DRAFT PROPOSAL TO _________________________ FOR REVIEW BY _________________________.
Background and Introduction
 Each year in sub-Saharan Africa an estimated 135,000 to 150,000 people die from reversible Acute Kidney
Failure (AKF) caused by malaria, sepsis (infection), acute diarrheal illnesses (especially in children), and
obstetrical complications.
 Since 2009, the Sustainable Kidney Care Foundation (SKCF) has demonstrated the effectiveness of treating
reversible AKF with Peritoneal Dialysis (PD) in low technology settings. Because of the simplicity of the
equipment, the proven clinical process, treating AKF with PD is possible in a growing number of developing
countries. SKCF has established successful programs in the effective delivery of this treatment in remote,
resource poor settings. Currently, SKCF has five active PD programs in sub-Saharan Africa with four more slated
to begin in the coming year. The need for these services is great given that most of the developing countries are
currently unable to provide this life sustaining service.
 While the programs SKCF has established have been fruitful, they lack the human resource support necessary to
continue training local clinicians and establishing grass roots educational programs to inform the local
communities of the availability of this vital service, educating them concerning prevention and assisting in early
treatment programs.
 SKCF proposes establishing a training ground for Greek nephrologists, including Fellows, nurses and recent
university graduates to work with SKCF programs currently underway and those soon to launch.
 Currently SKCF is working in consort with the three international nephrology associations in the education and
training of local healthcare workers:
o The International Society of Nephrology (ISN)
o The International Pediatric Nephrology Association (IPNA)
o And the International Society of Peritoneal Dialysis (ISPD).
 In this proposal, the SKCF seeks to join forces with prominent Greek nephrologists, nephrology practices and
nephrology departments in Greek hospitals and universities to help identify and supply the manpower and
expertise needed to expand PD programs and provide additional vital support to those programs already
underway. Terms of service can be as short as three months to as long as one year with opportunities for
extensions if desired.
General Outline of Proposal
The SKCF’s mission is”TO ESTABLISH ENDURING TREATMENT PROGRAMS WHERE NONE EXIST – FOR PATIENTS
WITH SUDDEN, REVERSIBLE KIDNEY FAILURE.” We therefore propose to establish programs to treat Acute Kidney Failure
using Peritoneal Dialysis in countries that currently are unable to provide this therapy. This requires training of local
clinicians, providing the consumables required to effectively treat AKF, and developing outreach programs in local
villages to refer AKF patients for treatment before their condition becomes untreatable, and to create AKF prevention
programs, as well.
Manpower
Hospital Based Programs
For each site selected, SKCF will recruit 1 – 2 doctors who will be committed to stay for a period of 3 months to one year
to work side by side with local doctors providing support and training in nephrology and peritoneal dialysis. Additional
support will be provided by senior level doctors who will be invited for stays of 1 -2 weeks expected to return every 3-4
months. Experienced dialysis nurses will also be invited to provide training to the local nurses in the methods of caring
for peritoneal dialysis patients
Outreach Programs
Currently, many AKF patients die because there is no PD treatment available for them or because they are referred too
late in the course of losing their kidney function. We propose for each PD program selected, that we will train 2-3 Greek
university graduates to aggressively liaise with villages in close proximity to PD program sites for the purpose of training
local health care workers in the availability of the program, helping to educate local residents to know AKF
signs/symptoms, and to assist in rapid referral of patients to established treatment programs.
Telemedicine
Telemedicine is the use of medical information exchanged from one site to another via electronic communications to
improve a patient’s clinical health status. Telemedicine includes a growing variety of applications and services using twoway video, email, smart phones, wireless tools and other forms of telecommunications technology. Examples include
patient consultations via video conferencing, transmission of still images, e-health including patient portals, remote
monitoring of vital signs, continuing medical education, consumer-focused wireless applications and nursing call centers,
among other applications, are all considered part of telemedicine.
As part of our proposal we plan to engage a Greek “telemedicine provider” (i.e. CardioExpress
[http://www.cardioexpress.gr/en/htmls/company.htm], or Vodafone, Greece
[http://www.vodafone.gr/portal/client/cms/viewCmsPage.action?pageId=11280&request_locale=en] – to develop basic
telemedicine capabilities whereby SKCF will be able to engage in better prevention and treatment of AKF.
Summary
At present, research we have done indicates the unemployment rate for doctors in Greece is estimated at 25%; for young
doctors just graduating from medical school the unemployment rate can be as high as 65%. Many are forced to leave
Greece to find employment elsewhere or continue to become a drain on the social services system. However, because
there is much need and work for them in the developing world, our proposal includes
 Providing a life giving therapy for indigenous people suffering from AKF
 Providing a creative employment opportunity
 And fostering improved knowledge, experience and skills for participants who will later return to Greece.
We estimate the cost for each site chosen to be approximately $335,000 for the first year, as summarized in the schedule
below. Currently SKCF has a long waiting list of hospitals in remote, resource poor countries anxious to establish PD
programs; our only limitation is the availability of personnel and the resources necessary to support them.
Estimated Budget per Site (US$)
Site 1
Physician 1 (full time)
Physician 2 (full time)
Physician 3 (full time)
Senior physician ( 4 visits)
Nurse (four extended visits)
Grad Student 1
Grad Student 2
Grad Student 3
Grad Student 4
Housing/Meals
Telemedicine costs
Health and other insurance
Transportation
Peritoneal dialysis consumables
SKCF Staff travel and administration
Total
Year 1
Year 2
Year 3
Total
$ 24,000 $ 24,500 $ 25,000 $ 73,500
24,000
24,500
25,000
73,500
24,500
25,000
49,500
4,000
4,500
5,000
13,500
6,000
6,200
6,500
18,700
12,000
12,250
12,500
36,750
12,000
12,250
12,500
36,750
12,250
12,500
24,750
12,500
12,500
80,000
116,000
134,000
330,000
8,000
12,000
14,000
34,000
25,000
42,500
47,000
114,500
64,500
86,000
96,750
247,250
35,000
30,000
15,000
80,000
40,000
45,000
50,000
135,000
$ 334,500 $ 452,450 $ 493,250 $ 1,280,200