubes both buried and externalised. Again this will aim to reduce the necessity of clients having to relocate to Perth. This position also provides kidney disease education to CKD clients at the specialist renal clinics and coordinates family meetings.

 

In 2005 WADoH tendered and outsourced Home Therapies (Peritoneal Dialysis and Home Haemodialysis). Fresenius Medical Care won the state contract. In 2007 Fresenius provided KAMSC with funding for a peritoneal dialysis (PD) nurse position in Broome, co-located with KSDC to train clients and manage them regionally. This provides clients with the opportunity to stay in the region to train up on PD therapy. Home Haemodialysis training and management currently remains based in Perth.

 

In 2007 WADoH provided funding for two machines to be located at the Derby Aboriginal Health Service (DAHS) to provide haemodialysis to 4 Derby residents. This is a Supported Community Satellite Dialysis service run by 2 local health staff. This set up benefits those clients who are not suited for Home Therapies and allows them to dialyse near home.

 

Due to the enormity of renal disease and the burden of care required for those with kidney disease, education of regional health staff is a priority for the KRSS. KRSS staff is currently working on renal education modules for the training of new staff to the renal area. On the job modules in Haemodialysis and Peritoneal Dialysis, also CKD modules for health staff out in the region working in primary health care and chronic disease. The KAMSC health school provides renal education to new AHW’s training in Aboriginal Primary Health Care at Certificate IV and Diploma levels.

 

With the increasing burden of kidney disease in the Kimberley KAMSC and the regional ACCHS will continue to develop the culturally appropriate hub and spokes model with the anticipated State and Commonwealth funding for the KRSS.

The KRSS aims to provide extensive education in renal primary health care through renal campaigns, workshops and on the job training for clients, communities and health staff. Also to improve access to dialysis therapies in the Kimberley by providing and supporting dialysis closer to home, where possible avoiding the need to relocate clients out of the region away from family, community and country.