The Beresford Swan kidney dialysis unit at King Edward VII Memorial Hospital has a kind of family atmosphere. Everyone knows everyone else.Some patients have been returning multiples times a week for more than 30 years. In the past, it was manned by foreign doctors who stuck around for a short time and then departed. This was hard on the patients. They had to get used to a new doctor over and over again.But all that changed, recently. The dialysis unit now has two Bermudian doctors Wendy Outerbridge and Lynette Thomas who say they aren’t going anywhere. They are devoted to their Bermudian patients.Two years ago, the Bermuda Hospitals Board funded a fellowship for Dr Thomas, 43, that allowed her to spend two years in Boston specialising in nephrology in Boston. Through Harvard Medical School she did the fellowship at Brigham & Women’s Hospital. Last July, she returned home better equipped to help Bermuda dialysis patients. Lifestyle’s Jessie Moniz met with Dr Thomas to learn more about her and the dialysis unit.Question: How come you decided to come back here instead of staying in Boston?Answer: My plans have always encompassed staying here in Bermuda. Bermuda has a disproportionately high burden of renal disease. I enjoy practising in Bermuda.Q: Why is there such a high level of people in Bermuda with renal disease?A: Unfortunately, a lot of it is what we call diseases of excess. Most of our end stage renal patients are diabetics. Our numbers are similar to the United States, which has a high burden of diabetes and hypertension. In Bermuda, we also have a high level of certain genetic diseases such as polycystic kidney disease. Studies have not been done, but I feel like those numbers might be disproportionate in Bermuda. Bermuda is a very closed genetic circuit. There are a lot of interesting areas for potential research in renal disease in kidney disease.Q: Do you see many younger people coming up in medicine who could maybe take that up?A: Well I am hoping I still have time to do it (laughter). I have an on-going research project with Julie Lin at Brigham. It is not clinical; it is academic. There are a lot of areas that can be looked at more closely here in Bermuda. There are a lot of willing nephrologists at Harvard who are interested in collaborating to collect data.Q: Has renal disease touched your family?A: My grandfather was on dialysis. He was a diabetic. He lived in the United States.Q: Do you do you now think, I wish my grandfather had had this care?A: A lot of times in Bermuda there is an assumption that there is better care to be received elsewhere. I have always felt our patients do very well here, and get optimum care. We had an outside nephrology director who looked at our statistics and looked at how our patients did. He was amazed at how well our patients did. Our patients did on almost all indices as well as patients in the United States. So I think our patients here do exceptionally well. They get very good care. I would just like to see less of them. Right now we are at maximum. We have one spot left without having to make some major changes in how we run the unit, because we have so many patients who are presenting with advanced kidney disease or who are progressing with it. Another area I would like to explore is in the area of public health and how we get people more aware before they get to this stage?Q: At what stage does it start, school?A: That is probably a good place to start, but adults who have disorders like hypertension or diabetes need to be more aware of the potential effect on the kidneys. We need to provide them with the information so they can take an active role to protect their kidneys. Not all, but we get a lot of patients who have not taken as much of a responsibility for their health care. It shows, and this is where we end up seeing there. We know through research there are things that can be done to slow the progression of kidney disease. I would like to see more public health initiatives to make not only patients but also their primary providers aware.Q: What is it that could be done?A: The number one thing is control of blood pressure. There are guidelines for the blood pressure levels that we should shoot for. The standard is less than 130 over 80. Studies will show you that in most offices, that blood pressure is not obtained. Sometimes it is patient non-compliance and sometimes it is physicians not really targeting the blood pressure that they should. That is the number one intervention that is going to help to preserve renal function. It is maintenance of strict blood pressure control.Q: Has working here changed the way that you lead your own life?A: I think so. I think any nephrologist’s worst nightmare is to be on dialysis. We have a very sick, very ill population. Some days, you can’t help but say oh my goodness, let me go for a run today, or do some exercise. We have a broad scope of patients. Some are severely debilitated and don’t do well over the long term, and we have patients who work out and teach exercise classes. It is very rewarding when you see the ones who do well. Those patients who work out are more likely to be transplant candidates. That is our ultimate goal.* For more information on the Bermuda Hospitals Board go to www.bermudahospitals.bm, for more on the Brigham & Women’s Hospital go to www.brighamandwomens.org