No to kidney failure
Swetha Kannan
Prevent kidney failure at Rs 15 only… the Kidney Help Trust shows the way at a small village near Chennai.
For Srinivasan, life has been a bumpy ride for the past seven months he suffers from chronic renal failure and has been on dialysis ever since. His blood pressure is erratic and his urine output is low, as he is on a strict diet regimen not too much salt, water or other fluids.
Three days a week, this 38-year-old goes to a Chennai hospital for dialysis. Each session, which lasts four hours, exhausts him and, he says, “upsets my work schedule.”
The routine also comes with a big price tag. At Rs 800 for each dialysis session, his monthly expenses come to around Rs 12,000, including the cost of medicines. He is scheduled for a renal transplant soon which will cost him a few lakh rupees. “While I somehow manage the funds, the treatment is indeed beyond the reach of the common man,” says the man who works in a private firm.
Apart from the physical and financial strain, the entire process is also mentally stressful. “When I was detected with kidney failure, I was told that I was close to slipping into coma. There were days when I felt really low. However, I have managed to pull through, but not without the support of my family. My employers too have been kind,” he says gratefully. It’s much more difficult, however, for many others. The worst affected are those who cannot afford treatment and no support system to fall back on. Chennai-based Dr M.K. Mani, a leading nephrologist, says dialysis costs between Rs 15,000 and Rs 20,000 a month. Transplantation costs around Rs 3 lakh and requires medicines priced between Rs 10,000 and Rs 1 lakh a year. The majority of Indians cannot afford long-term dialysis or transplant, which present a “lopsided cost equation”. In fact, it is estimated that only 3 per cent of Indians with chronic renal failure (CRF) are under treatment.
Prevention is better…
Prevention is perhaps the only viable alternative, he says. Eight years ago, Dr Mani with a group of doctors, as part of the Kidney Help Trust’s (KHT) initiatives in Chennai, pioneered a rural outreach programme in Sriperumbudur taluk, with the single aim of prevention. And today, this low-cost effort has paid off, with statistics indicating a fall in the incidence of kidney failure in this taluk. What’s more, a neighbouring area is waiting to adopt this model and see similar results.
While 33 out of 1,000 persons show below-normal kidney function in the neighbouring town of 21,000 people, the area covered by KHT (population of 23,000) has only eight affected persons per 1,000. “A small expense” has gone a long way in preventing nearly 75 per cent of CRF incidence.
Detailing the causes of kidney failure , Dr Mani says these include diabetes and hypertension, accounting for 30 and 10 per cent respectively in India. It has been proved that by controlling these two conditions, one can protect against damage to blood vessels and, therefore, to the kidneys. Also, since hypertension accelerates the decline in kidney functioning, good control of BP will give patients more years of healthy life, he says. The preventive programme involves simple measures, starting with a survey conducted by social workers usually girls from the area trained in basic healthcare.
Questions cover symptoms such as swelling of feet, difficulty in breathing, pain while passing urine, blood in the urine, and frequent urination. A urine test is used to check for sugar and protein; BP is recorded for those over the age of five.
Those with any of the complaints mentioned above and with high BP over 140/90 and blood and urine sugar are examined by doctors from KHT.
Prevention involves control of BP and diabetes through cheap but effective medicines that are provided free of cost by KHT.
This model was taken up in 26 villages in Sriperumbudur taluk. The demographics of the population were mapped and everyone screened once in 18 months. Ninety per cent of the population co-operated with the survey and only 30 per cent was previously aware of their disease. The survey revealed that 7.5 per cent of those examined needed help.
Among those who co-operated with KHT for treatment, blood pressure was controlled to ideal levels in 96 per cent, sugar levels brought down to normal in 52 per cent, with another 25 per cent showing some improvement.
The whole regimen costs just Rs 14.23 per person per year (excluding the cost of the tests which are done free of cost by Apollo Hospital, where Dr Mani is the chief consultant). “Something that can easily fit into the Government’s budget… It can be incorporated in health programmes using existing staff,” says Dr Mani.
He adds: “I have developed a protocol and demonstrated how it works. I now want others NGOs, institutes and perhaps even the Government to reproduce the same.” He also wants villages to “put in money” to make the programme self-sustaining.
Meanwhile KHT will continue this project. Dr Jan J. Weening, President, International Society of Nephrology, who observed the working of the project in the designated rural area, stressed the need for coalition in such endeavours. “It is important to involve all medical specialities, particularly health insurance, which is a major player in healthcare,” says Dr Weening.
Prof John Dirks, who has chaired the Society’s Commission for the Global Advancement of Nephrology since 1994, had also visited the area. He places great faith in public health enterprise. “Community-based studies have special outcomes. People here (in villages) seem to understand the problem, as their personal lives are greatly affected,” he says.
Link: http://www.thehindubusinessline.com/life/2005/03/25/stories/2005032500190400.htm