Dialysis in Asia

Ask Our Experts Dr. John Agar, Nephrologist
1

I am on my way home from the Asia Pacific Congress in Seoul and, as I await my connecting flight to Hong Kong then on to Melbourne, I reflect on the problems faced by your fellow users and my fellow providers in the emerging giant economies of the world … the new leaders of the 21st century - especially those of India and China.

I was privileged to have been asked - among other talks - to present the Australian Healthcare System and, to be specific, how it funds renal replacement therapy.

As we argue and debate the frequency of blood tests - weekly (yet, in their context, why?) or 6-8 weekly (also, I am afraid, in their context, why) - or whether our teams take ‘enough notice of us’ or provide all that we (patient and renal team alike) feel that we are ‘entitled to’ … we should consider the plight of those few ‘fortunate’ patients and even fewer nephrologists in, say, India where the average national per capita income remains < US$1,000, yes - one thousand - and where only those able to afford (and clearly this is not the average citizen) can get.

It is sobering to be reminded that, in India, ESRD claims almost all who develop it … and few can or will access dialysis but die, untreated, of their disease.

We, in Australia, call ourselves the lucky country … and that we are … for we are blessed as is no other nation on earth (though maybe Canada?) by an equitable (for all), affordable (for it is free) and accessible (treatment for all who wish it and for any ailment from which they suffer) healthcare system.

Yes, it has cracks, stressors and imperfections … but even the US (and perhaps of 1st world countries, especially the US) cannot claim the equitability and access we enjoy.

That very equitability, access and affordable system we enjoy made me feel both humbled and, yes, guilty when the very next speaker - the father of Indian Nephrology Kirpal Chugh, spoke of his very different problems … and his personal comment to me as we shared a few minutes after the meeting was … ’ maybe God will help’!

So … as we argue (as we should) about the minutia of care … spare a thought for and some empathy with our fellow human beings on this planet who are not, as we are, all blessed by systems that care for us (imperfect as they may be) - for at least we have systems, have carers, have …

It was a powerful session - and I was privileged to be there. It made me think that a similar ‘plenary’ session at the ADC on the same topic and with a similar speaker profile might bring home to us, the lucky few, the plight of those elsewhere who struggle against insuperable odds, yet seem not to complain - just work for something better.

Perhaps Kamal may want to comment. I for one felt helpless (not a comfy feeling for me) in the face of their plight.

Kirpal is a speaker of great power and simplicity and, for mine, is an international nephrological treasure beyond par. More should hear his message.

John Agar
http://www.nocturnaldialysis.org

2

Hello Dr. Agar,

Yes, it is indeed a very discomforting feeling to know this. Yet,it is true. The vast majority of people in my country who need dialysis cannot afford it and simply die knowing fully well that they can live but do not have the means to do so. I know quite a few people personally who died because they could not afford treatment. My gut wrenches when I think about them.

This is a terrible truth facing people of my country.

There are efforts to minimize this that are on. I can think of two such attempts - Aarogyasree, a health insurance scheme started by the government of my state (province) where the state has tied up with a big insurance company to provide free health care - some limited but life threatening conditions are covered - to people who are below the poverty line. Twice a week dialysis and transplants are included in this scheme.

The second is a scheme by a Jain Religious Trust where they pay about 75% of the cost of dialysis and the patient bears the rest. This has also helped save a number of lives.

These attempts cover only a small number of the needy and that too only in a smll part of the country. We need these attempts to be on a much, much larger scale.

The problem in a country like India is that things like dialysis are much lower down the list of priorities. More immediate worries are food and shelter. For the government, for the social welfare organizations and indeed for the people themselves.

So, when people in Australia and the US talk about optimal dialysis and more frequent dialysis, this hardly makes sense here because we are struggling to provide even the bare minimum dose.

Kamal

3

Dear Kamal.

Thank-you for that response.

For readers who might like to get a measure of the services in some of the emerging nations in the Asia region, several country synopses (including my presentation of the Australian scene) can be found at the APCN Website on

http://www.apcn2010.org/

where , if one clicks on the flashing ‘Check the scientific program and presentation materials’ where there is a red flash on the home page and scroll to Day 4 Tuesday 8th June) and to the second session of the morning … OR, alternatively, go direct to Kirpal Chugh’s presentation pdf at

http://www.apcn2010.org/03_program/downlaodfile/0608/F_[S14-3]healthcare%20System%20&%20RRT%20in%20India-APCN.pdf

I also gave my good dialysis presentation at the meeting on Day 1 (Saturday 5th June) … in the 1400-1600 CME01 Hemodialysis session. You can locate the pdf either by going to the day by day program then scrolling to the 1400-1600 time slot or by directly using the following link to my pdf as is shown below

http://www.apcn2010.org/03_program/downlaodfile/0605/CME01/F_[CME01-4]%202010%20-%20APCN%20-%20Beyond%20KtV_5.6.10.pdf link

Finally, the 3rd talk I gave at the congress (Nocturnal Haemodialysis: Home is best) is at Day 3 June 7th at

http://www.apcn2010.org/03_program/downlaodfile/0607/[S11-3]%202010%20-%20APCN%20-%20Home%20is%20best.pdf

… while there are a huge number of excellent presentations you may wish to scan.

John Agar
http://www.nocturnaldialysis.org

4

Thanks so much for posting the links Dr. Agar. The site has some excellent material that is of great interest to us.

Kamal

5

Education appreciated!