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Nepalis must travel to India for transplant |
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 |
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.
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