Pasifika kidney concerns
Players who are developing serious health issues are worrying some leading rugby and medical figures.
The number of Pasifika rugby players struggling with kidney disease is a concern that warrants further attention, says former Tonga player, coach and community leader Mana Otai.
His concern is shared by highprofile sports doctor John Mayhew, who says there are far too many kids playing under-17 rugby and league in places like South Auckland who “have big underlying health issues“, many related to “Third World” diseases such as rheumatic fever.
“It’s a huge problem in that community, kidney failure,” Mayhew told the Herald on Sunday.
The rugby community was in mourning this week with the passing of Dylan Mika at 45 from a suspected heart attack. The former All Black and Manu Samoa loose forward had managed Type I diabetes throughout his life.
Otai said he had become increasingly concerned at the number of Pasifika players dealing with kidney disease. Although the circumstances in each case are different, a tragic pattern is emerging.
The most famous rugby player of them all, Jonah Lomu, died of a heart attack in 2015. He had been suffering from nephrotic syndrome for most of his adult life and had undergone a kidney transplant.
Lomu’s wing partner at Counties Manukau and the Blues, Joeli Vidiri waited 14 years for a kidney transplant after being diagnosed with glomerulonephritis in 2001.
Another former All Black, Sione Lauaki, died last year aged 35 after suffering in his later life with kidney failure.
Otai has been involved in efforts to have Tongan player Sione Vaiomo’unga stay in Romania, despite an expired working visa, to receive dialysis treatment.
We hear about these cases because they are high-profile and some have tragic consequences, Otai says, but there are potentially hundreds of Polynesian players dealing with renal issues that we never hear about.
Vaiomo’unga has become a cause celebre for the lack of accessible dialysis treatment in the Islands, but the issue of kidney health among rugby players works hand in glove with the issue of kidney health among the Pasifika community.
Warriors team doctor Mayhew, in his other role as chief medical officer of Sovereign Insurance, has looked closely at the greater incidence of heart and kidney disease in Polynesian populations.
As the All Blacks doctor in the late 1990s, Mayhew was tasked with managing Mika’s diabetes and on one occasion administered a glucose injection at the 1999 World Cup when Mika had a hypoglycaemic attack.
Mayhew said it was important to distinguish between Mika’s Type I diabetes condition, which occurs when the pancreas stops producing insulin, and Type II, which is largely environmental and related to poor diet, lack of exercise and obesity.
Type II is by far the most common and is more prevalent in Polynesian populations due to both a genetic predisposition to the disease and the typical barometers of lower socioeconomic status.
“Even taking out the socioeconomic and environmental factors, the incidences of Type II diabetes are higher among Maori and Pacific islanders,” Mayhew said.
Type I, which counts Black Caps batting coach Craig McMillan and former All Black Jason O’Halloran among its sufferers, counts for less than five per cent of all diabetes cases and does not tend to discriminate.
Dr David Voss is on the front line of that issue as a renal physician with 25 years’ experience who works out of the Counties Manukau area and regularly visits the Islands.
Voss said the two “biggies” in terms of kidney failure among Polynesian populations was diabetes and glomerulonephritis, which is an acute inflammation of the kidney, typically caused by an immune response.
“One of the big challenges with these cases is they only present late because there are no symptoms until it’s too late to save the kidneys,” Voss said.
Said Mayhew: “One of the complications in places like South Auckland and the East Coast of the North Island is we continue to have high instances of rheumatic fever, which is a Third World disease.”
The vaccination rate in these areas is also low. By the time many players get into a high-performance environment under the eye of trained professionals like Mayhew, the damage is done.
Many, obviously, never get to that elite level.
Whether playing rugby or league exacerbates kidney problems because of the contact nature of the sport, Mayhew doesn’t believe so.
“That’s unlikely,” he said. “You can have problems with major trauma [but] I see very little kidney disease from injury.”
One of the big challenges is there are no symptoms until it’s too late to save the kidneys. Dr David Voss