Location: The unit is situated on Hospital property in what was once called Carrick and lies immediately across from the Hospital's main entrance. The facility was officially opened by the Premier, the Hon. Sir John Swan on November 8, 1984.

Prologue: The 10th anniversary year of the Dialysis Unit, coincidentally falls on the 100th anniversary of the KEMH. As with the mother institution, tremendous changes have occurred in this satellite facility in an effort to provide high quality care for all patients suffering from kidney failure.

History: The first recorded attempt at any dialysis procedure in Bermuda was in 1965. This was a temporary peritoneal procedure for acute reversible kidney failure, and the patient was subsequently transferred abroad for further management. This patient lived to the age of 84 and subsequently died in December 1990.

1973-1974: Three patients with kidney failure received kidney transplants in Montreal. Two patients received kidney transplants in Toronto. The first three received live related donors. Two received cadaver kidneys (kidneys from deceased donors) which were unable to return to Bermuda as there were no kidney machines to maintain life. All five of this original group had received intermittent peritoneal dialysis in Bermuda while waiting for relatives to donate kidneys. Of the five, three are still alive. Of the two transplanted in Toronto, both have died.

1974-1978: Hue and cry: It was the two patients whose kidneys were rejected in Canada, that required machine dialysis, and they were stuck there as there were no kidney machines in Bermuda.

This created quite a stir in the national media. And the two patients suffered hardship both socially and financially as they ran up bills of $250,000.00 or more over four years.

1978 mini-symposium on end stage renal failure in Bermuda: This was arranged by the then Chairman of the Department of Medicine KEMH Dr, Beresford M. Swan.

This symposium involved specialists from Boston, Delaware, Montreal, Vancouver and Washington DC, who reviewed our figures and agreed that the establishment of a dialysis facility was warranted, and noted that the rate of kidney failure in Bermuda was about two to three times the rate in other jurisdictions.

The 1978 passage of the Amendment of the Health Insurance Act by the then Minister of Health Dr. Clarence James: This established a pooled fund to cover the great expense of kidney machine treatments in Bermuda. In April 1978 the first ever machine dialysis performed in Bermuda was by Judith Smith-Tweed RN, Mr. Tom Punch and Dr. Swan. This first dialysis made possible by solving the great problem of untreated limited water by using technology from the US space programme.

Growth progress and statistics Original Dialysis Unit: Had three machines, two back up machines, one physician, two nurses and one technician. It was located between Curtis and Memorial ward. The unit started with three patients and by six months was up to 10 patients. And entry of patients to therapy was via standard criteria used in the 1980s.

Expanded Unit: Because of the rapid expansion of patient population with two years the unit had to be expanded to a six station dialysis facility with 10 machines, four nurses and two physicians. Because of the hardness of water at the KEMH 50 percent of the time the machines were down due to the inevitable slake in machine lines and sensors. Statistically we should have been seeing four new patients per year. But our figures at that time revealed that we were seeing eight-10 new patients per year. And the average patient time on the machines was four to five hours.

1980-1984 Planning for expansion: There was a concerted programme to alert Bermudians with respect to the prevalence of kidney failure which included all service clubs, all churches, the media and open public forums. We were seeing an inordinately high degree of kidney failure due to the ravages of hypertension, diabetes, inflammatory infectious diseases and heredity. Because of the great number of unexpected patients, a concerted effort of fund raising was instituted by the staff patients and interested parties. The Bermudian populace were extremely generous in donations to establish a fund to build a purpose built facility. This culminated in the design construction implementation of Carrick -- the current Dialysis Facility.

Demographics of the current facility: This is a purpose built state of the art hemodialysis centre. It has 11 chiars or treatment stations, supported by 12 computerised Hemodialysis machines, backed up by five portable dialysis machines and four stationary vintage but workable single pass hemodialysis machines. It's water treatment plant produces the highest grade of ultra-pure water in Bermuda using "Flash Point-Freezing'' technology. So pure is the water that it has to be protected and isolated from the atmosphere. This plant consistently produces water that surpasses the AAMI (American Association of Medical Instrumentation) standards for accredited dialysis facilities. It will be supplemented by a Reverse Osmosis (R/O) plant to help us out. The current facility has a staff of 10 certified nurses, one unit coordiantor, one asst.

unit coordinator, one dietitician, one social worker, one housekeeper, two dialysis technicians, two specialist physicians, one attending surgeon and a myriad of support personnel and resource facilities. Current patient census is 42 total and as such the dialysis patient population is larger than any Hospital ward. It has provided mandatory care for more than 200 tourists -- on average 10-15 per annum. On February 10, 1994, an NBC national reporter received dialysis in the KEMH facility. He called it the best session that he had ever had. This facility provides support to patients on cruise ships and private vessels year-round and around the clock.

Transplantation Statistics: It is generally agreed that transplantation is the best form of therapy fore kidney failure and in it's first decade the unit has evaluated arranged and managed 34 kidney transplants with the generous help of the Brigham and Women's Hospital Boston. Graft survival is at the 85 percent level and patient survival is at the 90 percent level.

The total number of dialysis procedures including local populations, tourists and acute patients in the ICU has exceeded the 50,000 mark.

Training courses and programmes are regular and to date 30 nurses have been trained in the theory and practice of hemodialysis and have all passed a certifying external examination.

The faith, generosity and support of the Bermudian population has led to a facility that they can be proud of.

*** Article submitted by Dr. Beresford M. Swan, Director of Dialysis, KEMH.