Breaking barriers to dialysis treatment

Monday July 6 2020

 

By Priyanka Sippy

For the past four years, Peter Mgabe* has been forced to live away from his home, moving his life to Arusha in order to receive the kidney treatment he needed to stay alive.

It was in 2016 that Peter realised he was experiencing kidney failure, after taking some extra blood tests and noticing some abnormalities.

However, for a long time, Peter put his symptoms of kidney failure down to problems with his heart, and was on medication for managing his blood pressure and hypertension.

“Despite being on the medication for my heart, I was still having symptoms of feeling tired, weak and generally unwell. My legs were swelling. I decided to have more blood tests to see what else could be wrong,” Peter tells Your Health.

At the time when Peter needed to receive treatment, it was only available at a small center in Arusha and a handful of centers in Dar es Salaam; so Peter moved his entire life to Arusha, and stayed with his extended family during the treatment.

However, over the past couple of years, Tanzania has invested more into dialysis treatment, working to decentralise care and make it accessible to those in other regions.

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Now, Peter is receiving dialysis at Arusha Lutheran Medical Centre, the largest dialysis center outside of Dar es Salaam, in Arusha, but soon he will be returning to his home in Haydom, Manyara - where a new dialysis centre has recently been set up:

“I am really looking forward to going back home. As a former doctor at Haydom Lutheran Hospital, I am really passionate about ensuring more people, like myself, can access dialysis without having to travel. Currently, there are four of us from Haydom receiving treatment in Arusha, we like it here - but we are excited to go home,” says Peter.

Accessibility

Peter is just one of the few patients in Tanzania that have had to change their life around and move cities to get kidney treatment, which isn’t as readily available outside of the country’s big cities.

As kidney disease has been on the rise in Tanzania, decentralising treatment has been a focus for the country, and one of the key aims of Africa Healthcare Network - the largest dialysis chain which works across Sub-Saharan Africa.

Nikhil Pereira-Kamath, the Chief Executive Officer, talks about the current challenges that patients face when accessing kidney treatment.

“There are typically three key elements which prevent patients from getting the care that they need: accessibility, awareness and affordability. And when it comes to improving accessibility, it is about bringing dialysis to the patients instead of making them come to us. Dialysis is a time consuming treatment – most patients will be on it three times a week for four hours per treatment, so previously, if you lived outside of Dar es Salaam, you would have to travel hours each day to receive treatment – which isn’t feasible. Over the past couple of years, we are now opening more regional treatment centres, and through ensuring a high quality of care, patients are able to receive dialysis and continue to live their life. We have patients that come at 5am for treatment, stay for four hours, and then go to do their day job,” Mr Kamath tells Your Health.

And despite the improvement in access to dialysis over the years, Mr Kamath believes that there is still a long way to go in order to reach the amount of people that need care.

“In Tanzania, around 1,200 people are receiving dialysis treatment, but if we go by the statistics that usually 1,000 per million people require treatment, in Tanzania we would expect around 60,000 people to be on it,” he says.

Preventing lifestyle diseases

But it is not just accessibility that Mr Kamath cites as a key reason why enough people aren’t receiving dialysis - it is also an issue of awareness.

“There is limited awareness of issues like hypertension and diabetes, which later can cause kidney disease if they are not diagnosed early and managed properly. It is really important to ensure people manage these diseases well, before the impact of kidney disease become irreversible. Once that happens your only options are dialysis or transplant,” he says.

Mr Kamath sees dialysis as becoming an increasingly prominent issue in the country, due to the growing burden of non-communicable diseases in Tanzania, which can lead to kidney disease.

Dr Kaushik Ramaiya, a Consultant Physician and leading Endocrinologist, based in Dar es Salaam, notes that the rise in cases of diabetes and hypertension is due to lifestyle changes over the past couple of decades – mainly revolving around diet and exercise.

“Over the last 20-30 years, the rate of non-communicable diseases has increased exponentially. Diabetes, for instance, was less than 2 per cent in urban areas, but now it stands at around 9.8 per cent. The rate of hypertension was around 10-12 per cent but now it stands at 28 per cent. The biggest cause of this has been an increase in weight of the population, and a lack of physical activity,” Dr Ramaiya tells Your Health.

Dr Ramaiya believes the trend of non-communicable diseases could continue down this path unless education and awareness is given, particularly to children in schools – helping to prevent the next generation from dealing with these diseases.

Mr Kamath echoes this, and says more needs to be invested in the prevention side of things, reducing the number of people that need dialysis care.

However, as this trend of non-communicable diseases does look to continue to rise, both Mr Kamath and Dr Ramaiya emphasise the importance of an early diagnosis.

This involves educating communities on the typical symptoms so that they seek medical care, while also building capacity of health staff in Tanzania to recognise, correctly diagnose such diseases, and then ensure proper follow up care with the patient.

Five years ago researchers at the Kilimanjaro Clinical Research Institution carried out a study in Northern Tanzania and called for more research in the demographic shift among the people in an effort to prevent chronic kidney disease (CKD).

“We observed a high burden of CKD in Northern Tanzania that was associated with low awareness,” reads part of the study, published in Plus One Journal, titled, ‘The Epidemiology of Chronic Kidney Disease in Northern Tanzania: A Population-Based Survey.’

The study pointed out lifestyle practices including traditional medicine use, socioeconomic factors, and non-communicable diseases accounted for some of the excess kidney disease risk.

Dr Ramaiya notes how just 10 years ago, the country had few nephrologists, compared with today, where there are more doctors and nurses trained in this area of care.

Is dialysis affordable?

The last piece of the puzzle in improving kidney care in Tanzania has been affordability.

Dr Ramaiya says the dialysis is a costly procedure and difficult for people to pay for from their own pocket. However, with the Government’s National Health Insurance Fund, more people than ever are now able to access treatment that previously wasn’t available to them.

While prevention of kidney disease through living a healthy and balanced lifestyle is the long-term goal, in the meantime, there is a growing acknowledgement and effort to improve access to dialysis to ensure those who do need care are able to get it. Mr Kamath and Dr Ramaiya both believe that Tanzania has the opportunity to be a model for Africa, as Mr Kamath says, “Kidney disease is a worldwide problem, but Tanzania has not yet reached the levels of many of the countries in the Western world.

Through investing in education and awareness on prevention, training and capacity building of local healthcare staff, and decentralization of treatment, Tanzania has the opportunity to really reduce the burden of kidney disease and not make the mistakes of the Western world.”

Prevention

According to Kidney Fund’s web portal, diabetes and high blood pressure are the most common causes of kidney disease and failure.

If you have diabetes or high blood pressure, working with your doctor to keep your blood sugar and blood pressure under control is the best way to prevent kidney disease.

Living a healthy lifestyle can help prevent diabetes, high blood pressure and kidney disease, or help keep them under control. Follow these tips to lower your risk for kidney disease and the problems that cause it:

Tips:

• Follow a low-salt, low-fat diet

• Exercise at least 30 minutes on most days of the week

• Have regular check-ups with your doctor

• Do not smoke or use tobacco

• Limit alcohol

*name changed

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