A Study of End-Stage Renal Disease Care in Asian Socio-cultural Settings

Prosperidad Luis
Co-Authors: Samuel Aguirre, Shina Samoza, Mariel Caguingin
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The kidney is a vital organ in the human body. Its most important function is to act as a filter to remove waste products and fluids from the body. When a person’s kidney has lost 85% to 90% of the capability to perform this function, the person becomes a chronic case, an end-stage renal disease (ESRD) patient who is “doomed” to a life-time routine of dialysis treatment until a functioning kidney becomes available for transplantation. ESRD patients usually come to a center three times a week for dialysis treatment that lasts for 4 to 5 hours at a time. Thus, the center practically becomes a “second home” to the patient.

In 2001, the National Kidney and Transplant Institute built a new Dialysis Center with 35 stations, through fund-raising projects, solicitations, donations and a build-operate-transfer (BOT) arrangement with a multi-national hospital equipment supplier.

The project found inspiration in the dialysis centers of the National Kidney Foundation of Singapore where standards are very high. The project is unique in the Philippine setting because the center, designed on the principles of patient- and human-centeredness, has freed itself from the negative and derelict physical image of a government facility. The hospital, as a result, has enhanced the image of government in healthcare provision and has attracted patients all over the country. With the volume of patients to the Dialysis Center rising, the hospital had to explore the possibility of expansion.

As a prelude to design, a study had been undertaken on socio-cultural aspects, using the methodologies of observation, interview and questionnaire:

to determine the effect of the extended family on the allocation of spaces;
to determine the best arrangement of dialysis stations, considering the apparent “kapit-bahayan” (“you are my dear neighbour”) relationship created among patients who see each other for treatment on a regular basis;
to validate and confirm the amenities necessary to create a "second home" for patients, using the existing facility and its patients as source of information; and
to gather information from patients and their families about feelings and thoughts, hope and despair, with regards to ESRD, to assist in the design of the expansion facility.

This paper discusses:

the reaction of patients to selected features meant by design for their well-being;
the other findings of the study and their integration in the design of the new facility;
how the hospital had enhanced the image of government support for healthcare; and
how thoughtful design, well-implemented construction and bold, progressive project management can create ripples towards change.