Meet Ywonne Lothsson, an assistant nurse with 39 years' experience in dialysis care

Posted August 30, 2018

What is your role at Diaverum?
I work as an assistant nurse. I start and finish dialysis treatments, which I've had the authority to do ever since I started in the dialysis department. If you ask anyone else, they'll say I deal with everything, I've been here so long. And I do like to help out. Other work tasks are booking taxis, handing out meals, patient fees, ordering materials for the store to fill it up and so on. But most of all I like the close contact with the patients. 

How did it come about that you decided to start working in dialysis care?
It was purely by chance. I was at secondary school at the time, and I was on my way home from school one day. I stopped at the hospital in Falköping, which was on my way home, and just went in and asked if they had any summer jobs. And they did. When I'd worked there a few years I got to train as a healthcare assistant, then I worked a few years more and trained as an assistant nurse.

When I'd worked for a while as an assistant nurse in a long-term care department, we heard that they were going to open a dialysis department at Falköping hospital. It was the first clinic of its kind in the county. I didn't know anything about dialysis, but I thought it sounded exciting. It was curiosity that attracted me. The new dialysis clinic opened in January 1979. First I got a summer job there, and the following year I was employed permanently.

How has the clinic developed since you started?
We started on a really small scale, and then grew bit by bit. When we started we had about five patients, and a few years later the number of patients had grown so much that a decision was taken to open another clinic in Skövde. That was in 1985.

The clinic was run by the county council at first. What happened when the clinic was turned over to private operation?
We heard that the operation of the clinic was being put out to tender, and then that it was Gambro that had won the tender, which was in 2001. Of course it caused a lot of speculation, and a lot of people wondered how it would all turn out. The agreement stipulated that the staff would be kept on by the company. We got to meet Gambro, who gathered us together and told us about the company. It was good to be able to get to know the company and have the opportunity to ask questions. Then things carried on as usual, and at first there wasn't a big difference. Then, after a few years, Diaverum took over the running of the business instead.

What would you say are the biggest differences between working in the public and private sectors?
One big difference, I think, is that you get closer to the decisions, and you can take part and have a say. It's more transparent who's in charge. Then, people think more in economic terms when it's run privately. And I think that can very often be a good thing. In the long term, it isn't just about the company's profit. It's also about tax money, and in some places you can work differently and use different materials without the quality suffering. Then, of course, the patients' welfare is the highest priority. The patients are always the focus of everything we do.

As far as results are concerned, we come out really high in various comparisons. I've always said that dialysis is an excellent operation to run privately, precisely because it's so clear what quality you're delivering. It's evident in every dialysis treatment, since you can follow up so many different values.

What do you think is the most motivating thing about working in dialysis care?
I've always really liked it, and I think it's been great fun. What I appreciate most of all is the contact with the patients. After all, they come to us three to five times a week, so you have really good contact with them. Dialysis is a life support treatment, and ultimately it's actually a matter of life and death. The patients have to have their treatment in order to survive. That makes the work feel really worthwhile. It's been a pleasure to go to work every single day, and I really feel at home in this world. Some people think that there is a load of technical stuff that has to be learned to operate the machines, but anyone can learn how to use a dialysis machine.

You've worked in dialysis care for 39 years. What are the biggest developments you've seen?
There have been lots of developments in my time, and the care has become much better. One huge step forward, in 1986, was erythropoietin (EPO), a drug that stimulates the production of red blood cells. If you suffer from kidney disease, you have difficulty producing red blood cells. Before EPO was launched, a lot of kidney patients needed blood transfusions, some as often as once every two or three weeks. Now they can have this drug as an injection instead, and they feel much better.

Another revolutionary success that also came in the 1980s was bicarbonate cartridges. Before they came along, the patients felt really awful, and often had sudden falls in blood pressure. This was because we were using acetate dialysis, which made the blood vessels dilate. The difference made by the introduction of bicarbonate cartridges was huge. You add the bicarbonate to the dialysis fluid.

Nowadays there are also new drugs that regulate phosphate levels. Dialysis patients have to take drugs that bind phosphate. These drugs used to contain aluminium, which was deposited in the brain and led to dementia. It's obviously a huge improvement that these side-effects have now been done away with.

Then there have been loads more improvements with better machines, more effective filters and so on. You can tailor the treatment in a totally different way than when I started.

Is there a development you'd like to see in the future?
There's a lot about the working environment that's better already. A lot of heavy lifting has disappeared with the production of better packaging. But one area where we've been talking and waiting for improvements for a long time is the working environment for the hands. It's a universal problem, and I wish the manufacturers could produce packaging and materials that are more ergonomic and don't cause so much wear and tear on the hands.

What are the strongest memories that will stay with you?
Those are the memories of times when there's a phone call and you find out that a patient has had a transplant. It might happen one morning that a patient on the transplantation list didn't turn up for their dialysis, and then, of course, you kept your fingers crossed for them. Later in the day, the patient themselves might ring from the transplant unit to say that they've received a new kidney. And the patient is obviously overjoyed. It's incredibly heart-warming when that happens. You've followed the patient for a really long time. Now they can say, for example, "I've just been to the loo. I've just had a pee!" And of course that's great. Some of them go through their whole lives without having a transplant. And for many of them it's a hard life. 

My strongest memories are also, of course, of all the great patients I've met over the years. We often have very close relationships with the patients, and it's like one big family here at the clinic. I think it's fantastic that so many patients accept their treatment and turn up every time with a positive, cheerful attitude in the midst of everything they're going through. That's really inspiring. It's with both joy and sorrow that I'm leaving this wonderful big family.