Working closely with others

The bags the patients bring with them to the renal care center on Blumentritt Street all look different—blue, black, sometimes plastic, sometimes fabric—but their contents are always the same: a small bottle of water, snacks, pillows and blankets. In the treatment room, blankets are draped over the chairs. Some are solid colors, some with flowers or balloons, embroidered, polka-dotted, checkered. The patients settle in the best they can. Some will pass the time with American TV shows or Korean dramas, others will read or sleep, while their blood is cleaned over the next four hours. Because when the kidneys are no longer functional or only function to a limited extent, they cannot filter out fluids or waste products of the metabolism.

Bernadette, on the other hand, is wide awake. She's not a patient, she's the head nurse at this renal care center in Manila, the capital of the Philippines. She was just in the waiting room welcoming a patient, and now she is standing at one of the fifteen machines in the treatment room where the words “end of treatment” are flashing on the screen. Bernadette removes the lines, throws them in the waste bin and gives the patient a shot to help with her anemia. ​

Being a dialysis nurse, Bernadette says, means more than just connecting people to machines and letting them run. “It’s much more of a responsibility,” she says. It is important to know the patients well and to carefully assess their individual strength and ability to undergo treatment in order to design dialysis appropriately. You need to know what other conditions the patients have, what medications they are taking and whether they have high blood pressure and, if so, when it occurs. “If you don't know what's going on with the patients, you can’t take care of them,” she says. It's that simple—and yet there is so much at stake.​

The renal care center as a social space

In the meantime, the waiting room, with its twenty chairs and a water cooler in the corner, is slowly filling up. Even though the next dialysis treatment is not for another half hour. The patients know each other, some arrive earlier so they can chat, ask each other how life is going. There is even a WhatsApp group where patients make plans to meet up or help each other jump through bureaucratic hoops. A woman in a flowered dress is the administrator of the WhatsApp group. Haydeeline used to work at a bank—now she takes care of her health, her home and her children. She says, “Bernadette takes really good care of us. She is strict when it comes to masks and hygiene in the treatment room, but, most importantly", Haydeeline says, "Bernadette is a friend to everyone".

Some patients have been in treatment for decades. Bernadette has been working at B. Braun for almost fifteen years. She sees patients several times a week, so she spends a lot of time with them. She is with them through the hopeless days, the weary minutes, and is also with them when things start looking up again, and their energy has come back. “It gets to a point where it’s not a patient sitting in front of you anymore,” says Bernadette, “it's your family.”

Switching off is not always easy, distancing yourself is difficult and maybe even counterproductive. When patients come to her for the first time, she says, many still don't realize what is happening to them. The hardest part, she says, is acceptance. Patients need to rearrange their lives, stick to a strict diet, keep an eye on their fluid intake. “It’s not the life these people imagined for themselves, so we have to slowly guide them along and be there for them,” says Bernadette. If a dialysis patient gets too much fluid, it can damage organs, increase blood pressure or cause swelling. And without regular treatment, the body slowly poisons itself.

Cutting-edge hemodialysis from South Africa to the Philippines

B. Braun operates more than 350 renal care centers around the world, from Germany to Malaysia, to South Africa and Australia. The center on Blumentritt Street in Manila has been open for two years. From 2018 to 2022, it was just down the way on Maceda Street, but eventually more room was needed. There were only ten dialysis machines but many more patients.​

Rhoda Mae has already had her treatment today. She is sitting in the waiting room while she packs her bag. Three times a week, she climbs into the passenger seat of a tricycle, a motorcycle with a sidecar attached, and goes to the renal care center close to the flower market. Monday, Wednesday, Friday—four hours each time, always the first shift at six in the morning, so she can get on with the day afterward. She was still a teenager when she started treatment ten years ago. She came with her father for her first treatment. She remembers how nervous they both were. But the team was so helpful, so easygoing, that her fear simply evaporated. To her, Bernadette is more than her nurse. Bernadette knows Rhoda’s father, her life, they are even friends on Facebook. “Bernadette looks after all of us,” Rhoda says. “In these ten years, she has never once forgotten to remind me to watch my hydration.”​

Before Bernadette became head nurse, she spent three years at one hospital based, about which she says, “That was a formative experience.” The ward had seven dialysis machines and even more patients—at one time during monsoon season, a flood came. “The water was up to my waist,” Bernadette recalls. Her car was flooded, the way to work blocked, getting through was actually impossible. But the responsibility—that was still there. And the thought of the patients whose bodies create more and more problems without dialysis was more than present.

So, she just went for it and found herself a tricycle. The sidecar was also flooded, so Bernadette clambered up on the roof. For three days, she had to sleep at the hospital before she was able to get back home. The patients were really grateful, because Bernadette brought them food every day—morning, noon and night. They did everything they could to keep Bernadette with them. “In those moments,” Bernadette says,” you learn to love your job.” She says that every job comes with responsibility, and she does not want to downplay that fact, but, as a dialysis nurse, you are taking care of people who need you to keep them alive. “That's something else entirely,” she says. ​

The dialysis nurses and doctors connect the patients, listen to their hearts, use thermometers or check patients’ blood pressure. A patient comes in, sits down, shakes his slippers off, leans back and jokes that he needs someone to hold his hand again. The nursing team laughs, they know him, and here they are happy to hold his hand. Bernadette says she couldn't do it without her team: “They make everything easier,” says Bernadette.

​At the renal care center on Blumentritt Street here in Manila, the next shift change is coming up. Bernadette is now in the waiting room, the second group of patients for today are leaving and the next are already seated and waiting. Bernadette smiles at an older gentleman, takes his large bag, helps him into the treatment room, cracks a couple of jokes, gives support, does not let him go until he is safely seated. Bernadette actually never wanted to be a nurse—she wanted to be a lawyer. A couple decades later and it turns out that, maybe, it is not an entirely different job, after all.