Providence Healthcare
Providence Healthcare

From top to bottom: Ray Mark and Fatima Benjamin-Wong in his room at Providence; the team in St. Michael’s Home Dialysis/Kidney Care Centre; the Providence team on A5; staff get the PD cycler ready for the next treatment. (Photos by Katie Cooper)

Bridging another gap in our system

Bringing peritoneal dialysis care to Providence addresses a pressing need

By Emily Dawson

Aug. 29, 2019 - Across Toronto, few rehab facilities have staff trained to provide peritoneal dialysis. That could’ve been an issue for Ray Mark.

Mark knew he’d need extensive rehabilitation following a series of significant health issues last winter that left him unable to use both of his legs. Mark had lived a full and busy life. He was working at a job he enjoyed, loved spending time with his young granddaughter and had an active social life with his partner, Nettie.

But last November, everything suddenly changed.

When he experienced some unusual shortness of breath, Mark made the drive from Ajax to St. Michael’s to have it checked out. A few weeks later, he woke up from a coma in the Intensive Care Unit, with barely a memory of what had happened.

“I remember sitting in the waiting room in emerg and hearing my name called,” said Mark. “I learned later that I’d had two heart attacks, and then a mini-stroke in the coma.”

During his five months at St. Michael’s, he stabilized and received the medical care he needed, including peritoneal dialysis for his kidney disease. Peritoneal dialysis, sometimes called PD, uses the lining of the abdomen and a cleaning solution called dialysate to clean the blood. It’s usually self-managed by patients as part of a home-dialysis treatment plan but was provided by his care team at St. Michael’s.

Fortunately for Mark, before he would be transferred to Providence for rehab, a new Unity Health Toronto initiative meant he could continue to receive peritoneal dialysis there.

Identifying the need for better integrated care for our communities, the new initiative saw Fatima Benjamin-Wong, a home dialysis case manager from St. Michael’s, train 30 Providence staff with the goal of being able to admit rehab-eligible patients needing peritoneal dialysis.

“It was a pleasure working with Providence’s A5 team, led by patient care manager Sofia da Silva,” said Benjamin-Wong. “I’m so impressed with how staff have embraced this learning opportunity, wanting to understand the holistic view of the renal patient and gaining confidence in providing PD.”

The team on A5 was ready when Mark was transferred to Providence in April. Mark requires 10 hours of PD each night, and his nurses are responsible for beginning the process every night and ending it each morning. On-the-job refreshers supplement the training they received from Benjamin-Wong.

“Patients on PD will watch their care team like a hawk, because PD is their lifeline. They become the teachers. So while I’ve been able to train staff to get the service up-and-running, their ongoing learning comes from patients themselves,” said Benjamin-Wong.

Seizing this opportunity helps position Unity Health Toronto as a leader in bridging gaps across our system. By bringing the right care to the right setting, we’re ensuring that everyone can access the treatments they need to thrive.

Over time, Providence hopes to extend its new PD expertise to other programs, such as Palliative Care and the Cardinal Ambrozic Houses of Providence long-term care home, to benefit even more patients with PD needs.

Mark’s rehab is progressing nicely and he believes he’ll be back to work in some capacity soon.

“On the day I arrived, I met the physio and occupational therapists and the physician. Right away, they wanted to know what my recovery goals were. For me, it was simple: to walk down the hall at Providence with my walker. I knew if I could do that, I’d be well on my way,” said Mark.

“Shortly into rehab, though, I realized that was not going to happen in the near future. I’ve come to grips with this setback. So for now, I’m working on being totally comfortable and mobile in a wheelchair. If I can accomplish this, we’ll start working on my long-term goals.

“I’m still gaining strength in my legs, arms and core but I’m getting there. I don’t know what I would have done without the rehab at Providence. The care has been marvelous.”

Collaborating for better care

St. Michael’s and Providence work together to expand peritoneal dialysis care.
(Video also available on YouTube)

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