2 April 2013

Uganda: Mulago to Offer Cheaper Dialysis

When eight-year-old Rena Kaitesi got a slight fever and was unable to study for one day, no one suspected she had a kidney problem. She was treated for malaria and was back in school after five days. However, her body gradually succumbed to weakness, pain and vomiting.

In August last year, her body started swelling uncontrollably. Her movement was paralysed and vision blinded. Dr Robert Kalyesubula, a nephrologist at Mulago hospital, explains that the swelling happens when one's kidneys lose their ability to remove different types of waste from the blood.

Kaitesi's father, Julius Busingye, took her to Kambuga hospital in Kanungu district but the swelling got worse. At this time, she was feeding through tubes. She was referred to Nyakibaale hospital and then to Mbarara hospital where she was discovered to have kidney disease. After another round of failed medication, she was referred to Mulago hospital.

"By the time the doctors referred us to Mulago, I was as poor as a church mouse. I had sold my car and land to cater for my daughter's health and yet I had to pay her two siblings' school fees out of my meagre earnings as a farmer," Busingye said.

Busingye obtained a Shs 4m loan from one of the district Saccos and travelled to Mulago in February to have Kaitesi put on haemodialysis. In this process, a person's blood is routed across a machine that cleanses it before allowing it back into the body. At Mulago, he parted with about Shs 800,000 a week and resorted to begging.

"I took pictures of my daughter in her swollen state, pasted them on to a box and sat outside Uchumi Supermarket to beg. It did not work because on a good day, I could raise about Shs 15,000," he recalls.

Then good luck struck. The hospital announced that it was going to offer free dialysis in a bid to reduce the number of patients. Kaitesi was offered the free services.

"I do not know what was happening to me by then because I could not see and talk to anyone. It was as if I was waiting to die," she said as she rested in her father's bosom.

Today, Kaitesi is a vibrant little girl waiting to rejoin school. Dr Byarugaba Baterana, the hospital's director, says Mulago has signed a contract with a foreign company to supply 20 dialysis machines and upgrade the water treatment plant.

A patient is recommended to use this 'artificial kidney' (dialysis) at least three times a week for several hours each time.

"By the end of April, we hope to have the machines on board," Baterana says. "They will boost the unit that now has 15 machines and we shall provide the dialysis at a cost less than Shs 60,000 per unit time so that where one has been spending about Shs 800,000 a week, one will instead spend about Shs 180,000."

The supplying company is going to place and service the machines while government will be responsible for buying the consumables. However, patients will buy their own catheters. Although the renal unit is capable of handling 75 dialysis cases a day, it currently handles between 20 and 40 cases because many patients cannot afford the cost of dialysis. In effect, majority of them are put on dialysis twice or once a week instead of the recommended three times.

In February the hospital received a boost of 10 Nipro dialysis machines as a donation from Dr Taro Kobayaski Tokuda of Japan. Dr Kobayashi had visited the hospital in 2004 and found the unit limping with only five machines.

"He has fulfilled his pledge and this is why we are offering free dialysis," Dr Simon Peter Eyoku, the head of the renal unit, said.

Already, some patients in Wards 5 and 4C have benefited from the offer. Grace Zalwango, a primary seven pupil at Kikajo Vision Parents School in Kyengera is among the beneficiaries. Every week for three weeks, her parents spent close to Shs 1m on her dialysis, sometimes affording only one session. After the free dialysis, she is recovering fast and is due for discharge.

"Dialysis is key towards renal transplant and we are working hard to ensure that we start renal transplant. Currently, two nephrologists are being trained in renal transplantation in Japan and by 2015, Mulago hospital will start renal transplant," Baterana said.

Elsewhere in Uganda:

There are not so many places that offer dialysis but some private hospitals like Case Medical Centre, Panorama Medical Centre, International Hospital Kampala and government-owned Mbarara hospital offer these services. Nsambya hospital and Nakasero hospital are in early stages of providing similar services.

Kampala Capital City Authority (KCCA) is spearheading efforts to implement peritoneal dialysis (PD), a process where one can receive dialysis at home, in rural areas. However, Dr Kalyesubula says there are challenges of infection associated with this kind of dialysis as not so many people are hygienically up to date.

Facts about kidney disease:

Majority of kidney diseases are as a result of high blood pressure, diabetes, obesity and self-medication.

"When you self-medicate, you burden the kidneys with toxins that may eventually lead to kidney failure," Kalyesubula said.

Kidney disease occurs in five stages. At stage one, the degree of failure is usually mild and the patient presents with few symptoms. At stage two, a person presents stronger symptoms than in stage one and these include abnormalities in urine or blood. At stage three, there is a moderate reduction in one's urine although the patient is not yet due for renal replacement therapy (dialysis and renal transplantation).

At stage four, there is severe reduction in one's urine and patients exhibit physical symptoms like swelling, severe itching due to compilation of wastes in the blood stream, and back pain. Preparation for renal replacement therapy begins at this stage. Stage five is commonly known as the established chronic kidney disease.

It is also associated with end-stage renal disease (ESRD) or terminal renal failure. Here, dialysis and kidney transplant are the only treatment options. Dr Edward Kigonya encourages the public to go for regular screening for early detection and treatment.

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