Health Officials: Dialysis Unit too costly

by Nelson A. King
in New York

As the broad-based St. Vincent and the Grenadines Renal Failure Relief Committee gets ready to stage its Third Annual Gospel Extravaganza this month, to raise funds to assist kidney patients here, it has increasingly become apparent that the establishment of a dialysis unit at home would be extremely cost prohibitive. {{more}}
This was conveyed in recent interviews with Minister of Health Dr. Douglas Slater, hospital administrator Pam Bonadie, and other leading medical practitioners in the country.
Dr. Slater, a Cuba-trained physician with a Master’s degree in Public Health, said that though he is extremely sensitive to each patient’s medical needs, it may not be cost effective to develop a dialysis unit in view of government’s severe budgetary constraints.
“There are so many needs, and we can’t address all,” he said, pointing out, however, that the incumbent Unity Labour Party (ULP) administration of Prime Minister Dr. Ralph E. Gonsalves is still very concerned about putting the kidney issue on the front burner.
“We have not written it off,” Slater said. “ We have not changed our policy. It’s still down as an issue we’re working at addressing. We’re trying to shuffle the pack.”
The health minister said the cost of treating kidney patients is extremely exorbitant in the face of wide ranging diseases afflicting nationals, stating that it would cost, on average, an estimated EC$50,000 annually to treat a kidney patient using a dialysis machine.
“It’s a very expensive procedure,” he said, noting that: “It is not something a whole ‘ton load’ of people may need.”
Dr. Slater said that preliminary estimates indicate that about 15 people in St. Vincent and the Grenadines may need dialysis annually. Therefore, with limited resources, “tough choices” have to be made, he said.
“We have hundreds of people dying of cancer,” he said. “How come you don’t hear people talking about that? The treatment of cancer, we’ll like to see more and more.”
Though peritoneal dialysis has been done in the past, Bonadie said that conducting hemodialysis would require injection of new funding, possibly through the formation of a kidney foundation, with private sector assistance.
“We’re trying to see if we can set up a foundation,” she said, “because we have a very large diabetic population, and diabetes (could) lead to kidney failure.”

Why disalysis?

Health experts recommend peritoneal dialysis for patients with End Stage Renal Disease (ESRD) in which the lining of patients’ abdomen is used as the dialyzing membrane.
In this process, dialysate enters the body through a special tube that is inserted into the abdomen. Excess water, wastes and chemicals pass from very small blood vessels, across the peritoneal membrane (hence the term peritoneal), into the dialysate.
After several hours, the dialysate is drained from the abdomen, after which the abdominal cavity is then filled with fresh dialysate. The cleaning process is repeated intermittently or continuously.
In hemodialysis, or kidney dialysis, two needles, attached to a thin length of tubing, are inserted into the blood vessel (usually in the patient’s arm). One tube carries blood to a machine containing a dialyzer, a unit comprising many very fine hollow fibers.
As blood flows through the fibers, dialysate flows around them, removing impurities and excess water and adjusting the chemical balance of the blood.
After being cleansed and adjusted, the blood returns to the patient’s body through the second tube. Treatment lasts three to six hours, and is usually performed three times per week, preferably in a hospital or in an outpatient dialysis clinic.
A leading Vincentian physician, who prefers to remain anonymous, agreed that the cost of treating patients on kidney dialysis is exceedingly high.
“The cost is very prohibitive,” he said, adding, however, in the same breath: “It’s a very emotional kind of thing, with people trying and can’t get dialysis.”
A 2001 study, commissioned by the St. Vincent and the Grenadines Ministry of Health and conducted by Barbadian nephrologist Dr. George D. Nicholson, recommended the co-existence of peritoneal dialysis and hemodialysis facilities.
Dr. Nicholson said that this is necessary because patients may be required to move from one modality to the other.
He said, however, that peritoneal dialysis should remain a therapeutic option, but would only succeed if patients are more carefully monitored.
He urged that nurses “of superior quality”, who are capable of taking “independent action”, be identified, and that they obtain additional training in peritoneal dialysis.
But Dr. Slater said that the government is exploring other possibilities in treating kidney patients, such as instituting a kidney transplant programme, which, he claims, provides a better quality of life for patients.
“The argument is, if you go to transplant, you (patients) can move about normally,” he said. “It needs proper planning. We’re looking at many different options.”
Already, a few kidney patients in St. Vincent and the Grenadines have received transplants at the International Hospital for Children in Virginia, through the efforts of an unidentified, prominent physician and the local Rotary Club.
Bonadie said that discussions are in the advance stage in constructing a Children’s Hospital in St. Vincent and the Grenadines, with significant input from the International Hospital.
“That project is far ahead,” she said, revealing that between 1994 and 2004, 31 patients, with chronic renal failure, have been treated by peritoneal dialysis.
Three patients have had kidney transplants, two have returned to the United Kingdom, and 24 have died, she said.

New York Vincies raise funds for kidney sufferers

In recent years, the St. Vincent and the Grenadines Consulate General in New York has been grappling with the economic costs of kidney patients who underwent surgery here.
Many, from the lower socio-economic rungs of society, are faced with humongous medical bills, primarily for post surgery treatment.
The consulate, through the instrumentality of Consul General Cosmus Cozier, has since engineered the formation of a Steering Committee, drawn from members of top Vincentian organizations in the Big Apple, with the aim of providing financial assistance for kidney patients.
The group has since launched the Renal Failure Relief Fund and will, on Sept. 19, stage its Third Annual Gospel Extravaganza, at Wingate High School in Brooklyn, hoping to realize US$15,000, the same target that was set in the inaugural event in 2002.
“I’m very optimistic that this is going to be very well supported,” Cozier said, “in view of the exposure it has got in the last few years. Moreso, gospel is the music of the day now.”
Bridget Blucher, the award-winning, pre-eminent Vincentian gospel diva, will lead a cast of gospel artists.
These include: Revelation of Tyme; Seltha Matthews-Browne; Ellsworth Quammie; Claudine Mitchell; Rhonda David; and the Divine Praise Mime Ministry, at Vanderveer Park United United Methodist Church, whose pastor is Vincentian-born Rev. Dr. Glyger Beache.
The Fund has periodically received financial contributions from a number of Vincentian organizations and individuals.
The Brooklyn-based St. Vincent and the Grenadines’ Ex-Police Association has been the latest to do so, contributing US$1,560 to help defray medical and other expenses incurred by ex-police sergeant Theophilius Pope, who is afflicted with kidney disease. Pope is undergoing treatment in Miami.
North Leeward native Osbert Hooper, now residing in Brooklyn, has also been among the Fund’s beneficiaries.
Last November, the St. Vincent and the Grenadines’ Nurses Association contributed $1,000 to Hooper’s plight after an impassioned appeal to patrons at the organization’s annual fundraising gala in Queens.

l The writer, a trained journalist, is a public health employee with over a decade of experience with New York City Department of Health and Mental Hygiene.