By Dr Elias B
Managing chronic kidney disease in Africa is very challenging; Ethiopia is no exception.
Assume I am sitting in a clinic in Addis Ababa seeing patients with end stage kidney disease that require dialysis.
What do I tell them?
As you all know dialysis is a very expensive technique of cleaning our blood from the toxic substance that we all produce on a daily basis. Without dialysis eventually all patients with end stage kidney disease ( not acute kidney failure, that can recover) die unless they can get kidney transplant. It is a financial doomsday even in those who have access to dialysis.
The cost of one session of dialysis in the few places that is available in Ethiopia is as high as 1500-2000 Birr (about $100) which translates to about 4500-6000 Birr/week for the standard three sessions. That is a staggering sum of 18-24,000 Birr / month.
So would I tell them to sell their house, borrow money from families, and sell all their belongings to receive dialysis service specially knowing that it is not enough to sustain them for few months or even a year?
Now let us assume that you own a dialysis unit. Will you turn them down if they ask you to provide them with dialysis after they promised you with the money, knowing that they are going to sell their houses and perhaps use all family savings?
At the same time we see many affluent Ethiopians travelling abroad to get better health services. In fact health tourism is a huge source of income to many Asian countries. Thousands of Ethiopians do travel every year to these countries and spend significant amount of money to get all forms of cutting edge treatments.
For those people who can afford to travel abroad, availability of dialysis at home even if expensive is still cost effective. The challenge is these are the privileged few.
Who should then get dialysis?
Is it fair to draw the line between the few rich and poor majority?
Ethiopia is one of the fastest growing countries in Africa. The health services, particularly in areas of prevention, have showed improvement. I would like to bring the challenges of dialysis in Ethiopia to every one’s attention to draw upon international experiences and tailor it to national, epidemiological, social, cultural and economic realities, and provides guidance on identifying what actions need to be taken to address the challenges of caring for patients with end stage kidney disease in Ethiopia
Dr Elias is an Interventional Nephrologist currently practicing in Pittsburgh, PA ( USA).