Life in a Person’s Account

The High Cost of Dialysis Puts Patients Suffering from Kidney Failure in Jeopardy

Kidneys serve an important function for humans – they are the organs that purify the blood by removing waste from it. Kidney failure, therefore, is a serious condition for people who suffer from it, usually requiring costly dialysis treatment. In Ethiopia, there are only a few medical centres that offer the treatment – and of those who do, one session can cost anywhere from ETB985 to 2,530. For the country’s poorest patients, this could prove to be detrimental financially and some medical professionals are calling on the government to intervene and improve the situation. EBR’s Meseret Mamo spoke with medical practitioners and those close to the issue to learn more about what is being done to help make dialysis more accessible in Ethiopia.

It was seven years ago that Yusuf Abdulhamid, now 70, was diagnosed with chronic kidney disease, which requires dialysis, an expensive technique of cleaning blood by removing toxic substances. However, while undergoing dialysis, Yusuf started to think about those patients who are struggling with the disease with little or no money. This is when he decided to establish the Kidney Failure Dialysis Association, along with 48 other patients, to support each other three years ago.
Running out of financial alternatives for those patients who he supports, Yusuf rented out his villa and currently stays in the two-bedroom house he built behind his main house with his wife and four children. “Although the decision created discomfort for my family, it was the only way out,” Yusuf, who is president of the Association, told EBR in frustration.
However, Shimels Mebrate, 25, is not as lucky as Yusuf. Born to a poor family in the Aris Negele Zone of the State of Oromia, Shimels came to Addis Ababa in March 2015 to receive dialysis treatment. For the last six months, his family has done what they can to raise money for the treatment, even resorting to selling their property and borrowing from relatives.
“But now we are left with only one option: begging,” Shimels’s sister, Almaz told EBR. For this purpose, Almaz borrowed a camera to take his picture to prepare a banner to display so that people understand the problem her brother faced. This is a practice many do in Addis Ababa and other major cities to raise money from ordinary citizens. Almaz wants to begin fundraising as soon as possible. “He might not receive the service from now on if I don’t get the money quickly,” she said in frustration.
Suffering from chronic kidney failure is a financial doomsday in Ethiopia, especially for those who do not have easy access to finances. Currently, there are a few working dialysis machines in the country mostly in private hospitals. The price for treatment ranges from ETB985 to 2,530 per session. For a person with chronic kidney disease, going through dialysis at least three times a week is required. This means one has to have a minimum of ETB11,820 or a maximum of ETB30,360 per month to stay alive.
However, the financial burden does not stop here. At least ETB1,000 is needed to obtain a catheter, a device that will be inserted in the patient’s neck to enable the blood to go through the dialysis machine and return to patient’s body. Since the opening in the neck is exposed to infection, those who need dialysis for a longer period will have to pay at least an extra ETB6,000 for a hole that will be created surgically around the wrist.
The high cost of dialysis means kidney patients in Ethiopia are simply out of luck if they can’t afford treatment. Since government is not subsidising the enormous long-term cost of dialysis, patients who are in need of the treatment are forced to finance the costs themselves. To put this in perspective, a single dialysis session can cost up to USD115 and Ethiopia’s average household income stands at USD600 per year, meaning most people in Ethiopia can’t afford the three sessions a week that are required.
However, those private hospitals that run dialysis centres say the cost is justifiable. Tomas Gebremeskel, owner of the Tom Higher Clinic, came from the United States seven years ago through an invitation from the government. After a two-year of project assessment, Tomas decided to establish a centre with two dialysis machines with a capital of ETB500,000.00. Now, the clinic has 12 active machines that provide dialysis for 56 patients and 30 nurses who work in shifts. The dialysis centre provides services for 24 people per day.
When the clinic started providing dialysis services, it charged a maximum of ETB1,300 per session, according to Tomas. Within five years of opening, the clinic has made two price adjustments, which lowered the price to ETB985. He is planning further reducing the price to ETB700 per session. “I know millions can’t even afford ETB100 per session,” Tomas told EBR.
However, he argues that providing discounts is not as easy as it sounds. “A medical kit, which consists of different tubes and a distillation unit that will be used during dialysis, is expensive and will be disposed after a single use,” he explains. “There should be enough kits for at least a year’s consumption, to avoid the risk of an interrupted supply.”
The kit, which is imported from different countries, costs a minimum of ETB500, according to Tomas, who says the cost of transportation, tax, profit margins, added importers and administration expenses almost doubles the cost. “To avoid this, I always search where the cheapest kit is available. Initially, I used to import the kits from the USA and Europe, but now I import it from China, where relatively cheap kits are found,” Tomas told EBR.
Tewodros Agonafir (MD), deputy director and head of the nephrology unit at St. Gebriel’s Hospital, which charges the highest price for dialysis, however, says the problem is much more complicated for his hospital. “Most of St. Gebriel’s Hospital patients are the diplomatic community. We have an agreement with the Economic Commission for Africa as well as the African Union to treat their workers,” Tewodros explains. “For this reason, we import kits from Germany, where a respectable company is operating.”
Administrators of hospitals that charge the highest prices for the service claim that for the sake of maintaining standards, it is impossible to provide discounts. “It is about maintaining standards and we are not here to make the service accessible to the majority,” asserts Tewodros.
Although Tomas and Tewodros have different explanations, they agree on the need for government intervention to lower the cost of dialysis in Ethiopia. “The government should provide some privileges for hospitals and companies that import dialysis equipment,” argues Tomas. “This is because we are doing what the government should do for its citizens.”
Ten years ago, the government tried to establish a dialysis centre at Tikur Anbesa Hospital, one of the largest public hospitals in Addis Ababa. However, it stopped providing the service because of the lack of a continuous supply of dialysis equipment such as kits, according to Addis Tamire (MD), director general of a special secretariat at the Ministry of Health (MoH).
There are currently 18 dialysis machines at the National Kidney Transplant Centre of Millennium Medical College. The Centre was established three months ago at St. Paul Hospital. Of these machines, 12 are dedicated to patients who are awaiting kidney transplants and the rest are for patients with acute kidney diseases, which is emergency kidney failure that can be avoided after short-term dialysis treatment. So far 350 patients suffering from acute kidney disease received services at a cost of ETB500 per session, according to Adhanom Girmay, director of the National Kidney Transplant Centre. However, since dialysis needs to be done on a routine basis, government is now resorting to the option of kidney transplantations.
Patients like Yusuf, however, who are in the immediate throes of a medical dilemma, prefer to act by themselves rather than awaiting the government’s response. After the film ‘Lamba’ was produced and released by Anteneh Haile, a film-maker who was drawn to the topic of kidney failure after witnessing the sacrifices of Yusuf, a national fund mobilisation effort was initiated by the Kidney Failure Dialysis Association in order to commence the operation of a dialysis centre at Zewditu Hospital.
As a long-term solution, however, Tomas suggests that the government should consider the option of producing dialysis kits in Ethiopia, much like India, Pakistan and Egypt have done in the past. Adhanom agrees about the possibility of producing the kit in the country. “It is a pack of simple plastic tubes and a filter, which doesn’t require sophisticated technology.” EBR