Home | News | GOVT’S COSTLY FIGHT AGAINST KIDNEY DISEASE

GOVT’S COSTLY FIGHT AGAINST KIDNEY DISEASE

18/11/2018 07:52:00 BY PHEPHILE MOTAU

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phephilemotau@gmail.com

MBABANE – There is a silent but deadly killer in our midst. The country is losing many people to this killer and more than E74 million is spent per year trying to fight it.

This killer is known as chronic kidney disease. The E74 million is spent on dialysis for those suffering from the disease.
Currently, according to an impeccable source who is privy to the operations of the Mbabane Government Hospital renal Unit, there are 314 people with chronic kidney disease on hemodialysis in the country. Each of these undergoes three sessions per week, and these sessions cost E1 500.

In hemodialysis, blood is removed from the body and filtered through a man-made membrane called a dialyzer, or artificial kidney, and then the filtered blood is returned to the body.

The source said private clinics cost E3 000 for the procedure, and government had formed a private public partnership (PPP) with a medical company, which allows it to enjoy discounts because of the high number of people. The government provides this service to emaSwati for free.

This could be calculated to cost government E73 476 000 per year, which is four per cent of the Ministry of Health’s E1.85 billion budget.

25 to 30 new cases monthly
Dr Thandiwe Dlamini, a Nephrologist at the Mbabane Government Hospital, confirmed that there were about 300 people on dialysis in three hospitals, namely the Mbabane Government Hospital, Raleigh Fitkin Memorial (RFM) Hospital and Hlatikhulu Government Hospital. She said the majority of patients were at the Mbabane Government Hospital.

She also said each month they received about 25 to 30 new cases of acute kidney disease. She said these patients had other illnesses, which affected the functioning of the kidneys. She said these patients were dialyzed, and once they got better, were discharged. If these people had an average of four sessions each, this would cost government an extra E1.8 million

She said these patients then attended the renal clinic, which is held once a week for further assessment. The money above does not include the medication the patients need to take while undergoing dialysis, which is also paid for by the government.

Dr Dlamini said the mortality rate of people with kidney disease was two per cent per month, which means that out of the 300, six were likely to die in a month. Recently, kidney disease claimed the life of socialite and former Times of Swaziland reporter Bayanda Dlamini. Swazi Observer Editor Thulani Thwala, who passed on last week and was buried yesterday, also underwent dialysis treatment at the Mbabane Government Hospital.

life expectancy 5-10 years
Dr Dlamini said people on dialysis had an average life expectancy of five to 10 years. She said this depended on the availability of medication and how well one followed their treatment plan. The source said the difference of patients between now and 2014 was alarming, as at the time, only 35 patients received dialysis.
Dr Dlamini said the difference between statistics in 2014 and now could be attributed to people being more aware of the disease, and the efforts they had done to educate members of the public. She said even medical professionals were now more educated on the disease and could properly refer patients for further tests. She said the majority of those diagnosed with kidney disease in the country had other underlying illnesses, including diabetes, HIV/AIDS and hypertension.
Patient statistics from the Eswatini Government website showed that for the period 2015/2016, the Renal Unit was a six-patient unit operated under a Public Private Partnership (PPP) between the Ministry of Health (MoH) and Fresenius Medical Care SA. However, due to the increase in the number of cases between then and now, the unit is now a 20-patient unit, and the 215 people take turns in getting the service.

unit works overnight
The unit consists of a nephrologist, medical doctors, supervisors with critical care training, 14 nurses also trained in critical care, six registered nurses and other support staff in the department. The unit works overnight on some days to accommodate the patients, according to the source.
She said there were many more other patients who were being treated, and had not started their dialysis and those with acute kidney disease came from the wards, on special instances, to receive dialysis.
To add more pressure on government, those who undergo dialysis need to have a fistula inserted in their bodies. The AV fistula is a blood vessel made wider and stronger by a surgeon to handle the needles that allow blood to flow out to and return from a dialysis machine. This procedure, according to the source, costs E25 000 in South Africa. She said government was lucky to create a relationship with Korean doctors, as they came to the country to do it for free.
The source explained that the most desirable treatment would be organ implants for the patients, as dialysis was meant to be temporary. She said, however, some of their patients had been receiving treatment for over 18 years, and they were still alive. “Some come just twice for treatment, and then they die,” she said.
The source said even if a person could get an organ donor, it would be impossible to perform the transplant locally, as the country did not have a Tissues Act, which allows for organ donation. She said there were three of their patients who have been sent to South Africa, after they got donors, to have their transplants. She said they also came to the Renal Clinic for follow-up procedures.

Organ transplants need
Principal Secretary in the Ministry of Health Dr Simon Zwane admitted that the Tissue Act was long overdue. He said they would present a health Bill to Cabinet early next year, which would go to parliament and then become an Act. Dr Zwane said the Bill would include the provisions contained in the Tissue Acts of most countries.
Meanwhile, the source went on to explain that unlike in other countries, Eswatini allowed the elderly to undergo dialysis. She said for other countries, those over 60 could no longer receive the treatment. The source said most people were ignorant about kidney disease, yet it was lifestyle related and could be prevented.
On the other hand, Dr Dlamini said a more permanent solution to people on dialysis could be peritoneal dialysis where soft plastic tube (catheter) is placed in the stomach by surgery.
A sterile cleansing fluid is then put into your belly through this catheter. After the filtering process is finished, the fluid leaves the body through the catheter. This process usually is done three, four or five times in a 24-hour period while you are awake during normal activities. She said this would be beneficial to people who were busy as they could perform it on the go. She said there were some people in the country who were under this type of dialysis, but it would be costly for government as it would require more resources like medical professionals and transport to visit the patients at home.
Dr Dlamini added that organ transplant could also be of great value, as a person needed someone with the same blood type who was willing to donate a kidney. She said so far, the only hindrance the country had was the Tissue Act. She also said most procedures that were related to kidney disease were now performed locally.
She also said she was currently the only Nephrologist in the country, but one would be joining her next year. She said besides the costs of dialysis also included medication which the patients had to take as part of their treatment. “Some even have to receive blood transfusions as kidneys some of the patients also become anemic,” she said.
The source said the unit made many requests to the blood bank. The source said most people were ignorant about kidney disease, yet it was lifestyle related and could be prevented.

Patients forced to quit jobs
A patient who has been undergoing dialysis for eight years said the biggest loss to her was losing her job after finding out she had kidney disease. She said she could no longer work as she could not afford to take three days off to attend four hours of dialysis per week.
She said when she first started suffering from swollen feet, back pain and one day, she collapsed at work. She said she was admitted to a local private clinic before she was taken to a Johannesburg hospital. “It took doctors two full weeks to discover what was wrong with me,” she said.
She said when she started her dialysis, she would vomit afterwards, but that got better as time went on. She said what she found most inconvenient was that she could no longer eat certain foods she liked. She said she was, however, grateful that she was alive, as a number of people she started the treatment with had died.
She said she had been told that dialysis had to be a temporary treatment measure, but there was nothing she could do in the prevailing situation. She said her life changes as she cannot urinate anymore.
The renal unit’s history dates back to March 2007, when a renal unit opened at the hospital: at the time, hemodialysis was performed in intensive care, but due to a steady increase in the number of patients, a separate dialysis unit was opened in 2009. Fresenius Medical Care took it over in June 2014. One of the first patients of the clinic was deceased former Prime Minister Barnabas Dlamini’s wife Jane, who succumbed to the illness in 2012.