Challenges of dialysis in Ethiopia

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).

About Tenayistilign

I am a physician trained at Jimma Institute of Health Sciences ( now Jimma University, in Jimma, Ethiopia) and Wayne State University ( Detroit, MI, USA). I teach and practice General Nephrology/Hypertension and Kidney Transplantation in the USA.
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13 Responses to Challenges of dialysis in Ethiopia

  1. Avraham says:

    Hello.

    My name is Abraham Tesfay, an economist who has been active in financing health care. I am currently working on a project on dylasis with my sister who is a dylasis technician. Our project aims to provide an affordable dylasis care to people who cannot afford the current cost of dylasis treatment in Ethiopia. What we have so far is a willing organisation to cover for equipment supply and training. To ensure this we still need to work on a plethora of issues ranging from financing operation cost including facility rent staff salary and maintenance. Also we need to cater for having a nephrologist who would be working with us in the project. If we can have the government willingness to fund the operation or if this can be met with the help of local or other international ngos then we hopefully could be able to help in a profound way in decreasing the cost of the treatment. As me and my sister are both currently residing outside Ethiopia anybody who is willing to help us in this regard could contact me on abrahambrh@gmail.com. my number is +27743345281

    Thanks.

  2. Prof Ahmed Halawa says:

    Dear All
    I’m Ahmed Halawa, Associate professor in transplantation and surgery of renal failure, United Kingdom. We are holding workshop in Cairo to train surgeons and nephrologists on the management of CKD-MB. The surgeons will be trained on the surgical technique of parathyroidectomy (hands on) and the nephrologists will be trained on the medical management.
    I’m looking for the contact address of the Ethiopian Renal Association to invite him (FULLY sponsored). Also for surgeons it will be subsidised subscription.

  3. haile says:

    dear DR Elias

    can any one sell or buy human organ as per the Ethiopian context ? for example
    blood , kidney ……

    • Adem says:

      Dear dr elias is there any way the goverment of ethiopia can do dialysis for free or ar affordaable,price for low income people i know its costly but with average salary of ethipians almost 85% of ethiopians can afford it

      • Adem says:

        Dear dr elias is there any way the goverment of ethiopia can do dialysis for free or ar affordaable,price for low income people i know its costly but with average salary of ethipians almost 85% of ethiopians can not afford it

  4. zelalem says:

    Dear Dr Elias
    I am an Anatomist in Debretabor University, one of the newly emerging universities in Ethiopia. I am proposing to conduct a study aiming at the arterial variation of the kidney on alive kidney donors in Ethiopia.
    If there is anything you can help me, please let me know. this is my mail zelalem.a01@gmail.com
    thank you in Advance!

  5. zelalem says:

    hello Dr Elias
    i am an Anatomist in profession in Debretabor university, one of newly emerged universities in Ethiopia. and i was planning to do some research on the possible anatomical variation of renal arteries which will be important in giving a base line information for the surgeon during renal transplantation, most importantly of an alive kidney donor. if you have something to say about it and help me you can contact me through my mail. zelalem.a01@gmal.com
    thank you in Advance!

  6. Yohannes says:

    Is there any incentive from the government to make it easier for investors to import dialysis equipments to Ethiopia?

  7. ABDU says:

    THANKS FOR THE TIMELY NEEDED INFORMATION. I AM A BROTHER OF CHRONICALLY ILL MAN IN ADDIS ABABA. I RECENTLY CAME TO ADDIS TO BE WITH HIM. HE IS ON A THREE DAYS A WEEK DIALYSIS PROVIDED BY A KOREAN CLINIC WHICH IS CONSIDERED HERE IN ADDIS AS THE BEST. COMING FROM WHERE I COME FROM, I FOUND THE PLACE TO BE LIKE A GARAGE RATHER THAN A CLINIC. IT LACKS ALL THE PROPER HYGINE EXPECTED. IT IS NOT NEAR WHAT I WOULD SEE IN THE COUNTRY THAT I RESIDE. TO MAKE THINGS WORSE, THE STAFF DO NOT SHOW ANY SORT OF HUMANE AND ETHICAL ATTITUDE TO WARDS THE PATIENTS AND THEIR ATTENDANTS. MY OBSERVATION ALSO TELLS ME THEY LACK THE TRAINING TO DO THE JOB PROPERLY.

    MY QUESTION IS, IF ONE CAN AFFORD TO GO ABROAD FOR THE THE SAME PROCESS, WILL HE BENEFIT FROM THE SUPERIORITY OF TECHNOLOGY AND PERSONNEL ABROAD.

    • Yewondwossen Tadesse Mengistu says:

      Dear Abdu,

      I am really sorry to hear about your negative experience at the dialysis unit of the MCM(Korea)Hospital. The hospital is possibly one of the better hospitals in Addis in terms of its facilities but not necessarily in its human resources.
      There are many private dialysis units in Addis none of which can be said to be optimal by American/ European standards BUT some are definitely better than others in regards to their facilities and human resources. The reason the MCM dialysis unit is preferred is because of its lower prices. It will be inappropriate for me to state here which facility I consider better than the others but you can make some enquiries and see for yourself what each dialysis unit in our poor town looks like.

      Kind regards,

      Yewondwossen

  8. I really like it whenever people come together
    and share opinions. Great website, keep it up!

  9. lW says:

    Hi Dr Elias thank you for sharing the reality. Do you think peritoneal dialysis could be a better alternative in terms of cost and technical issues?
    thanks.

    • Elias B says:

      Thank you very much! You have raised a very important question.
      Many African countries do practice peritoneal dialysis.The cost of providing the service depends on where the peritoneal sdialysis solution is obtained.In south Africa the cost of running hemodialysis is comparable to peritoneal dialysis.However there are other African countries who have relatively lower cost per patient.If the peritoneal solution is imported the cost is still going to be very high in Ethiopia .The best option in my view is to locally produce the peritoneal solution at home and this may minimize the cost.However the cost making or producing peritoneal dialysis solution at home should be thoroughly studied.
      Other important things we need to see includes; if peritoneal dialysis can be successfully started,it is easily done at home with minimum training and may save patients from higher transportation expenses.But the most important benefit could be that patient may not need to see a physician more than once a month.
      In general with the most recent epidemiological changes,we have to work on chronic kidney disease management and prevention of progression from DM and hypertension before patients end up on Hemodialysis.

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