National dialysis project, the miracle Kenya needed in renal care

Six years ago, a retired engineer drowned in his own body fluids. His kidneys had failed due to hypertension and, over time, and with money hard to come by, he could not afford care in private hospitals.

The only public centre for dialysis, Kenyatta National Hospital, was a mess. In a country of 40 million people, about four million of whom have bad kidneys, there were four dialysis centres in the whole country. And the treatment must be carried out twice or thrice a week.

It was not unusual for the dialysis centre on the ground floor of Kenyatta National Hospital to look like a political rally, with desperate patients, their bodies full of toxins, fighting for woefully inadequate life-saving treatment.

Priority was given to those whose condition was bad, so patients took to poisoning themselves by eating foods which would push them into collapse so as to jump the queue.

If you lived in Moyale, 776 kilometres from the nearest dialysis centre in Nairobi, and with bad, sometimes banditry-prone roads, you had two choices: move to Nairobi, or die. And if you were vulnerable, either because you were poor or a retiree on a fixed income and couldn’t afford to live in Nairobi, you, of course, died.

But even for those who lived in Nairobi and were too frail to fight in the queues at Kenyatta, private hospitals were a tall order, costing at least Sh80,000 a month. Dialysis was not insurable and the National Hospital Insurance Fund only catered for a fraction of inpatient costs. Kidney failure for vulnerable groups was a — sometimes suspended — death sentence.

REQUIRE DIALYSIS DAILY

Kenya had only one dialysis centre at KNH between 1978 and 2002, when four more were established in Nakuru, Kisumu, Mombasa and Eldoret. Huge numbers of patients required services at those centres. An estimated 10,000 Kenyans require dialysis daily, and only 10 per cent of those can be treated.

The retired engineer couldn’t keep up with the costs. So he resorted to esoteric alternative treatments, such as herbs and prayers, but of course these could not clean the toxins that were building up in his body.

Finally, he had so much fluid in his lungs that he had to sleep sitting upright in an armchair, like a Bukusu chief in his grave. When his condition became too bad and he was rushed to Kenyatta National Hospital, the orderlies, unaware of his full lungs, placed him flat on his back in a stretcher and he drowned.

“A critical part of healthcare was completely neglected,” said Ms Mary Matu, a US-trained public health expert whose firm has built and is in the process of commissioning 44 renal units in the country. “Our intention is to ensure nobody ever need die again, however poor, because of failure, either from distance or cost, to access renal care.”

TEST OF INTEGRITY

The Managed Equipment Services scheme, announced in 2013, has come up for various criticism, from the way it was contracted to the value-for-money proposition for a lot of the equipment. The same ministry procured containers for use as clinics and a lot of the other procurement will probably, in the long run, not stand the test of integrity.

But the dialysis programme is the gold standard in that project, eventually providing state-of-the-art equipment to all 47 counties, 20 of which are already being used for treatment.

“We have been slowed­ by training of staff. More than 200 nurses have already trained. By the end of the year, all the centres will be dialysing,” said Ms Matu.

The jolly University of Alabama and Havard graduate, with decades of health management locally and abroad, will run the programme for seven years.

Coupled with the provision of equipment, NHIF has also worked a small miracle by paying for treatment in whatever hospital a patient attends, whether public or private. Many county governments have also bought their own renal equipment, while leading companies, such as Safaricom and Kenya Commercial Bank, have provided funds for equipping other hospitals.

The cumulative effect is the availability of equipment, and therefore treatment of kidney patients at no cost in nearly every part of the country.

Had that engineer survived to this year’s World Kidney Day, which will be marked on Thursday, he would have led a long, normal life. That is truly a miracle.