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Tue, Jan

Kidney Failure: When Your Diagnosis Becomes A Slow Death Sentence

Thoughts From Afar
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However, in my view, the story must be told. According to the Dialysis Service Foundation (DSF), on average 12,000 kidney failure cases are detected among Ghanaian patients annually.
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In Alan Watts’s words, “we seldom realize, for example, that our most private thoughts and emotions are not actually our own. For we think in terms of languages and images which we did not invent, but which were given to us by our society.”

That we owe a lot to society cannot be understated. Humans over the years have, through no choice of theirs, been born into different societies. Between birth and the certainty of their death, society has through nurture either by default or through planning helped them evolve from infancy, adolescence to adulthood expecting contributions from each individual for the betterment of humankind. As a result, some have managed to influence the society that nurtured them positively; whilst others have at best exploited the same society to the detriment of not only the generation yet unborn but the elderly who in the past held the fort.

Watch | How To Take Care Of Your Kidneys

In the past year, I became aware of a very prominent Ghanaian, who I knew at first hand to have made a significant contribution to the advancement of medicine and healthcare in Ghana, seeking healthcare abroad at considerable expense. Initially, I was of the view that this fell into the remit of the usual health tourism that the well to do engage in. Probing further, however, I came to the realisation that he had a kidney problem that required lifelong dialysis. This intrigued me even further, as I knew that both Korle-Bu and Komfo Anokye Teaching Hospitals at least provided this service.

I decided to ascertain why someone who had been so instrumental in the setup of our health system including the training of some of its current leading lights could not rely on the same system. The account I provide about dialysis in Ghana, though cryptic, may be chilling reading. However, in my view, the story must be told. According to the Dialysis Service Foundation (DSF), on average 12,000 kidney failure cases are detected among Ghanaian patients annually. Each patient requires between 12 to 14 sessions of dialysis each month at an average cost of GHS250 per session. This is a yearly cost of GHS42,000 (approximately $7608 at current exchange rate). In a country where the minimum monthly state pension is GHS276 ($50) and few on retirement earn more than GHS2000 (approximately $355), one cannot help but wonder how many are expected to afford this treatment for a lifetime.

Kidney health

Then there is the issue of availability of treatment centres. In an article published in BioMed Central titled “The geographical distribution of dialysis services in Ghana”, Tannor et al. indicated that “fifteen dialysis centres with a total of 103 hemodialysis machines were identified with majority 59 (57.2%) in state-owned facilities.” They further indicated that half of the regions in Ghana did not have any form of dialysis facilities and that majority 65 (63.1%) of hemodialysis machines were in the Greater Accra region alone. As though this skew is not bad enough, they established that private hemodialysis services were available only in Greater Accra and Ashanti regions. Clearly, this is the biggest indicator that for the majority of Ghanaians living in the hinterlands, a diagnosis of chronic kidney disease was a sure death sentence.

Then there is the issue of the quality of service received by many patients at these renal units. Indications are that, like any other health-related customer service, the reception most receive is abhorrent. However, depending on your ability to pay and social class, considerable empathy could be extended to you. With so much pressure on health staff and equipment, many who lack the ability to pay are jettisoned or given excuses so the affluent can receive priority.

Further, there are many instances where facilities especially those in public hospitals experience shortages of vital supplies and chemicals, equipment breakdown or poor servicing schedules. Ironically, it is also found that public facilities pay more for their supplies on average than private providers. This is even when they obtain supplies from the same importer. Our understanding is that, whilst private hospitals are paying between GHS45- GHS75 for dialysers, government facilities are paying between GHS90- GHS110. We further discovered that this is because some workers in government facilities have become middlemen buying from importers and selling to their employers as independent agents in clear conflict of interest. The net effect of this situation is that whilst many private renal facilities are operating at a considerable profit, those in public hands are running at a loss.

I cannot help but wonder if these middlemen think they will metamorphose into stone. Truth is, with a bit of luck and thanks to their ill-gotten short-term riches, they may age and suffer similar chronic diseases. For many of them, they would have failed to convert their riches into generational wealth and would have nurtured a new breed of greedy health workers who will treat them as they currently treat today’s patients.

Speaking to this distinguished Ghanaian recently sent chills down my spine. He indicated that his condition was end stage and required peritoneal dialysis. Though peritoneal dialysis is available for the management of acute kidney injury (this is short term and resolves within days or week) in all four teaching hospitals in Ghana, it is routinely not available for end-stage renal disease (kidney failure that requires life-long dialysis for survival). I pressed him as to why that was the case. His view was that not much emphasis had been placed on renal conditions in the past and that successive governments had preferred to kick funding down the long grass. Due to this lack of foresight he continued, many senior citizens are having to pay through their noses for dialysis just to stay alive. Thankfully, some have children who are well to do and willing to pick up the tab for their treatment. For others, they pay whilst watching their bank balances and investment dwindle and drift into chronic depression. They wonder why they failed to envisage their current situation when they had the power and opportunity.

I have sought permission to put this story out and to remind our generation that we cannot afford to be caught in this net. We should not expect that our children will become our ATM in old age because we have failed to plan towards the inevitable when we were in charge and had the opportunity. We must realise that unless we work towards a functional health system that caters for all, our quality of life will be severely compromised when the trappings of our current careers come to an end. Should we fail and when that happens, we must not turn towards the generation we have parented for answers. We must man up to the reality that our failure to contribute positively to the nurturing cycle of society is what we are reaping.

In the parting words of this senior citizen, I found solace in the reason why giving up on our health system is something none of us must do. Hear him out, “I am fortunate that my children have the capability to keep me alive, but I have seen many who whittled away needlessly not because their kidneys could bear it no more, but because they run out of funds or in some cases could not afford the treatment in the first place. In my days as a clinician, I found these situations saddening but never thought it could happen to close friends let alone myself. Your generation must learn from our failings and ensure you are never in my situation.” With that, I thanked him hang up the phone and sat to ponder.

Then I remembered my opening quote from Alan Watts and concluded I cannot keep this as part of my private conversations and thoughts. I needed to share in all graphic detail, so the penny could drop and hopefully galvanise us to think health in a more coordinated way. This was when I redialed and with a lump in my throat sought permission to share excerpts of this otherwise private conversation. Thankfully, permission was granted.

Feature Image Courtesy of Pramote Polyamate

Edited by Winifred Awa

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