September Holiday time on dialysis. Clinical corner haemodialysis catheter. Entrepreneur success story of a chronic renal failure patient

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1 September 2017 Holiday time on dialysis Clinical corner haemodialysis catheter Entrepreneur success story of a chronic renal failure patient

2 Welcome! Dear Readers, It gives me great pleasure to introduce you to the NephroCare for me magazine. In this edition, we bring you some exciting and inspiring patient news from across South Africa. We then discuss holidays on dialysis, explaining how you can have dialysis anywhere in South Africa. We are happy to accommodate you in any of our NephroCare centres. We then take you through our clinical corner with some handy information on how to make your treatment more comfortable. Lastly, let's get cooking with our lovely winter recipes. So sit back...relax and enjoy this NephroCare journey with us!!! Your NephroCare editorial team

3 Fresenius Medical Care informs Fresenius Medical Care about us 4 Worth knowing in renal Clinical corner haemodialysis catheter 6 Different countries different habits Failure & pregnancy it s twins Experiences with Fresenius Medical Care Entrepreneur success story of a chronic renal failure patient Recipes Potato bread Creamed chicken with mushrooms Snow cupcakes Worth living Holiday time on dialysis 20 Information National footprint Contact information Inspiring Message of appreciation Brain calisthenics 26 27

4 Fresenius Medical Care about us As a patient in a Fresenius Medical Care centre the largest dialysis care giver in the world you may be curious to find out more about us! Fresenius Medical Care provides dialysis (peritoneal and haemodialysis) to over 300,000 patients worldwide. We boast vast experience in the speciality of renal care, working with expert nephrologists and dialysis nurses. Experience and data are shared around the world, including with South Africa, to ensure progress in the technology and care provided in our centres. Our care, known as NephroCare, is subject to strict guidelines to ensure your health and safety in our centres. This care benefits patients, staff and the community. We are a green eco-friendly company, ensuring safe disposal of all disposable components of haemo dialysis and peritoneal dialysis. Our devices, such as the 5008S CorDiax, ensure minimal use of water in the droughtstricken areas of our country. Staff training plays an integral role at Fresenius Medical Care to ensure you experience only the best treatment from nurses, clinical technologists and doctors. They are kept up to date with all the latest technology and techniques. A mentorship programme allows for senior staff to mentor, guide and support all our new staff in a practical setting. At Fresenius Medical Care, we have a quality management system (QMS), which provides practical guidance to staff about protocols in order to perform the best dialysis. An example of this is the hygiene policy, which gives instructions on manoeuvres to be performed during dialysis to prevent infections. Under the NephroCare approach, all our patients are in the good hands of our nurses in all Fresenius Medical Care centres worldwide Charles Swanepoel Country Medical Representative: Fresenius Medical Care 4 Fresenius Medical Care informs

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6 Clinical corner haemodialysis catheter Welcome to clinical corner! In each edition, this corner gives you information essential to your dialysis treatment. This information will be useful to you to understand and be more involved in your treatment. In this edition we kick off with a short introduction into the prevention of clotting of your catheters, explaining the medication we use in this procedure. In the next edition we will describe how these medications must be administered. Enjoy your reading! What you need to know about the haemodialysis catheter In order to preserve your catheter and prevent it from clotting, two anti-clotting agents are available (anticoagulants), for the nurse to lock your catheter. This is what these terms mean: Anticoagulants prevent the blood from backtracking up the catheter and forming clots, thus allowing the catheter to work with each dialysis for the life of the catheter, if instilled correctly by the nurse. Anticoagulants only thin the blood, they do not dissolve blood. Locking the catheter means the nurse must correctly instil the anticoagulant into the catheter once the blood has been returned to your body, and the catheter has been flushed with normal saline. Flushing with normal saline is important to ensure the catheter is clear of blood cells, to help prevent blockages. What are these anticoagulants? Intralock Is made by pharmacists without using animal products. Its active ingredient is a chemical known as citrate in a percentage of 4% (very low dose). It prevents clotting and the formation of biofilm (a resistant film that forms on the end of your catheter inside your body, preventing the catheter from working). It assists with reducing episodes of infection with its antimicrobial properties. Intralock works by interfering with calcium, which is used in the body for blood clotting. Clots will then not be formed at the end of the catheter. Intralock does not enter your body; it stays in your catheter provided the nurse instils it correctly. There are minimal side effects. 6 Worth knowing in renal

7 Heparin well known to all of you! This product is of animal origin, and interferes with platelet production (special little blood cells that are active in clot formation), thus preventing blood from clotting. Unlike Intralock, heparin tends to encourage the formation of biofilm which causes difficulties with your catheter function. Heparin also tends to encourage infection in catheters if proper care is not adhered to. Due to heparin overusage, we are starting to see resistance to heparin, as well as serious allergies. Heparin does not enter your body; it stays in your catheter provided the nurse instils it correctly. In the next edition, we will describe the method the nurse must use to instil these products into your catheter. Knowledge is power. 7

8 Renal failure & pregnancy it s twins Durban Kidney & Dialysis Centre Lungisile Mbali Manqele The Durban Kidney & Dialysis Centre is proud to announce its very first successful pregnancy. On 14 June 2017, Fresenius Medical Care dialysis patient of 3 years, businesswoman Mrs Lungisile Mbali Manqele, welcomed two bouncing bundles of joy named Nknyezi and Kwezi. This brother and sister duo have defied all odds and have been one of the very first set of twins to be born to a mother who is currently on dialysis treatment. Staff at the Durban Kidney & Dialysis Centre said that this truly was a miracle, as from a science perspective, the elevated levels of urea, creatine accompanied by a minimal to nil urine output would make a successful pregnancy, let alone twins, near impossible. Women who are on dialysis treatment are made aware early on that renal failure severely decreases the chances of a successful pregnancy and that is why Mrs Manqele only discovered that she was expecting 17 weeks into her pregnancy. She attributed her symptoms of pregnancy to the common cold, changes in her dry weight and even food poisoning. It was only through a blood test that pregnancy was confirmed, and when Mrs Manqele had her first ultrasound she did discver that she was carrying not one but two babies. Mrs Manqele had her babies delivered at Netcare St Augustine hospital via a C section 7 months into her pregnancy. During her second trimester her dialysis prescription changed to daily dialysis and two weeks before her set delivery date she was admitted and the daily dialysis continued in hospital with the aid of Fresenius Medical Care acute staff. She was also a given steroid treatment in order to allow the babies' lungs to develop fully. The now mother of four said that her babies were doing well and had added a new ray of light in the life of her family. She went on to say that, while the babies were unexpected, she and her husband could not wait to bring them home in a few weeks.. Mrs Manqele also said that the support, love and advice she received from the staff of Durban Kidney & Dialysis Centre and Fresenius Medical Care as a whole had been overwhelming. The Durban Kidney and Dialysis Centre would like to wish Mrs Manqele everything of the best in the future for her and her family. 8 Different countries different habits

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10 Experiences with Fresenius Medical Care Durban Kidney & Dialysis Centre Niresh Arroon Fresenius Medical Care gave me and many others the opportunity to return to work full time. In my case I returned to work as an educator in a senior position. I was delighted that Dr AA Khan had upgraded all his units from standards that were already high to the worldclass standard of Fresenius Medical Care. This has been a long time coming for me - ever since I joined Fresenius Medical Care. The dialysis has given me an opportunity to engage with some high-profile personalities. I don t think this would ever been possible if not for the management and staff and not to forget the staff that ensures our facility is always fresh. I only want to mention a few: Borrie, Zora, Shame, Craig and all of the staff both past and current have been so amazing that any issues, be it administration, treatment or other issues, have always been addressed in a timely manner. Fresenius Medical Care maintain a balance of senior personnel and a contingent of young personnel, who are confident, eager and world class, even though they are recent joiners. Most of the young staff have redoubled their efforts so that the patients receive the best of dialysis treatments. get back to work and engage in hobbies and new activities. in hobbies and new activities. Information on each patient is transferred to Germany and a full session of dialysis is encouraged in most cases. Many lives have been saved with instances of patients rushed to hospital. Compliance with the recommended fluid intake and diets is readily encouraged. Resources and visits by dieticians, programmes of optimal renal health are often encouraged by head office. Due to the popularity of world class dialysis, many new dialysis centres by Fresenius Medical Care have been opened by head office. The amazing thing is that Fresenius Medical Care has has provided dialysis to many patients while on holiday at venues throughout South Africa. International trips are made easy. The only requirement is that patients need to book early with their resident unit. When they arrive at their international destination. they don't have to worry as their time slots have been booked for them. Fresenius Medical Care leads the way in dialysis treatment in the renal care fraternity. New procedures are being researched all year round, and the treatments are bettering the lives of many of the patients most of whom Dialysis care doesn t stop here, and aftercare at home is often encouraged. There are many doctors, such as Dr S Maharaj, Dr Afzal, 10 Different countries different habits

11 Dr AA Khan, Dr Mody. Dr Rambaly has been instrumental in monitoring patients. It is often the case that doctors pick up on shortcomings of patients and notice that they don't follow their diet and their fluid intake does not comply with a renal condition. Doctors interact regularly with both management and ground staff, who work tirelessly to give information on the well-being of patients. The staff are awesome, vibrant and efficient, responding to situations, always willing to lend a hand to their co-staff and serving the needs of patients. So go Fresenius Medical Care, go! About the writer Niresh Arroon I joined Fresenius Medical Care in June 2013, where they gave me the chance to return to teaching, at Montarena Secondary (acting acting Head of Department), where I taught grade eleven business studies. I signed up with South Africa Tourism for a guest panel questionnaire at the Tourism Indaba 2014 to In 2016 I had the opportunity to be part of the panel and to interview TV personality Steve Harvey. There are several other engagements that I was able to meet due to the world class dialysis I was able to receive. Last but not least, I have an incredible following among the patients at Fresenius Medical Care. I take time, maybe 5 minutes before a session and immediately after a session in the reception areas. I try to make them laugh, but, hey, I'm not doing a good job at it. (I am the one laughing!) Further, I am trying new research in catering. Often I try my new layout with the staff. In most cases the Fresenius staff come back satisfied. It s the least I can do for them for keeping me alive and flamboyant and charismatic. Hey, Borrie, you've got to wait for your buffet. And thanks, Borrie! Niresh Arroon is shooting for the stars, but if he doesn t reach them, at least he will fall on the moon. Current status breathing and hoping for a transplant. Currently business partner of 5th Lock. Just signed on as a free agent for South Africa Tourism, African Renaissance and International Marine Time Convention. I m encouraged to rest by both management at all levels as well as staff. I laugh, have a lot of fun but remember to control my hypertension, which landed me here in the first place! (Laugh again.) Never crying. What an awesome journey! I must behave, watch my fluid intake and watch my diet. 11

12 Entrepreneur success story of a chronic renal failure patient Riverside Kidney & Dialysis Centre Thalefang Paakane Background The purpose of this article is to provide a summary and evaluation of a chronic renal failure patient on haemodialysis treatment, which is administered for four hours three times a week. At the same time, the patient is able to manage and direct his network of businesses spread across different districts of Botswana. Introduction Thalefang Paakane, a 62-year-old gentleman from Maunatlala, almost 300 km south-west of Francistown, is a retired school teacher who ventured into business in Soon after his retirement, he was diagnosed with chronic renal failure. Mr Paakane narrates his story as a painful and challenging time of his life. He had planned for a nice retirement with his family, but then suddenly something changed his life. He was living in Francistown with his family at the time. He was diagnosed in Bokamoso Private Hospital and later transferred to the Riverside Kidney Dialysis Unit on the 25 October Mr Paakane had severe weakness in his lower extremities and was aided with a wheelchair for a time. Through determination and physiotherapy, he slowly regained his power. Mr Paakane was also diagnosed with Type 2 diabetes Mellitus, Anaemia, and End Stage Renal Failure at the same time. During that time, Mr Paakane had a farm that is 360 km from Francistowm and a supermarket that is 30 km from Francistown. He also owns a welding workshop in Francistown, where he resides. Mr Paakane had to adjust his life to meet all the business expectations and management tasks in order to sustain his family during his retirement. At first after being diagnosed, it was difficult to concentrate and decide which business to keep and which to sell in order to focus on his health. Ultimately, he and his family decided to keep. In 2014, Mr Paakane was referred by Botswana's Ministry of Health to the Arwyp Medical Centre in South Africa for the surgical creation of an arteriovenous fistula (AVF). The 12 Different countries different habits

13 distance also affected his businesses, but as he was managing them by phone, they have since recovered. to his haemodialysis sessions and medication prescribed to him. Conclusion With the dialysis treatment given three times a week, the patient has managed to improve tremendously; he is more energetic and plans his business activities well so that they do not interfere with his dialysis schedule. Today, Mr Paakane has improved so much that he has adjusted his business management to his dialysis times, so he never misses any sessions. All his businesses are running well with the support of the rest of his family. He is the director of his businesses. Mr Paakane hopes that in future, the company will be able to introduce mobile dialysis for their customers who are entrepreneurs. He is also an active member of the Kidney Society of Botswana. Clinical history Mr Paakane is currently only treated for endstage renal failure, as the other conditions are being managed appropriately and he is no longer taking any treatment for diabetes. He has switched to a diabetic diet, which is a healthier choice, but is still currently on hypertensive treatment. In all the years this patient has never developed any chronic haemodialysis complications other than occasional post-dialysis cramping and headaches. Good compliance has led to some improvement in the blood results, indicating better kidney function. For some time now, he has not complained of any illness, he has adhered very compliantly Mr Paakane encourages and motivates other patients at times when they want to give up. He gets solid support from his family. His wife is a retired pharmacy technician who advises him on the importance of compliance. He is enjoying his retirement with his wife and children. When asked about kidney transplant, he responded that the procedure scared him because of stories that he had read in newspapers. He has been reassured about it. 13

14 Starter: Potato bread Main course: Creamed chicken with mushrooms Dessert: Snow cupcakes Potato bread (serves 10) Ingredients (10 servings) Sponge: 1 packet of yeast 100 ml lukewarm water 50 g flour Dough: 200 g potatoes (starchy) 2 tsp salt 2 tsp sugar 550 ml water 1 kg flour Nutritional values (per serving) Calories 377 kcal Protein 13 g Carbohydrates 76 g Fat 2 g Sodium 83.0 mg Liquid content 63 ml Phosphorus 152 mg Potassium 252 mg Method Stir the yeast into the water and mix with the flour. Let the mixture prove at room temperature until it has doubled in volume. Boil the potatoes in unsalted water, leave to cool slightly, peel warm and purée. Mix the salt and sugar with the water and knead a bread dough with the potatoes, the sponge and the flour. Let the dough prove in a bowl in a warm place for approximately 60 min. Preheat the oven to 230 C (220 C if fanassisted) (put a bowl of water into the oven as well; this will make the dough more fluffy). Shape the dough into a round loaf and bake it in the preheated oven for approximately 60 min. until the dough is baked (wooden pick test). 14 Recipes

15 Nutrition tips: Reduce the potassium content of the potatoes by soaking them beforehand. 15

16 Starter: Potato bread Main course: Creamed chicken with mushrooms Dessert: Snow cupcakes Creamed chicken with mushrooms (serves 4) Ingredients (4 servings) 4 chicken breasts 1 white onion 1 glass of white wine 250 g fresh mushrooms 1 tablespoon whole-grain mustard 250 g fresh cream Parsley Pepper 250 g rice Method Finely chop the onion and sauté with a little oil in a large saucepan. Cut the chicken breasts into small pieces and add them to the caramelised onion. Add pepper. Add the mushrooms, peeled and cut into strips. Add mustard and white wine to the mixture. When the alcohol goes flat, add fresh cream, parsley and lower the heat. Nutritional value: Calories 546 kcal Protein 44 g Carbohydrates 52 g Fat 15 g Sodium mg Liquid content 256 ml Phosphorus 512 mg Potassium 836 mg Simmer for 30 minutes over low heat. Serve with white rice. 16 Recipes

17 Nutrition tips: For fans of gourmet cuisine: this recipe for creamed chicken will seduce you! Quick and easy to make, this dish says everyday, meeting your requirements for salt and potassium. Rich in protein, necessary to maintain your muscle mass, it will thus be a source of phosphorus. Remember to take your phosphate binder! To reduce the potassium level of this dish, you can exchange the fresh mushrooms for canned ones (discarding the water in the can). 17

18 Starter: Potato bread Main course: Creamed chicken with mushrooms Dessert: Snow cupcakes Snow cupcakes (serves 16) Ingredients (16 servings) 120 g wheat flour 125 g icing sugar 125 g soft butter 2 eggs 1 packet yeast For the icing 150 g icing sugar 20 ml lemon juice Pearls of white sugar for decoration Method Preheat the oven to 180 C. Prepare the muffin moulds by placing paper liners on the inside. Melt the butter. Using an electric whisk, beat the eggs and sugar until light and smooth. Gradually add the butter while whisking, then add the flour with the yeast by mixing gently. When the dough is smooth and uniform, fill the moulds halfway and bake them for 15 minutes. Nutritional values (per serving) Calories 4058 kcal Protein 5 g Carbohydrates 64 g Fat 20 g Sodium 31.7 mg Liquid content 51 ml Phosphorus 79 mg Potassium 139 mg Allow to cool on a rack. Prepare the icing. Mix the icing sugar and lemon juice gradually for a shiny and soft paste. Using a spoon or spatula, ice the cupcakes and sprinkle with sugar snowflakes. Let harden for a few minutes and then enjoy. The cupcakes can be kept for a few days in an airtight container. 18 Recipes

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20 Holiday time on dialysis Whether you are on peritoneal dialysis or haemo dialysis, you are still free to go on holiday in one of our dialysis unit s around the world. You (and your spouse and any children) can plan your holiday, around your dialysis. Your dialysis nurse will assist you with this, to ensure the staff at your holiday destination know your history and fit your dialysis in, according to your agenda for your holiday and available space. When popular destinations are required, please book well ahead to avoid disappointment. If you are on peritoneal dialysis, your solutions and disinfection caps will be waiting for you at your destination. If you are on haemodialysis, all your important information and prescription will be ready for you. If you are planning a holiday in the sun, please take care to wear a high factor sun block to prevent burning and blisters. Your skin tends to become more fragile on dialysis. Watch for dehydration from perspiring in hot climates. If you are entering a malaria area, please speak to your doctor about prophylaxis in good time. Please pack your mosquito repellent, long socks and long trousers and long sleeves. Try and stay above floor height, since mosquitoes find ankles quite tasty! We all need a holiday so do not let your kidney disease and dialysis stop you having a great holiday, locally or elsewhere in the world!! Perhaps these photographs will inspire you to plan a holiday Durban Beach Kruger National Park Blyde River Canyon Cape Peninsula 20 Worth living

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22 National footprint NephroCare & Clinix Renal Care (Pty) Ltd NORTH WEST PROVINCE Rustenburg Kidney & Dialysis Centre Mafikeng Kidney & Dialysis Centre Potchefstroom Kidney & Dialysis Centre Carletonville Kidney & Dialysis Centre LIMPOPO Polokwane Kidney & Dialysis Centre (PPP Project) Thohoyandou Kidney & Dialysis Centre Phalaborwa Kidney & Dialysis Centre FREE STATE Bloemfontein Kidney & Dialysis Centre Sasolburg Kidney & Dialysis Centre MPUMALANGA Middelburg Kidney & Dialysis Centre Emalahleni Kidney & Dialysis Centre EASTERN CAPE Jeffreys Bay Kidney & Dialysis Centre Port Elizabeth Kidney & Dialysis Centre George Kidney & Dialysis Centre LIMPOPO Polokwane NORTHERN CAPE Mahikeng NORTH WEST PROVINCE Klerksdorp Upingtion Kimberley Bloemfontein Pretoria Mbombela Johannesburg GAUTENG MPUMALANGA FREE STATE LESOTHO KWAZULU NATAL Pietermaritzburg Durban EASTERN CAPE Mthatha WESTERN CAPE East London Cape Town Worcester Port Elizabeth Mossel Bay 22 Information

23 KWAZULU NATAL Victoria Kidney & Dialysis Centre Hibiscus Kidney & Dialysis Centre Empangeni Kidney & Dialysis Centre Durban Kidney & Dialysis Centre Richards Bay Kidney & Dialysis Centre Pinetown Kidney & Dialysis Centre Kokstad Kidney & Dialysis Centre Stanger Kidney & Dialysis Centre Ethekwini Kidney & Dialysis Centre Mount Edgecombe Kidney & Dialysis Centre Newcastle Kidney & Dialysis Centre Chatsworth Kidney & Dialysis Centre Vryheid Kidney & Dialysis Centre Umhlanga Kidney & Dialysis Centre Port Shepstone Kidney & Dialysis Centre WESTERN CAPE Cape Town Kidney & Dialysis Centre Panorama Kidney & Dialysis Centre Winelands Kidney & Dialysis Centre UCT Kidney & Dialysis Centre Hermanus Kidney & Dialysis Centre Athlone Kidney & Dialysis Centre Stellenbosch Kidney & Dialysis Centre Paardevlei Kidney & Dialysis Centre Khayelitsha Kidney & Dialysis Centre Worcester Kidney & Dialysis Centre GAUTENG Clinix - Vosloorus Kidney & Dialysis Centre Kempton Kidney & Dialysis Centre Morningside Kidney & Dialysis Centre Lesedi Kidney & Dialysis Centre Tshepo Themba Kidney & Dialysis Centre Vaal Kidney & Dialysis Centre Clinix - Naledi Kidney & Dialysis Centre Wits Kidney & Dialysis Centre (DGMC) Morningside Children s Kidney Treatment Centre Lenasia Kidney & Dialysis Centre West Rand Kidney & Dialysis Centre Pretoria Kidney & Dialysis Centre Tshwane Kidney & Dialysis Centre Morula Kidney & Dialysis Centre Arcadia Kidney & Dialysis Centre Brits Kidney & Dialysis Centre Randfontein Kidney & Dialysis Centre Waverley Kidney & Dialysis Centre Groenkloof Kidney & Dialysis Centre Atteridgeville Kidney & Dialysis Centre Midstream Kidney & Dialysis Centre NAMIBIA Windhoek Kidney & Dialysis Centre Ongwediva Medipark Dialysis Centre Swakopmund Kidney & Dialysis Centre SWAZILAND Mbabane Kidney & Dialysis Centre BOTSWANA Riverside Kidney & Dialysis Centre 23

24 NephroCare Medical Centres 24 Western Cape Athlone Kidney & Dialysis Centre Rawoot Square, Cnr Klipfontein & Carnie Roads, Athlone Tel: Cape Town Kidney & Dialysis Centre 14 Wilderness Road, Claremont Tel: Hermanus Kidney & Dialysis Centre Hermanus Medical Centre, First Floor, Suite 13, Ravenscroft Street, Hermanus Tel: Khayelitsha Kidney & Dialysis Centre Shop 19A Thembokwezi Square, Swartklip Road, Khayelitsha Tel: Panorama Kidney & Dialysis Centre 1st Floor, Panorama Healthcare Centre, Cnr Rothchild & Hennie Winterbach Streets, Panorama Tel: UCT Kidney & Dialysis Centre UCT Private Academic Hospital, D Floor, Room 51, Anzio Road, Observatory Tel: Paardevlei Kidney & Dialysis Centre 16 & 18 Gardner Williams Avenue, De Beers Grounds, Somerset West Tel: Stellenbosch Kidney & Dialysis Centre Office A.W. 202, Andringa Walk, Andringa Street, Stellenbosch Tel: Worcester Kidney & Dialysis Centre 25 Riebeeck Street, Worcester Tel: Winelands Kidney & Dialysis Centre Unit 3E, Arun Place, Sir Lowry s Pass Road, Sommerset West Tel: Eastern Cape George Kidney & Dialysis Centre 3 Cross Street, Dormehlsdrift, George Tel: Information Jeffreys Bay Kidney & Dialysis Centre PoliClinic, 15 Hanekam Street, Fountains Estate, Jeffreys Bay Tel: Port Elizabeth Kidney & Dialysis Centre GVI Oncology Building, 1 Mangold Street, Newton Park, Port Elizabeth Tel: Free State Bloemfontein Kidney & Dialysis Centre 141a Zastron Street, Westdene, Bloemfontein Tel: Sasolburg Kidney & Dialysis Centre 33 N G van der Merwe Street, Sasolburg Tel: Limpopo Thohoyandou Kidney & Dialysis Centre Shop No 17 Phangami Mall, Sibasa Road, Thohoyandou Tel: Phalaborwa Kidney & Dialysis Centre 86 Grosvenor St, Phalaborwa Tel: Polokwane Kidney & Dialysis Centre Cnr Dorp & Hospital Streets, Polokwane Tel: Gauteng Kempton Kidney & Dialysis Centre 2nd floor, Arwyp Medical Suites, 22 Pine Avenue, Kempton Park Tel: Vosloorus Kidney & Dialysis Centre (Clinix) Sam Sekoati Avenue, Extension 9, Vosloorus Tel: Morningside Children s Kidney Treatment Centre Morningside MediClinic - Level 4 (New Block), Hill Street, Morningside Tel: Morningside Kidney & Dialysis Centre Unit G1, Suite 403, 4th Floor, Summit Park, 495 Summit Road, Morningside Tel: Waverley Kidney & Dialysis Centre The Centre of Advanced Medicine, Scott Street, Waverley Tel: Wits Donald Gordon Kidney & Dialysis Centre 17 Eaton Road, Parktown Tel: Lesedi Kidney & Dialysis Centre (Clinix) Chris Hani Road, Diepkloof, Zone 6 Tel: Tshepo Themba Kidney & Dialysis Centre (Clinix) Cnr Braam Fisher Road & Dobsonville Roads, Dobsonville Tel: Lenasia Kidney & Dialysis Centre Humming Bird & Guinea Fowl Road, Block A, Signet Terrace Office Park, Lenasia Tel: Naledi Kidney & Dialysis Centre (Clinix) Clinix Private Hospital, Moshoeshoe Street, Sebokeng Tel: Vaal Kidney & Dialysis Centre 7 Edward Street, Medoc Centre, Vereeniging Tel: Randfontein Kidney & Dialysis Centre 37 Homestead Avenue, Greenhills, Randfontein Tel: Westrand Kidney & Dialysis Centre No 8, Ground Floor, Mayo Clinic, William Nichol & 14th Avenue, Floracliff, Roodepoort Tel: Arcadia Kidney & Dialysis Centre MediClinic Heart Hospital, 551 Park Street, Arcadia Tel:

25 Atteridgeville Kidney & Dialysis Centre Atlyn Centre, Cnr Khoza & Phudufudu Streets, Atteridgeville Tel: Groenkloof Kidney & Dialysis Centre 102 George Storrar Drive, Groenkloof Tel: Midstream Kidney & Dialysis Centre Midstream Hill Medical Park, Cnr Midstream Hill Boulevard & Godley Drive, Midstream Hill, Centurion Tel: Morula Kidney & Dialysis Centre Shop CU6, Morula Complex, Lucas Mangope Highway, Mabopane Tel: Pretoria Kidney & Dialysis Centre 359 Fred Nicolson Street, Les Marais, Pretoria Tel: Tshwane Kidney & Dialysis Centre Medical Suite 1140, Louis Pasteur Medical Centre, 374 Schoeman Street, Pretoria Tel: Kwa-Zulu Natal Newcastle Kidney & Dialysis Centre 77 Bird Street, Newcastle Tel: Vryheid Kidney & Dialysis Centre 184 Hlobane Street, Vryheid Tel: Chatsworth Kidney & Dialysis Centre 65 Gemini Crescent, Woodhurst, Chatsworth Tel: Durban Kidney & Dialysis Centre Clark Square, Clark Road, Berea Tel: Kokstad Kidney & Dialysis Centre No 94 Hope Street, Kokstad, Tel: Mount Edgecombe Kidney & Dialysis Centre No. 5/8 Flanders Road, Charoc House, Mount Edgecombe Tel: Ethekwini Kidney & Dialysis Centre Ethekwini Hospital & Heart Centre, Lower Ground, Suite 6, Queen Nandi Drive, Riverhorse Valley Business Estate, Newlands East Tel: Pinetown Kidney & Dialysis Centre Ground Floor Suite, 4 Simpson Place, Pinetown Tel: Umhlanga Kidney & Dialysis Centre Unit 15, Quadrant 1 The Centenary, 30 Meridian Drive, Umhlanga New Town Centre Tel: Empangeni Kidney & Dialysis Centre Hamlin House, Cnr Ukhula & Biyela Streets, Empangeni Tel: Richards Bay Kidney & Dialysis Centre Suite 1, The Bay Hospital, Krugerrand Road, CBD Area, Richards Bay Tel: Hibiscus Kidney & Dialysis Centre Dr K & S Pillay Medical Centre, 28 Bazley Street, Port Shepstone Tel: Victoria Kidney & Dialysis Centre 83 Brake Drive, Brake Village, The Haven of Rest, Tongaat Tel: Port Shepstone Kidney & Dialysis Centre Hibiscus Medical Centre, 33 Aiken Street, Port Shepstone Tel: Stanger Kidney & Dialysis Centre Shop 1A, Narainsinghs Centre, 181 Mahathma Ghandi Street, KwaDukuza Tel: Mpumalanga emalahleni Kidney & Dialysis Centre 2nd Floor, Room 202, emalahleni Private Hospital, 39 Mandela Street, Witbank Tel: Middelburg Kidney & Dialysis Centre 4 Beyers Naude Street, Middelburg Tel: North West Brits Kidney & Dialysis Centre Shop No 3, Cnr Pienaar & De Wit Streets, Brits Tel: Carletonville Kidney & Dialysis Centre 88 Agnew Road, Carletonville Tel: Mafikeng Kidney & Dialysis Centre (Clinix) Victoria Road, Clinix Private Hospital, Mahikeng Tel: Potchefstroom Kidney & Dialysis Centre Mooimed Hospital, 1 Albert Luthuli Road, Potchefstroom Tel: Rustenburg Kidney & Dialysis Centre 259 Beyers Naude Street, Rustenburg Tel: Namibia Ongwediva Medipark Dialysis Centre Auguste Taayanda Street, Ongwediva Tel: Swakopmund Kidney & Dialysis Centre Fransiska Van Neel Street, Pathcare Premises, Block D, Erf 669, Tamariskia, Swakopmund Tel: Windhoek Kidney & Dialysis Centre Maerua Lifestyle Shopping Centre, Shop No 17 & 18, Centaurus Street, Windhoek Tel: Swaziland Mbabane Kidney & Dialysis Centre Hospital Hill, Mbabane Tel: Botswana Riverside Kidney Dialysis Centre Plot 412/413, Baines Avenue, Francistown Tel:

26 Message of appreciation Potchefstroom Kidney & Dialysis Centre Dear management, sisters and support staff, I trust that you have watched and listened to Dr Maya Angelou s video. I want to take this opportunity to thank you for being a rainbow in the lives of us dialysis patients' lives. We have to spend five hours in the chair three times a week, and you certainly make it so much better by the genuine care you show, your friendliness. I for one enjoy the bantering and lots of laughter. Each of you has his/her own characteristic that makes you special. As dialyses patients we have a limited life expectancy, and one day in heaven (I hope you make it) you will find all of us (who made it to heaven) waiting at heaven s gate to welcome and thank you for your sacrificial service. In my view, all healthcare people that really care (as you do) need to have a stamp on your forehead: Made in heaven. God bless you all Albert 26 Inspiring

27 Brain calisthenics Sudoku is a logic puzzle consisting of a grid containing nine squares, each subdivided into a further nine squares which contain some of the numbers from 1 to 9. The goal is to fill the grid so that each square, vertical column, and horizontal row in the grid contain the numbers from 1 to 9. Easy Medium

28 Copyright 2017 Fresenius Medical Care Deutschland GmbH Fresenius Medical Care South Africa (PTY) Ltd. 31A Lake Road Longmeadow Business Estate Edenvale-Johannesburg, 1609, South Africa