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Nepalis
must travel to India for transplant operations
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Nine
months ago Dr. Sunil Chakradhar received a kidney in the Madras Medical Mission
in Chennai, India. He is just 29 years old.
Studying
medicine in Bangladesh, he had never imagined that he would not be able to
practice medicine, a dream he had tamed since childhood. His ambition in life
was shattered to pieces when doctors advised him to keep away from hospitals.
They feared he might get infected in hospitals.
While
doing his internship in Kathmandu, he had a brief period of high blood pressure
that seemed to be the cause of his kidney failure. Although he was never
diagnosed a renal failure patient, his doctors advised him to undergo renal
transplant surgery.
Organ
Trader Behind Bars
He
was lucky to find a donor. Hari Narayan Tamang, the man who arranged a donor for
him, has been in police custody since May 4 of this year. He is being held for
having been involved in selling human organs, a crime according to the Nepali
Act adopted five years ago that objects to the sale of human organs for
transplant.
Donating
one’s organs has not begun in Nepal and India like in other developed
countries. The problem that a kidney patient faces is that only relatives may
receive live organs in Nepal and India, whereas in all actuality, 99 percent of
kidney transplants take place outside the family.
If
proven guilty, Hari Narayan could be imprisoned for up to five years. He may
also be asked to pay a fine of US dollars 6,667.00 (half a million Nepali
rupees).
A
donor himself, Hari Narayan has confessed to the police of having convinced over
50 people to sell their kidneys. Hari Narayan has arranged donors for several
important people including famous writers, teachers and even a Senior
Superintendent of Police in Kathmandu. Photographs of 54 people, medical
prescriptions, contact addresses of various hospitals in India and lab reports
were recovered from his room.
Nepal’s
High Costs of Treatment
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It
is extremely expensive to find the perfect kidney match
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Dr.
Chakradhar and other kidney patients say that in India there are around 50
hospitals that conduct transplantation surgeries. The competition among them is
so intense that they offer commissions to kidney brokers to encourage them to
bring more cases to their hospitals.
Dr. Chakradhar is, however, thankful for the good work done by his surgeons. He
now lives like a normal individual on the strength of strong immunosuppressants
that cost him a minimum of US dollars 300.00 every month.
"I
did not do tissue matching tests because they are expensive, not available in
Nepal and doctors say that after around 200 tests, chances are that one will
match with your tissue type," said Dr. Chakradhar. "Even in the case
of twins, the tissue match is not 100 percent, so the doctors themselves advise
only for lymphatic tests that must be negative in addition to some other
standard tests required for transplantation."
A
doctor on the lookout for a job, he has difficulty meeting his medical expenses.
His major worry is finding a job.
There
is no saying about the problem that an ordinary person faces once they have a kidney problem. But there are a few things that
the government could do
to help them.
"If
Nepal directly imported these medicines, then they might be cheaper for
us," he says.
Jawar
Kumar Rai agrees, a former British Gurkha soldier who now teaches in Kathmandu
and a kidney patient who had kidney transplant surgery performed in another
hospital in Chennai, India.
Nepal
currently imports US dollars 105 million worth of medicine from India. The
immunosuppressants top the list of expensive medicines that are imported from
India but not manufactured by Indian pharmaceuticals themselves. If imported
directly from the country of origin, the medicine would be cheaper.
The
story is the same for hundreds of other Nepali kidney patients who have to
either sell their houses, land, or use their provident funds and wives’
jewelry to meet the high costs of treatment.
Nepali
Doctors Reach Out to the Poor
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Dr.
Kafle is concerned about the Nepali government’s negligence |
One
not-for-profit Nepali foundation dedicated to health services, however, provides
some relief to a few poor patients. The National Kidney Center (NKC),
established five years ago by the Health Care Foundation-Nepal (HECAF-Nepal),
provides some free haemodialysis sessions to those who finish all their wealth
and may die if dialysis were not available to them.
"I
can't let people die in front of me, so we provide free dialysis sessions to as
many poor patients as our meager resources allow," explains Dr. Rishi Kumar
Kafle, Nepal's top kidney specialist and Medical Director of NKC. "We are
not a rich institution but we hope to bring some innovative programs in the
future to help needy patients."
"We
thank our paying patients because of whom we are able to meet the high cost of
running the Center," Dr. Kafle added.
NKC
is housed in rented premises. The cost of electricity and water, the most
important components to run the dialysis, is extremely high.
"We
have not received any help from the government," said Dr. Kafle.
Dr.
Kafle is not alone in complaining about the negligence of the Ministry of Health
in kidney treatment in Nepal. Hundreds of patients share the same opinion.
The
Ministry of Health does not even have any statistics of Nepalis’ renal
problems. NKC sources say they have recorded 2,200 new patients every year since
they came into operation five years ago. This is an alarming figure for
Nepal.
Thanks
to the donation of some philanthropists from Germany, the dialysis facility at
NKC has increased from five machines to 15. NKC is the only facility available
where there is a separate dialysis room for Hepatitis B, C and HIV/AIDS
patients.
"We
reuse the dialazet, the artificial kidney, for the same patients for a couple of
times to reduce the cost of dialysis," added Dr. Kafle. "For Hepatitis
B, C and HIV/AIDS patients everything is changed and the machine is disinfected
after each session."
According
to the specialists, dialysis is not a long-term solution for renal failures.
They advise their patients to go for a transplant as soon as possible because
dialysis is an expensive treatment. In one year, a patient spends around US
dollars 6,667.00 for dialysis alone. They will need extra money for medicines.
The
cost of a renal transplant is around US dollars 12,000.00 (Nepalis rupees
900,000.00) in India, which may go up to US dollars 20,000.00 (a million and
half Nepalis rupees). The doctors at NKC say that only around 35 percent of
their patients have sought transplants. The rest continue to avail the dialysis
service and they have seen a 40 percent rise in patients coming for dialysis
over the years.
For
the patient willing to go to India for transplantation surgery, kidney surgeons
in Nepal provide a recommendation letter to the hospital that they plan to
visit. Kidney brokers, without whom it would be impossible to get a donor
and the treatment, organize all the necessary fake documents to the patients.
The surgeons are aware of this, the patients say.
"For
the past 15 years, I have strengthened transplant facilities in many Indian
hospitals as I have sent over 100 patients to them by now," said Dr. Kafle.
"Thank God we have an open border with India."
Nepal
Desperate for Transplantation Expertise
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The
way renal disease is increasing in Nepal, soon there won’t be enough
dialysis facilities for them all |
Dr. Kafle opines that the way renal disease is increasing in Nepal, soon there
won't be enough dialysis facilities for them all. He says transplants are the
best option and Nepal should start them as soon as possible.
"If
we could set up the facility and start transplant operations in Nepal, the cost
will go down to US dollars 2,667.00 (Nepalis rupees 200,000.00) and the patient
and his family members will be saved from the additional burden of
traveling," said Dr. Kafle.
However,
the government is against the idea of granting permission to private nursing
homes and Centers like NKC to operate in the near future.
"There
are only 10 nephrologists and they are not trained to do transplantation
surgery," Dr. Jyoti R. Shrestha, Senior Public Health Administrator at the
Ministry of Health shares his concern. He feels that there are not enough human
resources, trained doctors, and middle level nursing staff to support the
transplant operation.
"It
would be a criminal offence on the part of the government to allow them to
operate under such conditions," said Dr. Shrestha.
According
to Dr. Shrestha, the government is planning to start kidney transplants some
time this year in Bir Hospital, which has been made a focal point for kidney
disease in Nepal.
The
government is in the process of sending two nephrologists and a urologist for
training in Thailand. Other doctors and nurses are going to the All India
Institute of Medical Sciences (AIIMS). The government is getting some
instruments and is in the process of installing them.
Contrary
to what Dr. Shrestha’s beliefs, kidney specialists like Dr. Kafle are
confident that if given the opportunity, they will be able to create all the
necessary facilities to start kidney transplants. He opines that instead of
blankly refusing to allow them to begin transplant surgery in Nepal, the
government will do well if they fix certain practical standards.
"We
should not look for what they do in Germany or in the US, but we should see what
could be done in Nepal without compromising the health of the patient, "
says Dr. Kafle.
This
is a concern that kidney patients and their relatives have been voicing over the
years. Transplant operations in Nepal will save them and the government lots of
money. They will be saved from the additional trouble that they must face in
Indian cities. They also voice their concern that they should receive
concessions in medicines and transport as in India.
Prakash
Khanal is a Nepali science and environmental journalist and former
editor of RONAST Science Features as well as General Secretary of the Science
Writers Association of Nepal. You can reach him at: freeway@mos.com.np.
