The Past: An Era of Birth pains and Sanguine Ventures

In the early years of medical practice in the Philippines, internists needed to be trained abroad if they aimed to subspecialize. The application process itself was tedious, competition was brutal and being a doctor from third world country (as it was labelled then) means that you had to prove your worth every so often.

In 1971, the Philippine Society of Nephrology started out as a seed in the minds of thirteen newly minted nephrologists. Their intention was to spearhead the development of renal care throughout the country. Leading the group was Dr. Filoteo Alano as the President; Dr. Hilario Esguerra II, Vice President; Dr. Libertad Nazareno-Rosales, Secretary-Treasurer; and Dr. Ophelia Completo-Buot, Dr. Aurora Padolina-Perez, Dr. Ruben Basilio, Dr. Benjamin Atanacio, Dr. Adriano dela Paz, Dr. Elsa Jacinto, Dr. Cecilia Talusan and Dr. Antonio Talusan, Board Members.

The assembly believed that to be a master in nephrology, one must be a student at heart. And to ensure continuing medical education, conventions were held every two years boasting of distinguished speakers from all over the world. To acclimatize to the rapid evolution of Nephrology, conferences eventually became annual events. Hungry for continuing education, Dr. Filoteo Alano as Editor-in-Chief, directed the publication of The Philippine Journal of Nephrology (PJN), the official scientific publication of the society. The PJN publishes regularly and serves as an avenue for local scientific research papers in the specialty.

The Society noted that renal disease was steadily advancing in the ranks of the country’s top causes of morbidity and mortality. Thus, the need for home grown nephrologists were brought to the fore and hospitals in the country began developing their own training programs in nephrology. In order to standardize the quality of the subspecialty training, the PSN organized its Specialty Board (PSN-SB) and Training Program Accreditation Board (PSN-TPAB) in 1982. The PSN-SB is tasked with evaluating nephrology training programs in the country, as well as qualified graduates of local subspecialty training programs for certification as a diplomate and their eventual elevation to fellow, which signifies peer acceptance.

The Society understood that effort must be made to achieve the highest standards in the practice of nephrology, as well as to ensure that training programs remain current and well-rounded in developing renal physicians with a robust academic orientation and interest in doing research while maintaining humane and compassionate patient care.

In 1991, the Society became actively involved in the Preventive Nephrology Program of the National Kidney Institute. PSN launched this ambitious nationwide project of screening public school children for early signs of renal disease.

At the fore, adult and pediatric nephrologists were clustered together under the PSN. But in 1995, the pediatric nephrologists of the society created their own organization, the Philippine Pediatric Nephrology Society of the Philippines (PNSP) which is still under the umbrella of the PSN. The PNSP aims to address the unique and highly specialized needs of the pediatric renal disease population.

The new millennium started with the PSN manning the helm in celebrating the Kidney Month, which was previously led by the National Kidney and Transplant Institute. The Kidney Month was spent on increasing public awareness to renal disease and to allay false fears and misinformation, lay fora at different provinces were held.

Starting 2003, the PSN’s role in renal care was expanded with the mandate to accredit free standing dialysis centers. To encourage compliance to set protocols, workshops on quality assurance, in cooperation with DOH and Philhealth, were conducted.

The efforts of the Society were well received in the international arena as well. In 2003, the International Diabetes Federation and the International Society of Nephrology sponsored the Microalbuminuria Screening Day, a global campaign set on increasing awareness of the importance of screening for microalbuminuria in people with Type 2 diabetes. PSN was invited to be a member of the operation, and on September 13, 2003, the Society advocated the screening among patients with Type 2 DM in several hospitals in the country. The Philippines, through the Society, also hosted the 14th Asian Colloquium on November 2003 at Shangri-la Hotel.

The Present: A Decade of Unmitigated Catastrophes and Quiet Triumphs

The current decade was met with efforts to strengthen the framework of the truths and tenets of our institution. A Constitutional Convention was convened on July 30-31, 2011 in Tagaytay City with 33 core members in attendance. The grueling two-day meeting which often continued on until late in the evening, resulted to an enhanced version of the Constitution and By Laws, one which is responsive to the present needs and perceived issues of the society. A ratified version was presented a year later after further tweaks by the general assembly.

PSN also recognized the untapped potential for unrestrained connectivity and visibility inherent to the internet. Thus, the prototype of the PSN website underwent initial development and was released eventually after going through several revisions. The website proves to be a useful tool for information dissemination among the tech savvy nephrologists, but for others, it was simply a way to get in touch with old friends. The move lessened the society’s isolation from the public, as anybody could browse through its various articles, which ranged from the origins of the organization, to the current issues in nephrology.

As the society matured, so did the patients. It is because of this premise that a transition nephrology program was conceptualized in 2013. The Lipat Kalinga Wellness Program provided guidelines for pediatric nephrologists as well as adult nephrologists in the process of turning over patients to adult medicine.

2013 proved to be a controversial year, as the midyear convention slated in Bacolod City (which was tirelessly worked on by the Western Visayas Chapter), was unceremoniously cancelled due to security reasons. The Central Luzon Chapter graciously stepped in to take over, and the remaining few weeks were spent in delegating responsibilities and preparations. The two chapters bonded over the unconventional experience.

Nature, through its most belligerent expression of aggression decided to test the society’s mettle and dedication to service. On Nov. 08, 2013, Typhoon Yolanda swathed across Samar, Leyte and surrounding islands, leaving behind a trail of unparalleled destruction and detritus. Mortality climbed steadily over several days, with inaccessibility hindering relief operations. PSN, through the Typhoon Yolanda Relief Mission, aided by the ISN Renal Disaster Relief Task Force stepped in to provide assistance to the victims, specially to CKD patients on maintenance hemodialysis as there was a shortage of water and electricity. The veritable success of the relief efforts has proven that our society knows how to hunker down to the trenches when the situation demands it.

The society supports the thrust of the international community towards kidney disease prevention after noting that world-wide cases have skyrocketed. A partnership with the UST College of Nursing was formed to adopt Brgy. Balucuc in Apalit, Pampanga to conduct lay fora and screening activities. If the protocols developed prove to be successful, the practice could be replicated in other centers.

The Expanded HD Package is the brainchild between PHIC and PSN. The coverage has been improved upon; with 90 sessions allocated for hemodialysis, allowing for twice as formerly predicated. This translates to better adherence to hemodialysis and medication compliance and a reduction in morbidity and mortality rates.

Events were unfolding internationally: PSN had finally achieved ISN Collective membership. Locally, because of the influx of young blood, two new chapters were formed after having fulfilled the requisite number of practicing adult and pediatric nephrologists in the locality: Bicol Region Chapter and Negros Island Region. This proves that the Society’s dynamism and ethos has attracted more doctors to undergo nephrology training and belong to its ranks.

In order to intellectualize its aim of “Curbing the Increasing CKD Incidence” and to concretize its position as an “Authority in Kidney Health”, PSN formulated the Bahay na Bato – a conceptual framework on where the success of the Society rests. The Bahay na Bato grounds its pillars on the virtues of Pride and Integrity. There are five pillars: Membership Engagement and Expansion, Nephrology Curricula and Programs, Strengthening Research in Nephrology, Kidney Health for All and Financial Stability. All of these concepts are tied together to a singular goal: to be an Expert Champion in Kidney Health.

Chronic Kidney Disease has remained in the Top 10 causes of Morbidity and Mortality and serving the renal needs of hundreds of millions of Filipinos is no easy task for the society of a few hundred renal specialists. Fortunately, though, Cebu Doctors’ University Hospital and Bicol Regional Training and Teaching Hospital applied and was granted accreditation for adult nephrology while Southern Philippines Medical Center was given accreditation to conduct a pediatric fellowship training.

The Hemodialysis Clinical Practice Guidelines for the Philippines was finally launched on October 14, 2018. The protocols developed would be constantly evolving, as there are many questions and issues still unanswered. Suffice it to say, however, that a step in the right direction has been made for the conduct of Hemodialysis in the Philippines.

December 29, 2018 saw the onslaught of another typhoon that brought torrential rain and flooding. The affected areas of Mindoro, Bicol and Samar were still reeling from the deluge brought by Typhoon Usman when another deadly visitor stayed for the aftermath. Leptospirosis started rearing its ugly head shortly afterwards. It is with the joint efforts of Task Force and the PSN Committee on Disaster as well as the Philippine College of Physicians that the effects had largely been mitigated.

The decade is witness to the wholistic growth of the Society. Aside from civic work, the PSN has not been bereft of erudition. To fulfill its academic mandate, the Hemodialysis Committee has been periodically churning out post graduate courses for PODs, hemodialysis heads, medical directors, trainees, nurses and technicians. The PD Primer was successfully conducted, the second of which was August 2019. A Kidney Transplant Forum was started 2019, the first of many.

Our brand of nephrology has not gone unnoticed in the international arena. Several fellows in training and young diplomates have presented numerous papers and oral discourses on their respective areas of research in international symposia and conferences. PSN is actively involved with the research outputs and assistance provided to deserving researchers. The Society has maintained an active and visible membership in the ISPD, ISN OSEA (with seats in the regional board), APSN, and collective membership in the ISN.

The Future: A Time for Cautious Optimism and Unfettered Hope

The Philippine Society of Nephrology has grown by leaps and bounds. Currently, PSN boasts of 830 dedicated member: 51 Life Fellows, 16 Life Members, 314 fellows, 294 diplomates, 69 board eligibles and 86 members in training. The Society remains to be a formidable voice in government relations, proving to be the conscience of the civic sector in sponsoring the needs of kidney patients in the country.

The end of the current decade marks the 50th year of the Society’s existence- a concept which started from the brilliant minds of our nation’s pioneering nephrologists to becoming the leading authority in matters that concern renal health. The international society has even taken notice, acknowledging the contributions of our labors. But the day is far from over, and the laborers are few. There will be pitfalls in the future, as is inherent in any living organism, but it is our optimism and hope that will be the impetus that will carry on the vision of the society into the future.