20/05/19

My experience as an International Clinical Fellow – Dr Nicole Solomon

It was a great honour to have been given the opportunity to train at Birmingham Children’s Hospital, in an institution equipped with the resources and facilities to manage children with multiple renal conditions and disorders. This level of training and exposure was not possible or even available at home in Trinidad and Tobago.

I also had the privilege of working with members of the multi-disciplinary team who play such a vital role in the holistic management of these patients. The concept of the team was quite foreign to me as well, and it was amazing to see how integral each member was in ensuring that the patients and their families received optimal care.

I was able to work together with other professionals such as urologists, transplant surgeons, interventional radiologist and pathologists. They have all contributed greatly to my learning experience.

How has this fellowship benefited you?

Overall, this journey has been so rewarding. Professionally, in just 2 years I managed to perform over 65 renal biopsies, native and transplant, and I have actively participated in the work up, inpatient management and follow up of living related and cadaveric renal transplants.

My clinical experience involved the management of inpatients with acute nephrological conditions, including children with renal failure requiring acute peritoneal dialysis or haemodialysis. I was also asked to provide renal support to patients from other specialities and those in the intensive care unit.

One of the most valuable things that I gained was the opportunity to train in the interpretation of basic renal histopathology through attendance at departmental renal biopsy meetings and direct instruction in the department of histopathology under the supervision of a consultant histopathologist.

I attended the British Association for Paediatric Nephrology (BAPN) Winter Meeting, (Manchester) January 2019, the European Society for Paediatric Nephrology (ESPN) 50th Anniversary Meeting, (Glasgow) September 2017 and UK Kidney Week, Liverpool, July 2017.
Personally, I was given the opportunity to develop my leadership skills, acting in the role of consultant on call, giving renal advice to other hospitals, while overseeing the running of the ward and training of junior doctors on the team. I have established so many connections here that will never be forgotten and the bonds of friendship I have made will hopefully be ones that I carry with me for life.

It was incredibly difficult to leave my family and home, thousands of miles away, but when I think about the growth and development I gained personally and professionally, it was definitely worth the sacrifice.

Describe how this will help Nephrology in your own country

There is currently no paediatric nephrology service available in Trinidad and Tobago. It simply does not exist. Children with renal disease are managed by the adult nephrology team. To date I know there are children with end stage disease awaiting transplant and renal replacement and the adult teams struggle with the paediatric management of their complex care.

I look forward to be able to take back what I have gained from this experience to my people and to the wider Caribbean region. I hope that I can be given the opportunity to train other doctors in Trinidad in the management of patients with common nephrological conditions. It is indeed one of my goals to gather more data and research in the field of paediatric nephrology in my country and the Caribbean.

I am aware however of the challenges that exist. I know that we lack the resources and expertise of skilled personnel to manage these children. I have personally witnessed the value of the multidisciplinary team here at Birmingham Children’s Hospital and it will be one of my objectives to try to source the appropriate individuals who can offer the necessary support to these children in the different aspects of their care.

My hope therefore is to establish a link via the IPNA sister programme by collaborating with a supporting centre, such as this, on a one to one basis. This way, we in the Caribbean can continue to grow as an emerging centre and bring quality care to our children who desperately need it.

The Renal Association has formed a partnership agreement with the ISN to fund this opportunity.