Kidney ailments rise but services remain remote

Esborn Njuguna rests after a successful kidney transplant at KNH.RIGHT: Kidney specialist Dr Anthony Were.

By JOE OMBUOR

A consultant physician and kidney specialist Anthony Were says about 10 per cent of the 40 million Kenyans have some form of kidney disease.

“Out of these, about 800 patients per year develop kidney failure yet the services available can only take care of about 200 patients per year. The sad fact of the matter is that over 7,800 Kenyans die of kidney failure every year due to lack of access to kidney treatment, more than twice the number of the people we lose in road accidents,” says Dr Were.

He says that at Sh9,000 per session, dialysis in private hospitals is beyond the reach of ordinary Kenyans whose only option is to queue for the limited machines at public referral hospitals or painfully wait for death at home. Kenyatta National Hospital has 11 working machines, each of which does three dialysis sessions per day at Sh5,000 per session. The National Hospital Insurance Fund (NHIF) pays Sh2, 500 per session for member patients.

Were says patients on dialysis need two to three sessions per week to lead a near normal life. He describes as regrettable the policy by insurance companies not to cover dialysis and the fact that NHIF does not subsidise dialysis at private medical facilities.

Commenting on kidney transplant, Were describes the surgery that requires a donated kidney as the most effective remedy for the ailment despite its limitations.

“These include the hassle of getting a right, willing donor, the high cost charged at private hospitals, the shortage of specialist doctors and the dearth of facilities at public hospitals. Though expensive to pull through, transplant is cheaper in the long run and gives best quality of life.

Interlife programme

“Kidney transplant at high-end private hospitals in Nairobi exclusive of requisite tests and drugs costs Sh1.5 million. In India preferred by patients due to immediate attention costs Sh2 million. The same operation costs Sh300,000 at Kenyatta National Hospital,” explains Dr Were.

The specialist says the cost at KNH would be cheaper by as much as Sh50,000 if tissue typing to avoid rejection of a donated organ was done locally. Currently, the test is done in South Africa.

“It costs Sh70,000 to fly tissue samples to South Africa and back for the vital scrutiny. It would cost Sh20,000 to Sh30,000 if we had a recommended laboratory facility to do it locally,” he says. Were decries Kenyan laws governing kidney transplants, describing them as an impediment to moving forward.

“Our laws allow only living related transplants (transplants with kidneys donated by living relatives) as opposed to non relatives or cadaveric sources. Our law makers need to move with speed to change such archaic provisions to increase the availability of kidneys for deserving patients as happens elsewhere.

“The Government needs to increase the number of specialist doctors by setting aside money to train them instead of leaving the burden to individual doctors and those lucky to win scholarships from the much sought after International Society of Nephrologists (ISN). Currently the country has 20 nephrologists (physician kidney specialists) and 27 urologists (surgeon kidney specialists).

Dr Were who heads the renal unit at Kenyatta National Hospital hails Swiss multinational Pharmaceutical Company Novartis and Barcelona Hospital for teaming up with KNH and the University of Nairobi in the aptly Christened Interlife programme that has facilitated 110 transplants in the last four years.

Essential drugs

Under the five-year programme, Novartis subsidises post-transplant drugs essential in recuperation and brings over specialists from Barcelona twice a year to train local specialists and perform transplants.

The President of Novartis Pharma for Asia/Pacific, Middle East and Africa Rainer Boehm revealed while on a visit to Kenya recently that Novartis was partnering with Kenyatta National Hospital and expert surgeons in Spain to start a centre of excellence for renal transplantation in Kenya.

Were also lauds the Ministry of Health for a policy floated during the tenure of Prof Anyang’ Nyong’o that has seen dialysis facilities spread to referral hospitals. According to Were, kidney complications could be a result of many factors.

He says: “Causes range from inherited conditions such as sickle cell anaemia and permanent neo-natal diabetes to HIV and Aids, cancer, malaria, hypertension, untreated skin and throat infections to obtrusive diseases such as benign prostatic hypertrophy  (non-cancerous swelling of the prostrate gland).”