Freo Docker Sam joins effort to tackle kidney disease in remote WA
Sep 29 2021
Fremantle forward Sam Switkowski has joined researchers from The University of Western Australia in investigating ways to bring fresh water to remote Aboriginal communities in the Goldfields of WA as part of a plan to tackle the devastating effects of kidney disease and type 2 diabetes among locals.
The AFL footballer, in his final year of an environmental engineering degree at RMIT University, is part of a team from Optimos, D2K Information, RMIT, UWA and the University of Queensland who’ve been designing and testing pilot technologies to remove nitrate from drinking water.
It follows ground-breaking research undertaken as part of the Western Desert Kidney Health Project (WDKHP) which found that nitrate contaminated drinking water was a contributing factor to higher than expected rates of kidney disease and type 2 diabetes in the Goldfields.
Dr Christine Jeffries-Stokes, from UWA’s Medical School and the Rural Clinical School of WA, said the WDKHP study took place between 2010 and 2014 and covered an area larger than the state of Victoria in the Goldfields and Western Desert which starts 500km east of Perth and extends 2000km to the border with South Australia.
It saw health assessments carried out on 597 adults and 502 children in five small towns and six remote Aboriginal communities, representing almost 80 per cent of the Aboriginal population, with risk factors for kidney disease and type 2 diabetes present in participants of all ages, including children as young as two.
“The high levels of acid and blood in the urine of both Aboriginal and non-Aboriginal participants suggests factors contributing to chronic metabolic acidosis and inflammation or irritation of the urinary tract need to be explored, including drinking water which is known to be poor,” said Dr Jeffries-Stokes, who worked on the project with co-chief investigator Annette Stokes.
“In most of the study, the communities’ drinking water is heavily contaminated with nitrates and, in at least one community, uranium. One of the effects of uranium ingestion is kidney inflammation and damage, which is exacerbated by the presence of nitrate and the formation of uranyl nitrate.”
In two communities – Mulga Queen and Mount Margaret – a 2020 review by the Western Australian Auditor General showed there’d been no improvement in water quality over the past five years, and nitrate levels remained above international and Australian health guidelines, Dr Jeffries-Stokes said.
As the only WA-based person in the RMIT team who’d been tasked with looking at water treatment options, Mr Switkowski was able to visit Mulga Queen and surrounding communities in June this year to take water samples and speak directly to locals about their drinking water challenges.
“The other three members of my team – Matthew Barham, Matt Fitzpatrick and Lara Stovell – are currently testing three potential water treatment systems at RMIT in Melbourne to work out which will be the most efficient and the most feasible to implement,” Mr Switkowski said.
“For me personally, it’s been fantastic to experience another side of WA and to have been welcomed into several indigenous communities, thanks to Christine and her partner Geoffrey. It’s clear these communities aren’t getting the essential services they deserve, and as a result their health and wellbeing is at a higher risk.
“I’m incredibly grateful for the experience the project has given me and the opportunity that RMIT has provided in doing something purposeful and helpful for indigenous people. It’s ignited a passion in me and a determination to make a positive impact to those who don’t have access to clean and safe drinking water across Australia and the world.”
“It’s ignited a passion in me and a determination to make a positive impact to those who don’t have access to clean and safe drinking water across Australia and the world.”
Dr Jeffries-Stokes said the increasing burden of kidney disease and type 2 diabetes is a global problem, especially for remote and Indigenous populations. In Australia, the average life expectancy of Aboriginal Australians is at least eight years lower than for non-Aboriginal Australians.
“This disparity is more marked in remote areas and contributing factors are the effects of type 2 diabetes, kidney disease and their associated conditions and complications. Prior to our study, type 2 diabetes had been found to be the leading cause of avoidable mortality for Aboriginal residents of the Goldfields region, accounting for 20 per cent of deaths,” she said.
“Diseases of the kidney accounted for six per cent of all avoidable deaths in the region and the area had been estimated to have the second highest rate of end-stage kidney disease in Australia. Until our study there hadn’t been too much investigation into the reasons why.”
2012/14 + 2018/20 – Mulga Queen (Western Australia) – Nitrate
2012/14: Mulga Queen (Western Australia)
1 test above ADWG Guideline 2012-2014
14 tests above ADWG Guideline 2018-2020
2017: 55mg/L (high) ~46.2mg/L (av.)
2018: 61mg/L (high) ~45.4mg/L (av.)
2019: 51mg/L (high) ~49.3mg/L (av.)
19 tests above ADWG Guideline 2017-2019
One in five communities exceeded safe levels for nitrates or uranium
The most significant chemical issues for water quality come from nitrates and uranium, which occur naturally and are common in the Goldfields and Pilbara. Excessive nitrates in the diet reduce blood’s ability to carry oxygen. In infants, this can cause the potentially life-threatening Blue Baby Syndrome, where the skin takes on a bluish colour and the child has trouble breathing. Housing provides bottled water for infants under three months in communities with high nitrates. Long term solutions would likely include asset replacements or upgrades or finding new water sources, or a combination of these.
In 2013-14, fourteen of 84 communities in the Program recorded nitrates above the safe health level for bottle-fed babies under three months. Two communities had readings above the standard for adults (Figure 5).
Child Heath Levels Nitrate: 50mg/L. Adult Heath Levels Nitrate: 100mg/L
1 test above ADWG Guideline 2018-20
Thermotolerant coliforms are a sub-group of coliforms that are able to grow at 44.5 ± 0.2°C. E. coli is the most common thermotolerant coliform present in faeces and is regarded as the most specific indicator of recent faecal contamination because generally it is not capable of growth in the environment. In contrast, some other thermotolerant coliforms (including strains of Klebsiella, Citrobacter and Enterobacter) are able to grow in the environment and their presence is not necessarily related to faecal contamination. While tests for thermotolerant coliforms can be simpler than for E. coli, E. coli is considered a superior indicator for detecting faecal contamination…” ADWG
Mulga Queen (Western Australia) – Naegleria Species
Naegleria Species: 2 tests above ADWG Guideline 2012-2014
“GUIDELINE No guideline value is set for Naegleria fowleri in drinking water, but an ‘action level’ is recommended for water supplies likely to be contaminated. If the organism is detected, advice should be sought from the relevant health authority.
Naegleria fowleri is a free-living, thermophilic amoeboflagellate which causes the waterborne disease primary amoebic meningoencephalitis (PAM). This rare but fatal condition has followed use of water for swimming, or domestic bathing. The organism occurs naturally in freshwater of suitable temperature, feeding on bacteria. Its occurrence is only indirectly related to human activity, inasmuch as such activity may modify temperatures or promote bacterial production. PAM has been reported from many countries, usually associated with thermally polluted environments, geothermal water or heated swimming pools. N. fowleri is almost exclusively aquatic, and water is the only known source of infection. Numerous nonvirulent Naegleria species are known in Australia.
PAM cases have been recorded from South Australia, Western Australia, Queensland and New South Wales; Naegleria fowleri has been detected in water in each of these states and in the Northern Territory. Australia is the only country where N. fowleri has been detected in public water supplies (Dorsch et al. 1983). Most of the available data on the density of N. fowleri in water relates to water supplies in South Australia (including the highest reported densities). In temperate Australia, significant seasonal cycles of density occur, from below one organism per litre to hundreds or thousands per litre in poorly disinfected water (Robinson and Christy 1984). N. fowleri detected at water temperatures below 18°C is likely to be present as cysts, which are not infectious, but which may seed a suitable environment.” Australian Drinking Water Guidelines 2011.