Govt runs three dialysis centres, 63 machines

Chronic kidney disease and related complications has emerged as one of the leading causes of death in Uganda.

Despite this, most public health facilities have neither the equipment nor specialised personnel to help deal with the increasing number of kidney-related complications.

The government has only one dedicated dialysis centre with three machines across its 15 regional referral hospitals, meaning all other cases of chronic kidney disease in the country can only be handled at the country’s national referral hospital at Mulago in Kampala and Kiruddu, its affiliate.

This means the government runs only three dialysis centres dedicated to the treatment of chronic kidney disease.

But the Health Ministry spokesperson, Mr Emmanuel Ainebyoona, says the situation is not as pathetic.

He says the kidney treatment centres at Mulago Specialised Hospital has 26 Haemodialysis and four Continuous Renal Replacement Therapy (CRRT) dialysis machines.  He also says Kiruddu National Referral Hospital has 30 dialysis machines; and Mbarara Regional Referral Hospital with three dialysis machines.

This would place the total number of functional dialysis machines in public hospitals, excluding those in private health facilities, at 63.

Nevertheless, Dr Peace Bagasha, a specialist in kidney diseases based at Kiruddu, says Uganda has only 13 kidney specialists in public hospitals, with 10 of them based in Kampala.

“All other regions of Uganda except Kampala and Mbarara have no specialists,” Dr Bagasha tells Sunday Monitor.

A local non-government organisation, Training Health Researchers into Vocational Excellence in East Africa (THRIVE), lists kidney disease as the 13th leading cause of death in Uganda.

10-15 million Ugandans affected

Dr Bagasha says whereas the extent of kidney infections has not yet been quantified, it is estimated that one in every five Ugandans has abnormal kidney function, which means between 10 and 15 million Ugandans could be affected.

But she hastens to add that most of the cases are still in early stages and could be stopped from advancing if the country is equipped with the necessary medicines and specialists.

“Many of the infections are mild, requiring major renal replacement therapy and dialysis. People who come with advanced disease usually end up requiring transplants or dialysis, which are very expensive,” Dr Bagasha says.

Despite this alarming situation, the president of the Uganda Medical Association (UMA), Dr Sam Oledo, says: “Whereas Kiruddu and Mulago are deemed to be in central region, that is a national referral hospital and is the only public facility that has dedicated dialysis centres.”

This implies there is no available dedicated public dialysis centres outside Mulago for nearly 12 million people in the central region, about eight million people in northern Uganda, and slightly under 12 million people in eastern Uganda.

That would put the total number of dialysis centres in public hospitals in the country at only three, a figure which, Mr Ainebyoona, disputes. He mentions Mengo, a Protestant Church-run hospital, as one of the facilities equipped with dialysis machines.

Sunday Monitor established that other private hospitals, including International Hospital Kampala, Nakasero and Case hospitals in Kampala, also have them.

Even then, this would not change significantly the number of dedicated dialysis centres in a country with an estimated population of 45.74 million people.

Even for the western region, which has a dedicated dialysis centre at Mbarara Regional Referral Hospital, it means the centre caters for a population of about 12 million people.

The Mbarara unit, which was set up in 2018,receives patients from mainly western region.

Dr Rose Muhindo, a physician at the facility, said they treat about six patients in a week.

Dialysis machines are required to filter the blood of patients to remove excess water and waste products when the kidneys are either dysfunctional, damaged or missing.

The kidneys are termed dysfunctional, damaged or missing once they lose their natural ability and capacity to remove waste products from the body and maintain the requisite chemical and fluid balances.

The situation is deemed to have become chronic when the kidney’s natural function is lost over a period of time.  The person then requires hemodialysis.

According to the website, www.medicinenet.com, during the process of dialysis, blood is diffused with a saline solution called dialysate and the dialysate is in turn diffused with blood. The cleansed blood is returned to the patient once the filtration process is complete.

Pain of managing kidney patient

While national prevalence figures were hard to come by, the World Health Organisation places the global estimate at around 13.4 percent of the world’s population, while patients with end-stage kidney disease is anywhere between 4.9 and 7.1 million.

However, while speaking at the funeral of Ms Florence Kyeyamwa in Bulalu Village, Luuka District on Tuesday, Mr Daudi Migereko, a former minister for Lands and Urban Development, who was also the MP for Butembe County in Jinja District, suggested that the local prevalence might be very high, which has triggered a scramble for access to the few available dialysis clinics.

“People are forced to wake up as early as 3am and set off for Kampala as early as 4am just to be some of the first persons in the queue. But even when they get there, the dialysis sessions sometimes take up to four hours. For some people, this has to be done twice a week. That inadequate sleep and shuttling between Jinja and Kampala, does not help the healing process. We must bring treatment closer to these people,” Mr Migereko said.

The former minister’s comments arose out of a speech in which one of the deceased’s sons, Dr Herbert Kyeyamwa, said their mother had at some point required dialysis treatment, but failed to access it due to lack of a dedicated dialysis centre in Jinja.

The solution, Mr Migereko says, is the placement of dialysis machines in all regions to help reduce the inconveniences and costs that those with kidney complications are suffering in order to access treatment.

Cost of Treating kidney disease

THRIVE, an NGO, states in a post on its website that the cheapest dialysis treatment can be obtained from Kiruddu hospital in Kampala.

“A patient is required to pay between Shs1m and Shs2m at the start, and a minimum of Shs160,000 per week for the rest of their lives, excluding money for medications or laboratory tests,” the blog says.

But Health ministry spokesperson Emmanuel Ainebyoona defends the decision to charge kidney patients.

“Dialysis is a highly specialised service. The equipment is not cheap and also the treatment requires a number of usables,” he says.

The lack of dialysis machines in most public regional referral hospitals now means patients from eastern Uganda have to make journeys of between 70kms and 336kms in order to access treatment clinics in Kampala.

Patients from, for instance, Nwoya or Oyam districts, which are the closest points to Kampala from northern Uganda, have to make journeys of about 331kms, while those from as far as Moyo make journeys of more than 400kms.

The president of the Uganda Medical Association, Dr Sam Oledo, says it would be difficult for a patient who travels such long distances to stay alive. The solution, he says, is to take services closer to them.

“We must have dialysis machines, functional X-ray machines, ultra sound machines and CT scans at sub-region level. If we cannot have them at sub-regional level, let us have them at regional level, knowing that a patient will not be driven more than 150kms to access them. But imagine a patient being driven 300kms! That person cannot survive,” Dr Oledo says.

Mr Ainebyoona, told Sunday Monitor that plans are underway to ensure dialysis can be done at most regional referral hospitals.