Here, There, and Everywhere

IMG_2867We did it! This attempt at our delayed honeymoon was a real honeymoon… only one with my brothers and sisters-in-law which made it even better in my book. (Like that play on words?)

We couldn’t take a honeymoon right after we married because I got sick. Thank you so much compromised immune system for that. Then Bear had surgery that laid him up for a long, long, long time or so it seemed.

We finally planned our delayed honeymoon to Vancouver, British Columbia (Thanks for the help in planning that part, Denis Beaudry.) and Alaska. Thank you for the help in planning that part, Mark Rosen.

Bear always wanted to cruise the Inside Passage and ride the Alaska Railroad. I always wanted to see the B.C. distant family talked about. We got our wishes but IMG_1320couldn’t enjoy much of them due to Bear contracting cellulitis on the second day. That meant IVs and high fevers. Trash delayed honeymoon attempt #1.

But then, due to my sister-in-law’s generosity in inviting us to try a honeymoon again by joining my brother and her on their 48th anniversary/her birthday cruise, we finally got our long awaited honeymoon. We’d been married 2 ½ years by this time.

To round out the fun, brother #2 and his wife decided to join us.  Although various combinations of us have been together throughout the years, the five of us hadn’t all been together in 27 years!!!!! Bear was the most welcomed newcomer to the family.

oasis of the seasRoyal Caribbean International did it up, well, royally. Of course, this was only my second cruise, but my family is cruiseophiles and they told me this was so. I took a writer’s liberty to make up a word here. It means lover of cruises. Feel free to steal it.

So, what does any of this have to do with Chronic Kidney Disease, you ask? We did go to three different countries, although there was only a limited shore excursion in each and we saw only what tourists see in each. (Here comes my favorite phrase.) That got me to thinking. I wondered what CKD treatment was like in each of these countries.

Our first port of call was Labadee, Haiti. I’m told this is a very dangerous area. The comedian onboard likened the tourist area to Jurassic Park in that it is totally fenced in to protect the tourists and keep out the local people.  Funny, the cruise line referred to it as ‘a private beach.’ I guess it’s all a matter of prospective.

We took a catamaran ride in order to see more than the ‘private beach’ allowed and were repeatedly cautioned not to leave the encampment that was the tourist attraction, other than these sanctioned boat rides.  That’s also where we learned there are no police there. But was there CKD treatment?What is it

 

According to National Institutes of Health (in the background material of the abstract of a small study of CKD in the rural areas of Haiti):

In the Caribbean region chronic kidney disease (CKD) is an increasing challenge. High rates of non-communicable and infectious diseases and the rise in people suffering from diabetes and hypertension explain the observed and further expected increase of CKD. However, data about the magnitude of the problem are rare and in some countries such as Haiti completely lacking.

You can read a little bit more at http://www.ncbi.nlm.nih.gov/pubmed/25535765

So what data might there be? I did find a blog about another small study at http://blog.smw.ch/chronic-kidney-disease-in-a-rural-region-of-haiti/. However, this contained cautions about the population of the study and the fact that – again – only one rural region was studied. They did have some interesting, although not surprising, results.

CKD was found in 27% of the study population. Risk factors independently associated with CKD were: hypertension, HIV infection and age >60 yr.

What makes it worse is that Haiti has 80% unemployment and very few people have health insurance.

IMG_1398Maybe our next port of call, Falmouth in Jamaica, was more involved with CKD.

I went to http://www.worldlifeexpectancy.com/jamaica-kidney-disease for the following information.

According to the latest WHO [Reminder: that’s the World Health Organization.] data published in may (sic) 2014 Kidney Disease Deaths in Jamaica reached 550 or 3.08% of total deaths. The age adjusted Death Rate is 20.00 per 100,000 of population ranks Jamaica #37 in the world.

CKD is the ninth leading cause of death in Jamaica. It’s the eighth leading cause of death here in the United States. It’s a teeny country; ours is not. Draw your own conclusions.

Although we were again warned not to wander off by ourselves since this was also considered a dangerous country, we were able to tour a 1700s plantation. Just as Haiti, it was absolutely beautiful, but again – we saw only a few roads and what we were allowed to see. One of my brothers and his wife took a walking food tour and were appalled at how poorly the inhabitants of the country lived. Remember, we were only tourists formulating opinions on our quick view of each of these countries.

I was quite taken with the direct approach of The West Indian Medical Journal’s assessment of CKD in the Caribbean, although they do not especially mention labadee and falmouthJamaica.

There are not enough nephrologists in Caribbean countries and some countries may lack a nephrology service. Coordinating patient care between specialist and primary care physicians is essential in managing the burden of this growing disease.

You can read more at http://caribbean.scielo.org/scielo.php?script=sci_arttext&pid=S0043-31442011000400017

The only other information I could find was from 1999. I felt 16 years was a long time ago, too long to include that information here.

My conclusion is that these developing countries are well aware of the increasing incidence of CKD among their population, why it’s there, and how much of a financial burden it represents. You need to remember that both countries have a predominantly black population (although there’s been plenty of intermarriage) which historically has a higher incidence of hypertension, one of the leading causes of CKD.

Oh boy, looks like we’ll have to leave our last port of call – Cozumel in Mexico – until next week.

Until next week,

Keep living your life!

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