I need your guys help!

My name is Farruh i am from Uzbekistan Samarkand city, now i lived for 4 years in NYC Brooklyn, my sister shes name Nilufar she is transplant, we did transplantation in Moscow Russia, now after 5 years she is in bad condition she is kidney stop working and she need transplant or HD. So my question is if she came to US, NYC is it possible to get free or low cost HD in NYC, or second if i bye this mashine to get a HD at home hove much does it cost and where i can buy this, if so than i need to transport to my country…or there is another way to done all this problem, yes it is a problem because in my city we dont have good helth care system. Thank you for your consideration.

Dear Farruh

I am so very sorry to hear of your sister’s sad situation and wish I could be more help to you than the meagre suggestions that follow.

As an Australian nephrologist, living in Australia, I really have no clear idea of whether there are any services in NYC that might be able to provide ‘free or low cost HD’ for an Uzbeki lady who is not a U.S. citizen. However, I must say that I am rather pessimistic that you would find any to take her in to their program.

That said, I will ask Dori Schatell and Beth Witten at Home Dialysis Central - which IS a US-based organisation - to answer you far more accurately that I can, as they have a much closer knowledge of the US healthcare system than I do. But, I wouldn’t want to get your hopes up too high.

As regards machine purchase in the US to then return with it to Uzbekistan in order to provide dialysis there, this has problems too - and it goes far beyond just the purchase price of a dialysis machine. Indeed, the machine is much the smallest of the costs … the main expense (and complexity) comes from ensuring the ongoing supply of consumables, the lines, the dialysers, the fluids, and above all, the back-up supports needed for successful HD. In addition, a dialysis-aware medical and nursing care with full dialysis know-how would be needed back in Uzbekistan to achieve successful dialysis there once you had returned with your US-bought equipment.

That said, haemodialysis is certainly available in Tashkent, Samarkand and some (but not all) regional Uzbeki centres. But, as Tashkent and Samarkand are up the very eastern end of what is a very large and ‘east-west wide’ country, if Nilufar is not living in Samarkand but rather at the western end of your country, this might introduce a transport problem to overcome, too.

If your sister is medically able to have peritoneal dialysis, this might just be a more supportable option locally in Uzbekistan and may be the better way to go. Of course, I have no way of knowing this, but it would be worth making some enquires in Tashkent or Samarkand re the availability of peritoneal dialysis as well. Certainly, there is less equipment required, and - as I understand it - at least Baxter supplies to Tashkent.

In 2013, the following excerpt from ‘Uzbekistan Today’ quotes:

"Anvar Zufarov, director of the Tashkent Nephrology Center … [NB: the article said ‘Neurology’ but I suspect it meant ‘Nephrology’] … commented on the development of the organization and the use of its experience in improvement of dialysis service.

  • Recently the center has bought four hemodialysis machines. They helped to improve the reliability of our service. It is very important because the patients who receive treatment with the use of this equipment are mainly those who only have one alternative – kidney transplantation.
  • It means, the center is the largest dialysis service in the country.
  • It is the only medical institution in the country that has 20 hemodialysis machines and [the center] performs 21% of all dialysis procedures in the country.
  • Experts say that the experience of the center is [being] used [today] to develop dialysis services in the regions of the republic.
  • Last year, all regions received the multi-function dialysis devices with new water purification systems. And this kind of equipment was installed for the first time in the regions."

So, Farruh, it seems certain that, at the least, haemodialysis IS available locally in Uzbekistan and there certainly is a fully developed Nephrology Center in Tashkent. Have you been in touch with them?

That said, clearly haemodialysis services do still remain very limited in Uzbekistan - not only in Tashkent and in your home city, the fabled Samarkand, but to an even greater extent in regional and rural Uzbekistan.

As for PD, I am reasonably confident that PD is well established there. As I have said, this may be the better way - especially if she has not had any major abdominal surgery other than her Moscow transplant 5 years ago. It’s worth following up.

To be honest, my best guess is that she may do better seeking care at home in Uzbekistan than trying to get care within the largely corporate systems of America. I know that here in Australia, dialysis - beyond brief ‘holiday’ dialysis - for patients who are not Australian citizens or accepted immigrants awaiting full citizenship is very difficult to achieve - if at all - under the free-healthcare-for-all system we enjoy here. I am afraid that I suspect you may get a similar ‘message’ from the US authorities too. I know that sounds harsh, but it is the reality.

I don’t know whether that has been of any help, but, look out for a follow up comment from Dori or Beth as to the likelihood (or not) of getting free or low cost care for her in NYC.