SUN-210 IMPACT OF FLOODS IN DIALYSIS SERVICE DELIVERY IN NORTH KERALA

Abstract

The heavy rains of monsoon season in two successive years have created catastrophic floods culminating in loss of life and property across Kerala state in South India. Patients undergoing dialysis have also suffered in myriad ways. In 2019 the floods were mainly restricted to northern Kerala which had the highest number of dialysis facilities. We aim to study the impact of floods of year 2019 on dialysis patients in northern Kerala. This is a cross-sectional observational study. All dialysis facilities from 6 districts of northern Kerala – Kannur, Kasargode, Kozhikode, Wayanadu, Malappuram and Palakkad were included in the study. Data was collected by telephonic interview with the staff or Nephrologist in-charge of each dialysis unit. The study was conducted with the permission of District administration - Kozhikode Jilla Panchayat - with the understanding of sharing the data to the administration for facilitating improvement strategies in the future. There are 111 dialysis centers in north-Kerala. Kannur and Kozhikode had the most number of centers-30 and 35 respectively, other 4 districts together had 46 centers. Of the 111 centers, 69 were hospital-based (HBC) and 42 were stand- alone-centers (SAC); they collectively catered to 5721 patients for regular maintenance HD. Fifty two centers were providing ≥ 3 shifts of service whereas 59 centers had ≤2 shifts. Twenty one of 111 (19 %) centers and 409 out of 5721 (7%) patients were affected by the floods. Of the 21 centers, 15 were water-logged, source water was contaminated in 17 centers and RO facility disrupted in 4 centers. KSEB power failure occurred in 28 of 110 centers. Forty centers of 111 (36.5%) had accessibility issues for patients and staff. Of the affected 409 patients, 154 (38%) had to skip HD session; 166 (42%) were accommodated in other units without getting their schedule curtailed. Eleven patients had to be hospitalized and four patients died during the period. The affected units returned to normal functional status within 2-14 days except one unit. Successive years of flood warrants us to ascertain the safety of our dialysis centers in providing uninterrupted service to our needy patients. Around 19% of centers and 7% of patients were directly affected whereas nearly 40% of centers had accessibility issues. Of the affected patients 40% received inadequate dialysis whereas remaining could be accommodated with help of nearby centers, which highlights the need of net-working for contingencies. Detailed cost analysis of the damages has to be done to formulate remedial measures for the future.