Managing kidney failure is tricky
By Noman Ahmed
Reliable facilities for kidney patients are hard to come by
AMONG the healthcare challenges that confront Pakistani society, renal ailments are fast becoming a major issue. According to conservative estimates, at least 30 people between the age of 25-55 years in a population of a million, suffer from kidney failure of acute nature. Estimates about children and elderly are not available, though the trend of disease occurrence is rising.
Hypertension due to professional, domestic or other socio-economic affairs; poor quality of water and incidence of high blood pressure are reported as the main causes for the rise in renal diseases. And the rising cases of kidney failures, happens to be a very serious problem.
Limited facilities exist to treat the cases of renal ailments. In Karachi, Sindh Institute of Urology and Transplantation (SIUT) and the Kidney Centre are two quality institutions known for their services and efficacious treatment.
Maladies related to kidney failure can be dealt by two methods; dialysis and kidney transplantation. According to Dr Rashid Iqbal Khan, Administrator of Kidney Centre, dialysis is a periodic process that is essentially prescribed to all such patients who are forced to live the rest of their lives with failing kidneys. It requires enormous support from family members of the patient. Treatment is expensive and can cost up to Rs180,000/- per year if no other complication arises. The patient has to be brought to the hospital for dialysis twice or thrice a week which by itself is a cumbersome errand. It is a very sensitive type of treatment that requires continuous monitoring by qualified and competent professionals. The possibility of catching external infections, anaemia, caution in drinking water, maintaining the appropriate balance of calcium, other chemicals and vitamin D level in the body are few issues that may also need attention.
Overall complications in treatment, dependence on others, high expenditures and a haunting feeling of helplessness often results in depression and psychological disorders. Such patients consider themselves to be in a near death situation and start losing hope in life. The only lasting hope for them is in obtaining a healthy kidney transplanted into their system through a meticulously done operation.
Transplantation is defined as the process of planting a healthy kidney from the body of a donor to the patient under medically and surgically favourable conditions. It is considered to be a preferred option compared to dialysis for several reasons. It saves the patient from the physical effort of dialysis.
New red blood corpuscles can be formed easily in a normal way which by itself is a healthy sign. The patient can consume normal diet and usually gets free from the extra-ordinary precautions subscribed while undergoing dialysis. Bone related ailments that evolve due to failing kidneys usually start healing after transplantation. A person can lead a normal life even participating in the usual physical activities such as sports and other labour intensive chores. However, organ transplantation is an issue which is neither understood nor properly promoted as a viable option for such patients.
Ideally the best type of organ donation can come from one’s own siblings. This also includes first cousins and other blood relations. Results have shown that patients of such transplants normally lead a healthy and otherwise trouble free life. Kidneys donated by others may not necessarily possess such advantages. However, in order to abdicate the moral and humanitarian binding of donating their organ to their siblings, such people guide the patient to approach a person who willing to “sell” his or her kidney.
A kidney from non-related donor can give rise to complications in times to come. Religious taboos are another major case. Whereas reputed religious seats of learning around the Muslim world, including Al-Azhar University have allowed organ transplant as a means of saving precious lives, our local clergy has yet to come up with a collective stand on the matter. Few of them even reject cornea transplant let alone a kidney related procedure.
This orthodox approach results in negative fall out. Followers and devotees of such religious orders disapprove of these otherwise medically and socially valid options of life saving. Besides there is no law that exists in the country that could enable the use of body organs of such people who die accidentally. This can help in rescuing hundreds of near dying folks who can get a new lease of life if timely access to an organ transplant could be made.
Organ transplant is an aspect that is marred by several unethical and criminal practices that have lately become rampant. It is becoming a cause of exploitation of the poor and needy who do not have any other means to survive. Such people, in utter desperation, are made to sell their organs to those who are in need, often at ridiculously low compensations.
Some times ignorance and lack of education becomes the greatest depriving factor. People are even kidnapped by ruthless exploiters. Without their knowledge or consent, they are operated to obtain their vital organs. Not even a penny in compensation is paid.
A few weeks back, a news item in several national dailies reported the horrendous story of a dozen villagers in southern Punjab who lost one kidney each to a gang of exploiters simply due to ignorance. Poor people had gone to a quack with symptoms of some stomach ache where they met this unfortunate incident. Many clinics in different large and small cities of the country are alleged to conduct such illegal transplants under highly inappropriate conditions. Due to absence of monitoring capabilities on the part of health departments, these practices thrive unchecked.
Experts are of the view that if utmost care is not taken in matching the tissues and other details, the chances of survival become remote. For this reason, ethical practices in transplantation need to be promoted. In July 2003, the Kidney Centre joined the list of those few institutions that strictly adhere to the practice of ethically valid transplantation procedures. They follow a comprehensive code of medical conduct including strict denial of organ trading, acceptance of organ donation only from siblings and/or first cousins and ensuring proper tissue typing and cross-matching.
Developed as a ‘not for profit’ institution, the Kidney Centre is an entirely philanthropic attempt by concerned souls who wished to establish a well equipped facility for treating kidney and related diseases. Apart from transplantation, the Kidney Centre provides dialysis with proper screening, lithotripsy (breaking kidney or bladder stones through shock waves), consultation and diagnostic services to all cross sections of the society.
Through its patient welfare funds, the otherwise expensive treatments are subsidized for those who cannot pay the entire cost. The very poor are often treated free of charge. Over Rs30 million were spent in the previous year for the treatment of such deserving patients. The institution is affiliated with the College of Physicians and Surgeons (CPSP) for postgraduate teaching and research in renal diseases.
It can be safely said that the country in general and the city in particular needs many more health care facilities in such areas where the incidence of renal disease is on the rise. This becomes all the more vital when the cost of treatment is entirely expensive for most of the patients.
Providing treatment in small towns
ADVANCED health care facilities in Pakistan, whatever little they are, are concentrated in cities like Karachi and Lahore. This despite the fact that most of the country’s population dwells in rural Pakistan.
Health care facilities barely exist for village folk. Add to this illiteracy, poverty and lack of civic facilities and you have a worse picture. It is hard for poor and simple relatives to carry a sick patient suffering from complicated disease from far-flung areas to a large city. Mostly the factors hindering are that they are strangers in a metropolis, they don’t have sufficient money and it is time consuming. In fact, in the face of such odds, at times one feels that it is easier to die than to live as a sick, poverty-stricken member of a family with no money.
Renal diseases fall in the category which when not treated in an early phase, gets complicated, expenses become manifold which are mostly out of reach of an ordinary person.
In the absence of sufficient government medical support, a fairly large share of our health care facilities are provided by NGOs. Millat Hospital and Millat Foundation are among such organizations serving primarily the local population of remote Sadikabad that help the needy in general and the sick in particular.
About half a century ago when the hospital was established at Sadikabad — a small town at the junction of three provinces of Pakistan, even the facilities of electricity and water supply were non-available. Even today, services are being rendered wholeheartedly when the general economic conditions have worsened.
Back in 1993 endoscopic surgery for urinary tract was introduced in the same hospital that is even today considered as the most modern technology in the world. Even in our government and non-government sectors, this facility is nowhere available. Earlier, the affluent used to travel to the UK or the US to be treated endoscopically. However, the facilities at Sadikabad made the treatment a whole lot easier.
Though free treatment to poor and monetary help to the needy was a prominent part of the services of Millat Hospital, its facilities were channelized and extended in 2001. A charitable organization, Millat Foundation was created and common health care facilities in general and cure for renal disease, particularly stones, in specific was focused. Now, in spite of its location in a remote area, people come to Sadikabad from all over the country.
In an effort to accomplish the best there is, health professionals are trying their utmost to discover or invent such methods of surgery in which maximum benefit is achieved while the trauma to the patient is minimum. The term ‘Minimal Invasive Surgery’ had been created for such procedures. Such methods are applied to each and every organ of the human body and each day new development appears.
Endoscopic surgery in urology is a type of the above-mentioned minimal invasive surgery in which all the operations from kidney to urethra can be performed with minimum or no trauma.
To provide facilities worth millions of rupees for nominal charges or completely free of cost is not in the capacity of one person or small organization. Financial help from the well to-do is required until our country reaches the level of economic status where health care services are provided to everybody, as is being done in welfare states. — Dr A. Munim Khan
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