Video: Take Care Of Your Kidneys — Doctor Willie Ong Health Blog #7

By Dr. Willie T. Ong (Internist and Cardiologist)

Most people know how to protect the heart, but do you know how to care for your kidneys? The kidneys’ job is to help remove various toxins (drugs and food wastes), and expel them through the urine.

As we grow older, our kidneys will also start to age. A problem with kidney disease is that majority of patients have no warning symptoms.
Some time ago, we interviewed Dr. Elizabeth Montemayor, a nephrologist at the Philippine General Hospital. Here are 10 ways to protect your kidneys:

1. Limit your salt intake — Too much salt is not only bad for your blood pressure, it’s also bad for your kidneys. Many die of kidney disease, which can be partly attributed to a high salt intake and fondness for fish sauce, soy sauce, plain salt and salted fish. Even instant noodles, chips and nuts are teeming with salt. The problem with salt is that it encourages the body to retain water, and can increase your blood pressure (which damages the kidneys).
2. Don’t load up on high protein foods such as meat and steaks –A high protein diet makes the kidneys work twice as hard. Pretty soon, your kidneys could get tired and some of the weaker kidney cells can die. A friendly reminder to people on a high-protein Atkin’s Diet or South Beach Diet. The time-tested doctor’s advice of moderation in everything will serve you well. Eat a balanced diet of rice, vegetables, fish and fruits and you can’t go wrong.
3. Keep your blood pressure at 130/80 or lower — If your blood pressure is above 140 over 90, this can cause kidney damage within five years. The kidneys are said to be “happiest” with a blood pressure of 130/80 or lower. To help control your blood pressure, you should limit your salt intake, reduce weight and take medicines for high blood pressure, if needed.
4. Keep your blood sugar below 120 mg/dl — Diabetes and high blood pressure are the two leading causes of kidney failure. A person with uncontrolled diabetes for 5-10 years may develop significant kidney damage. Consult your doctor and keep your blood sugar under control with diet, exercise and maintenance medicines.
5. Drink 8 glasses of water a day — Doctors usually advise people to take in 8 glasses of water a day, but this really depends on your age and condition. If you’re sweating a lot and work outdoors, you may need to drink more than 8 glasses a day. However, if you are above 65 years of age, you may do well with just 6 glasses a day. Drinking enough water also prevents the formation of kidney stones.
6. Watch your intake of pain relievers and other drugs — Taking pain relievers like mefenamic acid, ibuprofen and the coxibs (like celecoxib) for a prolonged period of time may cause kidney damage. Because of this, we should limit taking these medicines to only a week, or just take them as needed. For those with chronic arthritis, try to look for other ways to relieve the pain such as using a hot water bag, pain reliever ointments, or the safer paracetamol tablet.
7. Be careful with tests and procedures using contrast dyes — Some tests, like CT Scans and MRIs, and angiograms, use a contrast dye which helps doctors delineate the organs better. The problem with such dyes is that they can cause kidney damage. To be safe, I would strongly advise you to consult a kidney specialist before undergoing such procedures.
8. Don’t drink too much Vitamin C — Excess vitamin C (ascorbic acid) can lead to the formation of kidney stones in predisposed individuals. If you need to take vitamin C, a dose of 500 mg or less is safer.
9. Don’t rely on food supplements to protect your kidneys — The above tips are so far the best tips to care for the kidneys.
10. Get a kidney check-up –Simple tests, such as a complete blood count, BUN and creatinine, and a urinalysis are the first screening tests for the kidneys. Finding a trace of protein in the urine can alert the doctor of possible kidney disease.
Bottomline is: Kidney diseases are expensive and difficult to treat. Let’s take the necessary steps to protect our kidneys today.

By Dr. Willie T. Ong (The Philippine Star, March 11, 2013)

Here are Secretary Enrique Ona’s plans for the Department of Health (DOH) until 2016 and beyond. To complete the promise of Universal Health Care, here are the innovative projects the DOH has started.

1. More specialty hospitals nationwide – After the successful rebuilding of the National Kidney and Transplant Institute as a modern government hospital, Secretary Ona has set his sights at building dozens of hospitals nationwide. The DOH has started the plan of creating multiple specialty hospitals nationwide. This will replicate the benefit of the 5 specialty hospitals in Metro Manila, namely the Philippine Heart Center, East Avenue Medical Center, Lung Center, National Kidney and Transplant Institute and Philippine Children’s Medical Center. For starters, he has asked Philippine Heart Center Director Dr. Manuel Chuachiaco to help build multiple Heart Centers nationwide. Next, it is within Secretary Ona’s vision to one day see lung centers, kidney centers, cancer centers and children’s centers also in Visayas and Mindanao. In addition, majority of the DOH retained hospitals have already been given additional multi-million budgets to improve its equipments, structure and services. It is now up to the hospital directors to carry the torch and implement changes.

2. DOH modern multicenter complex –After analyzing the present DOH location in Tayuman, Rizal Avenue, Manila, Secretary Ona has come up with a plan of transforming this old compound into a modern medical hub for public health and hospital care. First, Fabella hospital will transfer into a new 8-story building inside the DOH compound. Second, the two adjoining hospitals, Jose Reyes Memorial Center and San Lazaro Hospital (located beside DOH) will be renovated and improved to meet the escalating needs of patients. For these three hospitals, Secretary Ona wants a modern diagnostic center that will be shared by the three hospitals to improve efficiency. Finally, at the center of these three hospitals will be the new DOH complex, with higher rise eco-friendly buildings to save space. These institutions will be built to last at least 50 years and cater to the health needs of both poor and rich. Inside this DOH compound will be a large housing facility to be rented to health workers. Hence, even in cases of calamities and emergencies, these institutions will be kept running and functional.

3. Vastly improved public health (health center) system – Concurrent with the hospital improvements is the renovation or construction of approximately 3,576 health centers, birthing centers and other health facilities. This will cater to the primary health needs and birthing needs of the barangay folks. To decongest and save on hospital expense, the simpler medical cases can be treated in these primary care facilities.

4. More free vaccines to eradicate diseases – The DOH understands the need to maximize preventive care in the form of free vaccines for children and adults. Hence, in addition to the usual vaccines in the Expanded Program of Immunization, the DOH has added two new vaccines. These are the rotavirus vaccine to prevent diarrhea and the pneumococcal vaccine to prevent pneumonia in children. Lower income senior adults will also be given free pneumonia and flu shots.

5. Philhealth to cover all Filipinos – The national government has already poured in billions of pesos into Philhealth to cover the poorest segment of the population, which is around 25 million Filipinos. This Philhealth money will in turn go the health providers and hospitals. Depending on the funds available, the government is planning to further increase the free coverage of Philhealth.

6. Landmark legislations – Two landmark health bills were enacted, which is the Sin Tax Bill and the Reproductive Health Bill. The former will pour even more money to the health sector, while the latter will help prevent mothers and babies from dying. This will lower the country’s maternal mortality rate and infant mortality rate.

In addition to the big picture, DOH will lay the groundwork to complete the plan for universal health care. There are other important health issues that needs be addressed, such as health manpower, and cheaper and effective medicines.

Surely, until 2016, all these plans will be implemented. After that, we hope that the current health gains will be continued and enhanced by our future leaders for the benefit of all Filipinos.

By Dr. Willie T. Ong, The Philippine STAR

There is a lot of debate on the pros and cons of corporatization in public hospitals. To learn more about this, let us look at a World Bank report on corporatization. The report, authored by April Harding and Alexander S. Preker, is entitled, “Understanding Organizational Reforms: The Corporatization of Public Hospitals.”

For simplicity, the three main hospital systems discussed are the budgetary organization, the corporatized organization and the privatized organization. Let us see if we can apply these ideas in the local setting.

Budgetary Organization:

The current set-up in most public hospitals is the budgetary organization. This means that the National Government gives a certain budget to the hospital every year. The hospital is then tasked to deliver goods and services to the people. This set-up appears ideal at the beginning but the experience worldwide shows that it has many problems. These issues include among others, (1) the inferior quality of services, (2) social services are unresponsive to the needs of the patients and (3) poor staff treatment of patients.

At first, it is easy to blame the administrators and the staff for these shortcomings. However, since these problems cropped up worldwide, the authors conclude that the flaw is in the system and not the individuals. The budgetary system suffers because it is not exposed to competition and market forces. Hence, there is no incentive for the hospital to improve its services since they will get a budget anyway.

Privatized Organization:

Seeing the problem with budgetary hospitals, economists therefore looked at the system used by privatized organizations. The World Bank researchers saw the topnotch quality of healthcare delivered by private hospitals. The staff is also motivated to perform their best. Why is this so? The answer lies in competition and incentives. The private hospital has to compete and be at their best so they can attract paying patients. The staff should also perform well or else they could be demoted.

However, there is one weakness in the private hospitals that we don’t want for our public hospitals. This is the profit-oriented goal leading to high cost. The challenge for the government then is to get the high quality of care of the private hospital while still retaining its mandate to serve the poor. Thus, was formed the idea of corporatization.

Corporatized Organization:

Corporatization is the middle ground between budgetary hospitals and private hospitals. Similar to private hospital, a corporatized hospital will have a board of directors. This could mean that the corporatized hospital will hire several experts like a finance manager to manage hospital operations. This hospital will now be accountable for its financial status. They cannot always operate at a loss. A corporatized hospital should ideally be exposed to competition and market forces which will drive quality of care upwards.

In the Philippines, we have four specialty hospitals, which are already corporatized. These are the National Kidney and Transplant Institute, Philippine Heart Center, Lung Center of the Philippines and Philippine Children’s Medical Center.

The challenge for a corporatized hospital is to maintain its pro-poor services. This is where government support is needed such as (1) PhilHealth reimbursements, (2) some government support to maintain pro-poor services and (3) perhaps additional PDAF of politicians.

From the World Bank discussion, the take home message is that for corporatization to succeed, it must work hand in hand with government support programs. Otherwise, cost may escalate to the detriment of the patients. This is where PhilHealth should come in as a strong financer for the poor.

The Parent and Child Analogy:

Once, there was a father and his son. The father would give his son a stipend of P5,000 every month in exchange for helping out in the family business. Whatever the child does is up to him, he will still receive P5,000 every month.

After a few years, the business went sour and the customers were complaining of the poor service. Now who is to blame? Is it the son’s fault, or is it the parent’s fault with the way he brought up his son.

So now, the father decides on a new system, similar to corporatization. The father will now only give the child P1,000 per month. The other P4,000 will be placed in a bank (similar to PhilHealth). The son can get the P4,000 if he does well in attracting more customers in the business.

Of course, the son would understandably complain saying, “I want the old system. Just give me a regular budget.”

Being a good parent, the father knows that if he gives more money, then the child will have no “incentive” to work harder. The son will also not be in “competition” with others to improve services. As the story goes, the happy ending should be that the son agrees to the new corporatized set-up. He works hard and the business succeeds.

In summary, there will be challenges with this new set-up. But maintaining the status quo of the past decades is equally undesirable. Health care and medical technology are increasing at a tremendous rate. Our public hospitals cannot be left behind. The people deserve a higher standard of health care.