Poor kidneys

I’m sharing some of the reflections I gave in a keynote speech last week at the Philippine Nephrology Society’s annual convention, where I spoke of the challenges that nephrologists face from a medical anthropologist’s perspective.

“Kidney” is a lonely and dark word when borrowed into Filipino. When we say “May kidney siya,” we don’t mean it literally as in “He or she has a kidney.” Instead, we mean “kidney disease,” just like “appendix” means “appendicitis.”

At least with “appendix,” we are specific about the problem—an inflammation of the appendix.  “Kidney” is generic, given that there are so many possible kidney diseases. Moreover, the term has an ominous tone, associated with very serious illness.

Unless serious illness has set in, the poor kidney is so undervalued in Filipino society. Even the names for the kidney are telling. I checked the UP Diksyunaryong Pilipino and it defined (in Filipino) the Spanish-derived rinyon as “internal organ of humans and animals that are shaped like the seeds (buto) of the patani.”

Then there’s “bato,” which the UP Diksyunaryong Pilipino also defines as a stone, a hard object, any stone of value (i.e., a gem) and the illegal shabu (metamphetamine hydrochloride). The dictionary does mention “kidney” and “kidney stones.” In daily usage, I’ve heard “bato” used as well for gall bladder stones.

Other vital organs are privileged when it comes to our daily conversations: the heart (puso in Tagalog) associated with a wide range of feelings, the sikmura (gastrointestinal system) for, well, gutsy emotions, the brain (utak) for genius and brilliance and scheming, like what we’re seeing in the election campaign. In Malay cosmology, the liver in hati is the seat of emotions, as we see in terms borrowed into Tagalog: dalamhati (sadness), lualhati (happiness), pighati (anguish).  No wonder the liver (atay) figures prominently in folklore, a gourmet favorite for that creature of the night, the aswang.

Talking about food, Filipino carnivores will eat almost every part of the animal, whether a cow, pig, or chicken. But the kidney? The ethnic Chinese like kidney with misua, which does sound strange in a menu when it appears in English. Imagine now if it were in Tagalog: “Bato Misua.”

Even within the medical specializations, nephrology is not quite as popular or glamorous as the others. I’m sure when a doctor is asked what his or her specialization is, the nephrologist will quickly say “kidney” rather than “bato.”

Yet, the kidney is so essential to the body’s overall functioning, the Balara waterworks system coming to my mind.  The kidney is a filtration system for our waste products, and also, like the dam at Balara, regulates fluid levels in the body, as well as important chemicals called electrolytes in the fluids.

The kidney should be used more often to describe society.  When mismanagement of our waterworks occurs, entire cities suffer (as in flooding and contaminated water). It’s the same thing with our kidneys: When there are problems in other parts of the body, diabetes and hypertension especially, the kidneys are damaged, leading to more health problems.

Just the day before the nephrology conference, I was at the Philippine Pediatrics Society’s convention and there was much talk about how poor maternal health affects kidney development in the fetus, and increases the risks for a number of diseases after being born. The risks for kidney diseases, including metabolic syndrome, are amplified by unhealthy foods during childhood, from milk formulas to soft drinks.

The week’s medical conferences got me thinking, too, of how kidney diseases also relate to socioeconomic inequities.  It’s the poor who suffer most grievously, unaware of the links between unhealthy lifestyles and foods to kidney diseases, and unable to afford dialysis and other medical interventions when kidney diseases do strike.

I’m always reminded about the stark inequities when I go to buy pet supplies, and notice all the specialty pet foods, including formulations for older dogs and cats with kidney disease. These special foods are low in protein, sodium, phosphorus and potassium.

Lucky dogs, lucky cats, poor Filipino.

‘Balisawsaw’

At the nephrology conference, I did talk about very high awareness of balisawsaw. This is a term used to refer to difficult urination, usually a perception that there’s too little urine, or irregular flow. Painful urination is also included under balisawsaw.

The condition is attributed to excessive heat (init), outside and within the body. A common belief is that balisawsaw comes from sitting on a chair or any place that has become hot, usually from someone else who sat there for some time.   I showed the nephrologists postings from an Internet site where people were exchanging folk remedies for balisawsaw.  These were mostly about increasing fluid intake, with coconut juice being a favorite. There were some strange ones like dabbing the umbilicus and the back with water. There’s also awareness of “a pill” that makes a person urinate but the blogger could not remember the name. (It was most probably a diuretic, meaning a medicine that increases urination, either hydrochlorthiazide or furosemide.)

In that chat group, one posting did mention that balisawsaw might be UTI (urinary tract infection), and suggested using Bactrim Forte (generic name: cotrimoxazole).

Difficult urination can come from kidney stones and maybe kidney dysfunction. But balisawsaw can also be associated with prostate disease—when the prostate is enlarged, it presses on the urinary bladder and causes irregular urination. Urinary tract infections as well as sexually transmitted illnesses (there’s a difference between the two) can also cause painful urination.

We do need to promote more fluid intake among Filipinos and to explain it’s not just because of “heat.” Plain water is fine; in fact, my nephrologist-friends worry that too much coconut water can actually upset the balance of electrolytes in the body.

There have been no surveys yet on water intake, but I suspect there are differences even within Filipino society. Women will cut down on water intake because they worry about having to look for a toilet, preferably a clean one.

The poor, too, take less water for various reasons. They’re not sure about how clean the water is (“criminal water” is a term I’ve heard being used among urban poor residents to refer to their tap water). If they have to buy water (and soft drinks), that means an additional drain on their budgets.

When traveling, the poor have to make do with long commuting in buses without toilets, having to wait for rare breaks to make a mad dash for often dirty CRs.

The supreme irony is that the poor, who are at such high risk for kidney diseases, are also the ones who have to sell their kidneys to raise money.

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