A decade of care and teaching; RMC’s Dialysis Access Institute known worldwide

The DAI is a one-of-a-kind facility that helps treat difficult dialysis procedures and provides educational programs and training in dialysis access for physicians, nurses and technologists from across the globe.

It is believed to be the only facility of its kind in the nation.

“We don’t want to make one splash and one set of ripples,” DAI Founder Dr. John Ross told those gathered for the institute’s anniversary celebration.

“To be a Dialysis Access Institute, we have to keep making splashes and making more ripples. That is what we want to do, that is what we have been doing, and we will continue to do. We are going to be ripplers,” he said.

In the beginning

The DAI’s origins stem from a call Orangeburg nephrologist Dr. Mohammad Nassri made to Ross, who was practicing at the Bamberg County Hospital at the time.

Nassri told Ross of a patient who needed an arteriovenous fistula. Nassri asked if Ross could do the procedure.

“I said absolutely I would do that,” Ross recalled. “Never done one before in my life.”

“We did the little fistula connecting the artery and vein in the wrist and, lo and behold, it worked,” he said. “I was amazed that it worked. More patients would come down to Bamberg that he would send.”

The first procedure turned into a second and a third.

“The practice started coming down where we were doing more and more of this dialysis access in this 55-bed hospital with one operating room and one procedure room,” Ross said. “The practice started with about 15 to 25 cases on a day.”

“We were doing big-time surgery in this very small hospital,” he said.

Then there was a turning point.

The Bamberg County Hospital was set to close, leaving dialysis patients without care.

“We were not going to abandon them. That was just not going to happen,” Ross said, noting he was serving a large number of patients.

And then he realized, “What we really need to do is to establish an institute.

“What is an institute? Well, first of all we have to take care of the patients very well. Number two, we need to do training. Number three, we need to do clinical trials.”

The rest his history.

The decision was made to move the procedures to Orangeburg, which led to the construction of a 16,000-square-foot building with six operating rooms.

“It is a showplace in one sense,” Ross said. “There is nowhere this elaborate anywhere that I am aware of in the world.”

Training around the world

Physicians who have benefited from the institute agree.

“The Dialysis Access Institute is one of the great jewels, not only regionally or nationally, but internationally,” Dr. John Aruny said in a video presentation at the event.

“This little building in this little town has really served the entire world,” he said.

Aruny served as the director of vascular and interventional radiology at the Yale University School of Medicine for 23 years before coming to Orangeburg to practice with Ross.

Ross said he has often been asked how a little rural hospital has been able to become world-renowned.

“I said, ‘Look around look at my people,’” he said. “It was not unusual for the visiting physicians to say, ‘You have the greatest assembled team we have ever seen.’”

Ross explained how the DAI has become so well-known.

“The word that gets used is that we caused a ripple effect,” Ross said. “You don’t get a ripple in the pond unless you make a splash. The appropriate question is how did you make a splash?”

“In the dialysis access pool, our pond, we made a splash,” he said.

The key to the institute’s development was the focus on a goal, the motivation to reach the goal, energy targeted toward reaching that goal and enthusiasm, plan implementation and outcomes.

“We learned as much as we can about dialysis access,” Ross said. “We read books, we go to meetings and guess what? We found out that a lot of things that had been in the textbooks and that had come up in meetings was dead, flat wrong. Why is it wrong? Because they were not following their patients.”

Ross said, “Who was the best teacher that we had to create this Dialysis Access Institute? The patients. That is where we learned what worked and what didn’t work. We are in the business of education. We love to bring doctors in.”

DAI Medical Director Dr. Mark London is one of those doctors.

London said he began to do dialysis access procedures while in private practice in Pennsylvania and attended conferences throughout the country.

He met Ross and the two became friends. During a September 2016 visit to Orangeburg, Ross asked London if he would move to South Carolina and work with him at the DAI.

Last June, London became the medical director of the institute.

“The knowledge and experience that I have gained from Dr. Ross over these last five years has made me the well-rounded access surgeon and interventionalist that I am today,” London said.

London said the DAI provides every type of dialysis access and intervention from fistula creation to the placement of arteriovenous grafts, placement of peritoneal dialysis catheters by advanced laparoscopic techniques and more.

He also said the institute has been at the forefront of research, conducting clinical trials for new and innovative techniques, devices and equipment as well as having leading companies in the field such as Gore, Boston Scientific, Bard and Medtronic sponsor doctors to come to the DAI to learn.

Doctors have come from countries such as Brazil, Paraguay, Argentina, Canada, England, France, China, Guam, Philippines, Kenya, Nigeria, Sweden, Germany, Japan, Ukraine and Australia.

Ross “has pioneered so many different techniques and devices,” London said. “To be training under him to me is like being trained under Dr. (Michael) DeBakey as a general surgeon, which is a very famous name in the surgical world.”

London also noted Ross is one of only about 302 surgeons in the world to have received the achievement of being a member of the Academy of Master Surgeon Educators.

The honor is recognized by the American College of Surgeons for continual advancement in the science and practice of education, teaching, learning, assessment and scholarship.

London said the DAI serves as a tertiary center for dialysis access where difficult cases are sent.

“This is a place to come,” he said. The DAI performs nearly 4,000 procedures and operations each year and has patients come from across the state and from outside the state.

The DAI is accredited by the American Society of Diagnostic and Interventional Nephrology as a hemodialysis vascular access training center.

Ten-year accolades

The 10-year celebration included the Orangeburg-Wilkinson High School Junior ROTC Color Guard presenting the colors.

The “Pledge of Allegiance” was said and the “National Anthem” was sung by South Carolina State University Student Government Association Chief of Staff Jeremiah McFadden.

RMC Board Chair the Rev. Dr. Caesar Richburg praised the work of Nassri, RMC trustee Betty Henderson, the late RMC vice president of strategy and compliance Brenda Williams, as well as for the Board of Trustees for their work in helping convince Ross to come to RMC.

“Dr. John, as I affectionately call you, thank you ever so much for you and your remarkable team and all the good work you all have done,” Richburg said. “This has really been a remarkable service to the greater community not only to Orangeburg, of course, but to the state and, believe it or not, the greater nation of ours.”

“This is a really a jewel for our community – not only for Orangeburg and Calhoun counties, but also for the state of South Carolina and nationally,” RMC President and CEO David Southerland said. “There are only a few of these locations in the entire country and for us to have one here in Orangeburg is quite amazing.”

“We also bring in physicians from around the world to come to train with Dr. Ross and his team,” Southerland said. “We are spreading the word around the whole world about Orangeburg and the technology and the techniques that Dr. Ross has brought to us.”

Southerland said the DAI also “brings light to the Regional Medical Center, that we do provide good services here.”

Southerland said the hospital is focusing on quality and service.

“We are trying to rebuild certain types of services, rebuild our volumes and return the operations of this hospital back into a very proud operation so we can continue to provide these services to the communities of Orangeburg and Calhoun counties,” he said.

The celebration was held during March, which is kidney month. The centerpiece of the event was a kidney sculpted out of ice.

Congressman James Clyburn, who could not be at the event in person, submitted a letter honoring the work of the institute.

“This institute has provided educational programs for doctors, nurses and others regarding dialysis access to ensure the best practices can continue to be developed and reviewed for patients across the globe,” Clyburn wrote. “These extensive teaching capabilities have enabled DAI to train other surgeons and without a doubt have saved thousands of lives.”

Clyburn also thanked Ross for his vision in enabling Orangeburg and RMC to become a significant training center.

“When investments are made in these facilities, groundbreaking treatment and unparalleled outcomes are possible,” Clyburn said.

“It is my hope this facility will continue to serve the local community and beyond for years to come.”

State Rep. Jerry Govan and state Sen. Brad Hutto sponsored a resolution congratulating the DAI for its 10-year anniversary. The resolution was presented to the directors and staff of the DAI.

“Ten years is a milestone,” Hutto said. “Ten years for something like this is a long time. We remember things like the Pony Express. You know how long the Pony Express lasted? 18 months. We still remember them to this day.”

“This is something unique to have this type of facility in small, rural South Carolina,” Hutto said.

State Rep. Russell Ott said the DAI has touched countless lives over the last 10 years.

“We have a lot of those types of things going on here at the Regional Medical Center across the board,” Ott said. “Just wonderful things we that we all should be proud of. We have to continue to tell these stories.”

“Continue to make those splashes so our community can continue to benefit from those ripples,” Ott said.

Looking back, ahead

Ross said looking back over ten years, he would not change much, adding that being in Bamberg actually helped get the institute up and running.

“In a big city, I probably would not have the latitude to do that,” he said.

As to the future of the institute, London said the federal government is looking for more dialysis treatment to be done at home. That means the DAI will be focusing on how to more effectively evaluate and treat patients in such a way.

“We will continue clinical trials and research programs to allow us to remain being the leaders in our field,” London said, adding that the DIA will look to expand and grow training programs to include peritoneal dialysis catheter placement and other access procedures.

London said the DAI will also seek to provide more education and outreach to patients in the community and provide transport services for patients.