Target low-cost kidney care

Weighed down by the burden of loans he had taken out for the treatment of his mother, 17-year-old Abdul Mottalib came to Dhaka in 2007 in search of a job.

His migration from Sirajganj's Kazipur, an area hit by river erosion, paid off as he got a job at an Export Processing Zone factory in Savar and eventually repaid the Tk 2.5 lakh loan in the next four years.

By that time, his mother, who was having some lung complications, also got well after a successful surgery. Two years later, he got married and became a father.

But Mottalib's happy days did not last long. His world turned upside down after he was diagnosed with kidney disease towards the end of 2015.

Since then, his treatment has been costing him around Tk 18,000 every month, whereas his salary is only Tk 15,000. Earlier, the machine operator could work for some extra hours. But now, he cannot even complete his regular work hours.

“I tried hard but could not find someone who would donate me a kidney,” said Mottalib, now 27. He lives in Ashulia on the outskirts of the capital and has to go to the Kidney Foundation in Mirpur for dialysis at least twice a week.

Like him, many with similar stories go to the non-profit healthcare service facility every day. All of them dream nothing but to get better but struggle to continue the dialysis for financial constraints.

In such a situation, Dr Zafrullah Chowdhury, founder of the Gonoshasthaya Kendra (Peoples' Health Centre) is working to set up a non-profit dialysis centre at the Gonoshasthaya Nagar Hospital in the capital.

The aim of the centre, to be named Gonoshasthaya Dialysis Centre, would be to provide kidney patients with global standard dialysis and transplantation services.

Recently, Zafrullah, who also gets dialysis at the Kidney Foundation, shared with The Daily Star how the idea came to his mind.

“One day, I saw a patient crying at the Kidney Foundation. As I asked him what had happened, he replied he didn't want to live anymore.” 

The burden of his treatment cost had already become so heavy that his family could no longer continue the studies of his younger brothers and sisters.

Zafrullah said he talked to several other patients at the Kidney Foundation, and almost all of them were in similar condition, after paying high fees for the dialysis for months.

Later, he inquired about the dialysis fees charged by different private hospitals in Dhaka, and came to know that a hospital, on an average, charges at least Tk 3,000 for a four-hour session.

A kidney patient needing dialysis has to have two or three such sessions every week. Besides, he or she needs to have blood tests and erythropoietin injections. So, the monthly treatment cost ranges between Tk 40,000 and Tk 1 lakh, said the public health activist.

“This cost is too high and making the families of the patients almost destitute.”

After learning about the fees, Zafrullah, who is recognised globally for his contribution to Bangladesh's essential drug policy and community-based healthcare, prepared a report on the healthcare of kidney patients in the country.

Quoting official data, the report said 1.5 to 2 crore people in Bangladesh are suffering from chronic kidney disease (CKD),  caused by uncontrolled blood pressure and diabetes, scabies in childhood, nephritis in kidney, long-time and too much use of painkillers or variety of antibiotics, and not having enough drinking water.

 CKD turns into End Stage Renal Disease (ESRD). Some eight lakh people in the country are currently suffering from ESRD that requires either dialysis or kidney transplantation, Zafrullah added.

 As per Bangladesh's Organ Transplantation Act, 1999, a kidney transplant can take place only when the patient and the donor have blood relations, an issue that limited the scope for kidney transplantation.

On the other hand, most of the patients stop the dialysis after continuing it for about a year because of financial constraints, he said.

The cost is reasonable at the public hospitals, but the dialysis machines there “often remain out of order”. “Every year, 40,000 kidney patients die after failing to have dialysis.”

Taiwan, Japan, Iran, Canada, Cuba and the European countries have national health insurance schemes that cover the dialysis cost for patients there. Even in India, the cost of each dialysis session is less than RS 1,000, he said.

He said the Gonoshasthaya Kendra Welfare Trust had already approved 35,000-square-feet space inside the hospital for the Gonoshasthaya Dialysis Centre free of cost, initially for 10 years.

“We have already ordered 100 dialysis machines. All the preparation were going on at full speed. We are inaugurating the centre this March,” said Zafrullah.

Of the total patients to receive services at the centre, five percent would be from the extremely poor families, and they would get free dialysis.

Seventy percent of the patients, who would be from the poor families, would be paying just Tk 1,100 for each dialysis session.

Again, 20 percent of the patients from the middle class would pay Tk 1,500 while the rest would be giving Tk 3,000.

The centre, which is to remain open round-the-clock, will be able to conduct 400 to 500 dialysis every day. All the patients would avail erythropoietin injection for just Tk 600.

“The patients staying on the peripheries of the city will be given transport during the night only for Tk 100,” Zafrullah said.

Asked, he said they were mobilising funds given by individuals and institutions as donations to set up the centre.

“For capital investment, we needed Tk 30 crore. We have already collected Tk 18 crore. We are seeking assistance from businessmen in this regard,” he said, adding that around Tk 15 crore would be needed every year to run the centre.