Renal patients ‘sent home to die’

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Durban - Renal patients who depend on public hospitals for treatment say they are being sent home to die. The Sunday Tribune has learnt that as many as 60 patients with organ failure were no longer being treated at Durban’s specialist hospital Inkosi Albert Luthuli Central. Addington, RK Khan, Prince Mshiyeni and Wentworth hospitals were also turning away sick patients. It is believed that the lack of funding, equipment and skilled personnel were among the reasons. Hospitals were unable to keep patients indefinitely as this prevented new patients from receiving treatment.

Treatment was provided on the basis that patients were “ideal candidates” for transplants and dialysis would keep them alive long enough to receive an organ.

The sheer volume of patients in need of dialysis and the finite resources of the healthcare system left patients hopeless after being turned away.

The majority of the patients interviewed could not afford private health care.

Former police officer Marlon Pillay lost total kidney function and now depends on dialysis to survive, but Inkosi Albert Luthuli Hospital told him “there was nothing they could do”.

The Queensburgh father of two almost died last year after being removed from the programme and not receiving dialysis for a week. Pillay had been diagnosed with stage two kidney disease, but few months later it went up to stage five.

“I don’t know how my condition worsened or if they missed something. I then received treatment from Albert Luthuli, but they said I was not an ideal candidate and was sent home.”

He was left without treatment that resulted in build-ups of toxins and fluids that went to his brain.

“I was septic and dying. I was hopeless and filled with dread. What if I never saw my daughters again? All because I could not afford treatment and the government I served had abandoned me?”

The cost of treatment ranged between R1500 to more than R2000 per dialysis session, which was required every second day. Access ports and catheters are required for the dialyser to connect to the patient but cost more than R25000 per surgery.

Due to the specialised nature of the prescribed medication, some tablets can cost R3000.

Pillay is among a group of patients being assisted by the Islamic Medical Association (IMA), an NGO run by the Baytul Nur Trust.

It provides treatment through a renal unit based at Ahmed Al-Kadi private hospital in Mayville, Durban.

Solly Suleiman, the chairperson of the Baytul Nur, said: “We serve humanity through donations and financial support from the community. All of our 60 beneficiaries were turned away from state hospitals.”

He said since the programme’s inception, more than a decade ago, more than 500 patients had been treated.

“We can treat 15 patients per session and perform three sessions a day. The third session is for patients who prefer treatment after work or once the children are settled down at home. It provides normalcy to their lives.”

Soraya Khan is the IMA renal unit manager and a nurse who specialises in renal care.

“All our patients are stage five patients, which is end-stage renal disease, where they cannot live without dialysis. So we do our best to provide world-class treatment but patients come in terrible conditions from the public health system. Some cannot walk and they do not have access ports to be dialysed. We have to get those surgeries performed,” Khan sain.

She said after a few weeks of reatment there was a renewed energy and optimism. “They begin to hope again and feel as though they have a fighting chance.”

Khan said patients had to apply to join the programme and would be assessed.

Afzal Khan, resident nephrologist at Ahmed Al-Kadi, screened each patient considered for the IMA renal support programme. “Criteria needs to be met before a patient is enrolled. But for a person to be excluded there would have to be multiple complications like pre-existing heart conditions, impaired circulation to limbs and a propensity to strokes.”

He said some patients required intensive care after being discharged from public hospitals, but it was costly.

“We have a finite amount of funds and resources, so taking on a patient is not a small task.

“We have to see if we will have enough medication and machines. Dialysers cost between R170000 to R200000, so if we could get more funds we could get more patients (on treatment).”

Khan added that the alternative to transplants was a non-starter for most.

“They are incredibly costly, plus you have to wait for a donor and suitable kidney. Most patients sit on the donor list for years and eventually die. There is only one donor list in the province and it was shared between the public and private sector.”

He added that renal disease affected anyone at any age as long it was a hereditary disease.

But for Glebelands men’s hostel resident Samkelo Tukuse, there is no hope. The 33-year-old man who was diagnosed with renal failure would receive his last treatment later this month.

He said when his legs and stomach got swollen in 2014, he had no idea what it was until he was diagnosed with renal failure at Wentworth Hospital. He has been receiving medical treatment at Inkosi Albert Luthuli Central Hospital.

“I have no hope of surviving without dialysis. I feel let down by the system. Life has become meaningless to me because I will die soon,” said Tukuse.

He said chances of seeing his 6-year-old son becoming a man were very slim. Tukuse was removed from the dialysis after he had a heart condition.

A staff member who cannot be named, because she’s not authorised to comment, said more than 120 patients were treated every month at Inkosi Albert Luthuli.

She said when a patient is excluded from the dialysis, he could not last more than two weeks.

“After patients are excluded from the programme, they eventually die. It is like being placed on death row,” she said.

She said only patients with more than one organ failure were removed.

A doctor from Inkosi Albert Luthuli said patients could not be treated indefinitely.

“If you are not viable for a transplant, you cannot stay. Space has to be made for others. Patients have to be referred to us. They are assessed by their local hospital who would send results to us.”

The KwaZulu-Natal Department of Health's spokesperson Noluthando Nkosi said due to the complex nature of certain ailments, clinicians often had to make difficult but important decisions that may be difficult for patients and their relatives to understand.

"The exclusion of certain patients from dialysis or other medical interventions is not unique to the public healthcare sector, but is a global practice," Nkosi said.

She said the suggestion that patients are "sent home to die" was a symptom of an attempt to oversimplify cases that tended to be complex.

She said medical exclusion criteria from dialysis might include:

• Active, uncontrollable malignancy or short life expectancy

• An advanced, irreversible progressive disease of vital organs such as:

- cardiac (heart), cerebrovascular or vascular disease

- advanced cirrhosis and liver disease

- medically or surgically irreversible coronary artery disease

- lung disease

- unresponsive infections e.g, HPV, Hepatitis B and C.

"Patients with proven habitual non-compliance with dialysis treatment and lifestyle modification will be excluded or removed from chronic renal dialysis programme," she said.

Nkosi said that patients and relatives who do not comprehend the rationale behind exclusion from dialysis are urged to seek clarity from health-care workers.

* This article has been updated

Sunday Tribune