Dr. Martin Bitzan on a mission: MCH nephrologist spends six weeks working in India

By Lisa Dutton
The little boy was in acute kidney failure. By Canadian standards, he would be treated with dialysis and supportive medication, and if needed, he would receive a kidney transplant. But the child was not seeking care at The Montreal Children’s Hospital; he was at St. John’s Medical College Hospital in Bangalore, India. There would be no dialysis, no kidney transplant; in fact, there would be no further care for him because treatment is expensive. “For the good of the family, his parents stopped treatment and returned home with their child,” says Dr. Martin Bitzan, Director of the Nephrology Division at the MCH. “Continuing treatment would have bankrupted the family, jeopardizing the future of the other siblings,” says Dr. Bitzan who estimated the boy would live for only another three to four weeks.
These are the heartbreaking decisions that Dr. Bitzan witnessed daily during his six-week fellowship at the Medical College. The college, a highly regarded, not-for-profit institution, was created to train physicians and nurses to serve the underprivileged and those living in rural and remote communities. Access to health care as we take for granted is a luxury reserved for the rich in India. “Imagine patients having to buy each dose of medication to be administered in hospital. The cost of some meds can be 10 times the daily minimum wage of an unskilled labourer and is therefore rarely provided,” says Dr. Bitzan. “Patients are not given dialysis three or four times a week as in Canada, rather they receive it sporadically, whenever the family can scrape together some money.”
The collaboration between the MCH Division of Nephrology and the Bangalore hospital started about eight years ago with a research project between Dr. Paul Goodyer and Dr. Kishore Phadke. The partnership was expanded thanks to a ‘Renal Sister Program’ which pairs ‘emerging’ and ‘supporting’ renal centres. This program encourages faculty exchange and transfer of clinical expertise, including regional conferences for continuing medical education.
During Dr. Bitzan’s stay, two nephrology fellows were glued to his side taking the opportunity to quiz him on pediatric and nephrological problems and acting as his local guide. Dr. Bitzan also participated in daily hospital rounds and clinics, including what he says was a well-functioning, weekly, interdisciplinary nephro-urology clinic.
“There is a huge disparity compared to the types of patients I normally treat,” says Dr. Bitzan explaining that in India, the patients often seek medical care once their ailment is very advanced. “I am not used to seeing patients being admitted (and dying from) severe nephrotic syndrome (severely damaged kidneys), often complicated by pneumonia or peritonitis. What particularly impressed me,” remarks Dr. Bitzan, “was the medical team’s ability to work, and make do, with space limitations, overcrowding and limited resources. This, for me, is only the beginning of an ongoing learning process.”