Developing Nephrology Worldwide: The Work Of COMGAN

John H. Dirks, MD

Under the auspices of the Inter-national Society of Nephrology (ISN),
the Commission for the Global Advancement of Nephrology (COMGAN) has brought nephrology
continuing medical education to some 60 countries around the globe. COMGAN has been a
fulfilling enterprise for ISN since it was placed on the drawing board in 1991 under ISN
President, Ike Robinson. He formed a strategic planning committee for the Society to
consider the kind of outreach that could be undertaken. Stewart Cameron, who succeeded
Robinson, and later Bob Schrier, gave strong support to the objectives of COMGAN
appointing Barry Brenner (Boston) and John Dirks (Toronto) as Co-Chairs in 1993. The
progress of the commission has been extraordinary with the number of participants in the
various CME courses matching the number of attendees at ISN’s biennial Congresses.
This far-reaching endeavor has been heartwarming for the leaders of ISN as a myriad of
relationships with nephrology professionals from around the world have been seeded and
developed opening many new doors for continuing medical education in emerging countries.
Barry Brenner who stepped down in November of 1999 has made an enormous contribution to
this ISN outreach. Dr. Brenner introduced the philosophy of making site visits and went to
great lengths to prepare and participate in many CME programs during the course of his
term. John Dirks, who now Chairs the commission, has been joined by Eberhard Ritz
(Germany) and William Couser (USA) who serve as Vice Chairs. Dr. Ritz has taken primary
responsibility for Model Sister Centers and Dr. Couser will assume responsibility for
developments in China. For a review of COMGAN activities between 1995—1998, refer to
the article published in Kidney International, “Toward global advancement of
medicine: The International Society of Nephrology experience,” Vol. 54 (1998) pp.
1017-1021.

The distribution of Kidney International, as part of the library
enhancement program, has been very well received, and ISN Treasurer, Bill Mitch, and
Informatics Chair, Kim Solez are looking for additional ideas to improve dissemination of
nephrological knowledge. We welcome your thoughts on these and other matters.

Organization

In 1994 COMGAN Co-Chairs, Brenner and Dirks, established 5
subcommission regions and appointed Chairs and Vice Chairs for each domain including:
Africa, Asia, CIS & Middle East, Eastern & Central Europe and Latin America. Each
subcommission leader invited other key leaders from, or interested in, the region to form
the subcommittee with each subcommittee comprising, on average, five to seven members.

COMGAN is in the process of being reorganized by continent into
subregions and this will continue as activities expand. Under Tom Andreoli’s
leadership, it was proposed that the COMGAN Chair be given membership on the ISN Executive
Committee, and this is happening pending the approval of the General Assembly in San
Francisco in 2001.

Model Sister Centers

The initial success of the Renal Sister Center Program introduced in
1996 has seen 135 formal sister linkages established with some 25 sister center
relationships highly active with exchange of faculty and trainees as well as laboratory
and clinical supplies and equipment. The program has been expanded to develop Model Sister
Centers and twenty-two applications have been received for the program with submissions
for Latin America, Asia, Eastern and Central Europe, Africa and the Middle East. The goals
of the Model Sister Center Program are: 1) to enhance clinical and teaching programs; 2)
to exchange faculty and trainees with sister centers; 3) to begin research; 4) to develop
a nucleus of nephrologists for the next generation; 5) to set examples of excellence for
the region.

CME Activities

The heart of COMGAN’s activities have been the CME courses carried
out in some 60 countries. These may have consisted of a major ISN Update in a region or
country with a number of ISN speakers. More frequently, ISN supports national and regional
meetings with several speakers. Usually there is a partnership with the regional society
regarding costs with highly significant corporate funding. A number of regional
associations such as EDTA/ERA, SLANH, ASN and Asia Pacific Society are partners. ISN
speakers participate entirely on a voluntary basis except for costs of travel and
accommodation. Approximately 100 ISN members have given freely of their time, some on
several occasions.

Since the ISN Congress in Buenos Aires in May 1999, CME courses have
occurred in many countries including: Bangladesh, Cuba, India, Pakistan, China, Tunisia,
Nicaragua, Philippines, Cote D’Ivoire and Egypt, to cite a few. Examples of recent
COMGAN programs include major participation in the Egyptian Society of Nephrology attended
by 450 in February and this heralds continuing annual ISN participation. In Marrakech,
Morocco, ISN held a one day ISN Update at the meeting of the Arab Society of Nephrology
and Renal Transplantation (ASNRT). This meeting was attended by 700 participants from 25
North African and Middle East countries. In February 2000, Eberhard Ritz and a contingent
of ISN speakers drove 400 km from Budapest to present an Update in Belgrade, Serbia. The
meeting involved over 100 Serbian nephrologists and follows the excellent work of Norbert
Lameire, Kim Solez, and Fred Finkelstein in Pristina and Kosovo. ISN makes a great effort
to provide support to our colleagues working in this part of Europe and, in the words of
Nada Dimkovic of Belgrade, aspires to create a “nephrology republic without
borders.”

We have also held Updates in Moscow (May 31—June 2, 2000) and
Istanbul (June 5—9, 2000). In each case there were parallel nurse-technicians
programs organized by the World Federation of Renal Care headed by Geraldine Biddle of the
USA. Dr. Natalia Tomilina, the Moscow organizer and COMGAN Subcommittee representative,
did a superb job and arranged for an excellent social program, a testament to the quality
of Russian culture. Associated with the Moscow meeting, Dr. Fred Finkelstein of Yale took
on the role of ISN Visiting Scholar and made visits to centers in the Greater Moscow Area,
Pskov, Ekaterinburg and Minsk, Belarus and then joined the CME program in St. Petersburg,
Russia June 21—24. Fred along with Ellin Lieberman, Asghar Rastegar and Art Cohen
were asked to review the postgraduate program in nephrology of the Medical Academy of
Postgraduate Studies in St. Petersburg.

The Moscow Program focused on PD, HD and Transplantation with Drs.
Atkins, Wilcox, Vanholder, Collins, Blake and Dirks attending for ISN. The conference was
attended by some 450 physicians and nurses registered. 220 attended from Moscow, and 230
from the rest of Russia and 7 former Soviet countries. The program was very well received
and in the months ahead we will develop a longer term blueprint for ISN activities in
Russia, which include development of a Russian nephrology website and assistance with
their journal.

Following the Moscow Update, The White Nights Seminar, organized by
Konstantin Gurevich of St. Petersburg, with 350 participants from Russia, Ukraine,
Belarus, Kazakhstan, Moldova, Uzbekistan was very successful with many participants from
Moscow. Daily plenary sessions and three concurrent workshops were held. Clinical case
discussions on Clinical Nephrology, Morphology, Pediatric Nephrology, and Renal
Replacement Therapy were actively attended and local organizers expressed gratitude to ISN
for support and sponsorship of the Seminar.

In March, ISN supported the annual Iranian Society of Nephrology
meeting. Dr. Asghar Rastegar of Yale, who takes COMGAN responsibility for Iran, was a
speaker as were Agnes Fogo of Vanderbilt and Eberhard Ritz. The Iran Congress was well
organized with high quality posters and free communications. ISN was widely acknowledged
at the meeting and in the daily paper. It is considered to have opened a door when other
scientific organizations were reluctant to do so.

Haiyan Wang of Beijing reported on the excellent renal pathology course
held in Beijing May 23—June 2, 2000 where 15 national speakers and 2 international
speakers (Drs. A. Cohen and A. Fogo) participated. Renal pathology diagnosis guidelines
were established by the end of the conference and it is hoped these will play an important
role in promoting the standardization of pathological diagnoses of kidney disease in
China.

COMGAN Research Subcommittee

A Research Subcommittee has been established with Giuseppe Remuzzi as
Chair and Drs. Bill Keane (USA), Anita Aperia (Sweden), Dick de Zeeuw (The Netherlands)
and Jaime Hererra (Mexico) as members. The general aim is to provide unique opportunities
for research in emerging countries in which western expertise can be applied to local
problems. One of the major challenges for renal medicine in emerging countries is
developing strategies for screening subjects potentially at risk. This endeavor will make
it possible to design population-oriented preventive measures that will limit the need for
dialysis and transplantation. Prevention is increasingly important given shortages of
financial and other resources where dialysis centers and trained personnel are frequently
unavailable to the general population. This goal can only be achieved by establishing a
specific program that should be viewed not just a supporting intervention but as a
coordinated, organic project that in its general structure should be extended to different
local needs. Please contact Beppe Remuzzi (Italy) for further information or input.
(E-mail: [email protected])

Consensus Conferences

The proposal that regional and national consensus conferences on key
issues such as prevention of chronic renal disease and quality of dialysis is receiving
considerable attention. As part of COMGAN’ s CME activities we will hold a one day
“Quality of Dialysis” meeting at the Egyptian Society of Nephrology meeting Jan
23—27, 2001 in Cairo and at the Indian Society of Nephrology meeting Nov 24—26,
2000. Under the purview of the Research Subcommittee an outline of such a consensus
conference on “Prevention of Renal Failure” has been developed by Beppe Remuzzi.
Experts from ISN and from the region will lead discussions with the goal of enhancing
renal care through presentation, exchange and the establishment of locally acceptable
guidelines monitoring progress in some pattern of regular meetings. Dr. Remuzzi’s
proposal can be found on the ISN website and further inquiries can be directed to John
Dirks.

COMGAN Workshop

The next workshop will be held in Toronto October 12 10AM—4PM at a
location to be determined. Ideas are welcome and you are encouraged to discuss COMGAN
issues with your regional representative. All committee members and their invited guests
are welcome to attend.