Low access to dialysis threatens the lives, futures and incomes of patients in need of dialysis, our Staff Writer JAMES CHAVULA and Correspondent CHRISPINE MSISKA write.
Who cares about a caregiver when she needs care too?
Carol Kachilonda, a 30-year-old nurse at Mangochi District Hospital, kindly helps patients in agony, but the healthcare facility lacks tools to save her from a slow but familiar killer.
“I experienced kidney failure while at Mzuzu University. Since Mzuzu Central Hospital [MCH] doesn’t have a dialysis machine, I’ve to travel to Kamuzu Central Hospital in Lilongwe for the blood-cleaning procedure,” she narrates.
The 370-kilometre trip became “so hard and costly” that Kachilonda requested a transfer to the capital city and switched to night classes.
“Since June 2023, I’m supposed to attend three dialysis sessions weekly, but I’m limited to two sessions because KCH machines are not enough to support many of us,” she states.
Kachilonda finds the weekly hospital trips discomforting.
“It’s hard to sit in a minibus for hours. It causes breathing problems and excruciating pain,” she says.
Her situation personifies the plight of kidney failure patients outside the cities with the country’s few dialysis machines.
Dialysis removes chemical waste from blood when kidneys fail.
“When kidneys collapse, you cannot urinate. So, everything you eat or drink accumulates in the body. The ‘artificial kidney’ helps remove toxic waste from the bloodstream,” says Victor Makupe, who has been on dialysis since 2019.
However, only two public hospitals—KCH and Queen Elizabeth Central Hospital (QECH)in Blantyre—offer dialysis, pushing patients to costly private clinics.
MCH and Zomba Central Hospital (ZCH) have none, forcing patients from the North and East to travel beyond their regions.
Zomba’s dialysis dearth hugely affects Kachilonda, who commutes from Mangochi to Lilongwe every Monday and Thursday.
“This hasn’t been easy,” she laments. “I’ve since requested a transfer to be close to KCH.”
The gap in kidney treatment contradicts policymakers’ commitments to ensure everyone gets quality healthcare close—no more than five kilometres—to where they live and without financial hardship.
Secretary for Health Dr Sam Mndolo says: “Dialysis is a tertiary-level service—to be offered by central hospitals. The best we can do is to have all four central hospitals providing dialysis. Mzuzu will start very soon [later this month]; meaning three of the four central hospitals will have dialysis services.
“Secondly, we must remember that dialysis is supposed to be a stop-gap measure while awaiting kidney transplant.”
Kachilonda wants more support for kidney patients.
“If Mangochi or Zomba hospitals had a dialysis machines, it would have been easier to access the procedure and tests closer,” she states.
ZCH senior medical specialist Dr Rittah Pleasant Mario says dialysis provision in the old capital would help save patient’s lives and money.
According to her, the Eastern Region’s largest hospital recorded 12 acute kidney injury cases and 18 chronic ones between January and March.
“All acute cases needed dialysis, but we only referred two to QECH. All chronic kidney disease patients needed dialysis, but we did not manage to send them for dialysis,” she states.
ZCH receives critical patients from Zomba, Mangochi, Phalombe, Machinga and Balaka districts.
Mario observes: “These districts refer patients who need dialysis to Zomba even though there is no machine. They do so with hope that we’ll refer the patients to QECH. However, QECH [which serves the rest of the South], also has patients who need dialysis.
“QECH’s dialysis machine might be fully booked or down and Zomba might not have fuel to transport patients. At times, the patient is too critical to be transferred.”
QECH deputy director Zuze Kawale says the country’s largest hospital has five machines, but requires at least 15.
“It would be better if Zomba had dialysis unit. This will relieve pressure from QECH and it will serve patients from Mangochi, Machinga and Balaka and Ntcheu, which put more pressure on our limited resources” he says.
Health rights campaigner George Jobe says the life-saving machines should be available “not just in central hospitals, but in all the 28 districts”.
He told The Nation: “We are burying people not because there’s no treatment; but because they were born poor.”
Low investment in kidney treatment threatens promising futures.
The weekly hospital trips leave those who cannot afford dialysis in private hospitals a medical bill away from poverty.
“I pay K30 000 per trip, but the cost sometimes doubles with fuel scarcity. As a civil servant, my income isn’t enough for weekly hospital trips and drugs when KCH runs out of medication,” says Kachilonda.
Still, the nurse in agony serves other patients with a smile.
“It’s in my blood,” she says. “I’ve to clear my workload and it’s not very heavy.”
Kachilonda survives on a costly special diet dominated by light meals, fresh fish, white meat, fruits and vegetables.
“I no longer eat the food I used to enjoy and my parents’ household has changed what they eat to suit my diet. This breaks my heart,” she says.
The nurse juggles kidney treatment with schooling, hoping to serve her patients better and longer.
She says: “While balancing kidney treatment with my job and schooling, I have seen some patients with a similar kidney condition die and others falling even to walk. It’s hard.”
* Extra reporting by our correspondent Holyce Kholowa .
