Over 30,000 kidney patients in Nepal are at risk because the COVID-19 lockdown is preventing them from travelling to hospitals for regular dialysis. Stuck at home, many also are not getting regular supplies of vital medicines for their condition.
Some have died.
Nar Bahadur Sunar of of Kanchanpur needed regular dialysis, but the lockdown meant he could not travel to hospital because public transport was off the roads. His son in the Indian Army used to send him vital drugs from India, but even that stopped.
Sunar died on the day after New Year’s on 14 April.
In another village in this district in the plains of far-western Nepal, 24-year-old Anirudra Chaudhary has been getting twice-weekly dialysis at the Seti Zonal Hospital. But because of the lockdown, the dialysis is only performed on Mondays.
This means that Saturdays and Sundays are unbearably painful for Chaudhary as his legs swell, and he struggles to breathe. He has reduced immunity, and is afraid he might catch the coronavirus. His father Ghanashyam cannot bear to see his son suffer. “It is especially difficult to watch him as he struggles to breathe,” he says.
Over in Surkhet, Anita Raskloti has been receiving dialysis at home for the past four years, but she has run out of medicines because the government cannot provide them.
Laxman B K returned to Nepal from Saudi Arabia after his kidneys failed, and he has been living in Pokhara where he gets free dialysis at the Gandaki Regional Hospital. “There are now buses, and I cannot afford an ambulance, so I have to walk two hours to get to hospital,” he says. Even if the medicines he needs were available, he would not be able to afford the Rs5,000 per month cost because there is no income from his wife’s shop.
Although patients seeking medical attention are allowed to travel during the lockdown, the poorest patients cannot find transport, or cannot afford them. In addition, patients receiving treatment thrice a week have now been reduced to twice a week because the medical staff also cannot travel during the lockdown.
Although the government made dialysis free last year, it is not easy to get the service. There is a lot of paperwork needed from the ward office, District Administration Office, District Health Office, and hospitals have waiting lists. Only 57 hospitals in 20 districts provide free dialysis. But hospitals themselves are facing a shortage of medicines due to the lockdown.
Min Bahadur Bista from Kanchanpur has shifted to a rented room in Bhaktapur just to be close to the Shahid Dharmabhakta National Transplant Centre where he gets his free dialysis once a week. After every dialysis he needs a special medicine, which is now more expensive even when it is available.
“This lockdown is more difficult than the earthquake,” says Bista, who has been getting his dialysis regularly for the past five years. As if the treatment was not difficult enough, other patients have been forced out of their rented rooms because landlords are afraid they will bring the coronavirus from hospital.
In Dang district, Dilmaya Pun must reach the Community Dialysis Center of Lamahi twice in a week for her treatment, but her travel cost has increased from Rs30 in a public transport to Rs750 for the roundtrip by ambulance. She used to reach the hospital in a scooter, but police seized it for breaching lockdown rules.
“Every year, there are 3,000 new kidney patients who need dialysis, and there just are not enough facilities to manage this demand,” says nephrologist Santosh Gurung. There are more than 1,000 patients in Kathmandu alone who need treatment, and the difficulties they face have multiplied after the lockdown.
Half of the 54 hospitals designated for kidney dialysis are in Kathmandu Valley, and of the total 525 dialysis machines in the country 276 are in the capital. Some of the machines in government hospitals are not working. Of the ten machines at the Seti Provincial Hospital, only five function.
Kidney patients from Karnali Province are now referred to Nepalganj or Kathmandu due to lack of machines. Kathmandu’s hospitals have to not just treat patients from the Valley, but many from west Nepal.
Once a patient’s kidneys stop working there are only two options: a kidney transplant like the ones performed on Prime Minister K P Oli, or dialysis twice a week. It takes four hours to complete dialysis procedure, so the machines can treat only three kidney patients in a day.
This means there is a long queue, and hospitals cannot take on any additional patients because the machines are ‘booked’. In fact, a wait-listed patient gets a slot for dialysis only if the hospital arranges for additional machines, a patient gets a kidney transplant, or dies.
Photos: NIKHIL ACHARYA
Hospitals are even reducing the four-hour dialysis to three hours, just so they can accommodate more patients. Most patients cannot afford transplants, so they have no option but to get regular dialysis.
There are 170 kidney patients are waiting their turn at Sahid Dharmabhakta National Transplant Center, 130 at Bir Hospital and 216 at TU Teaching Hospital. While the patients wait for new openings, they have to go to private hospitals where the service is supposed to be free but often is not.
Patients in the Tarai who used to go to Indian hospitals for dialysis also cannot go now because the border has been sealed for a month.
Mohan Joshi, from Kanchanpur is staying in Bareli in India after the lockdown just for his dialysis. “I want to be close to the hospital, but it is hard to survive and I am running out of money,” he said over the phone.
For Jason Sigdel from Khotang who has been taking care of his father undergoing kidney dialysis in Kathmandu, the lockdown has become a life-or-death issue. He says: “Poor kidney patients staying in rented rooms in Kathmandu are suffering the most. There are no medicines, and no more money.”
Center for Investigative Journalism Nepal.
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