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The novel coronavirus disease (COVID-19) outbreak and the nationwide lockdown enforced to curtail it has had a big casualty — delivery of non-COVID-19 critical medical services, including dialysis.
Dialysis units and centres have been shut or converted into COVID-19 facilities to deal with increasing patient load. In most cases, hospitals and medical colleges are being told to take dialysis machines and set them up elsewhere.
Even a minute change in the frequency or routine of dialysis can lead to medical complications, unless it is done in consistent and close supervision of the nephrologist.
Take the case of forty-five-year-old Narayan (name changed). The hospital he was admitted in asked him to move to another place on March 30.
“For five days, I visited almost every government and private hospital in and around my city. I am also Hepatitis C positive. My body was swollen and I started developing breathlessness. Finally, a hospital accepted me as an emergency case,” said Narayan.
He used to pay Rs 1,080 for one session at the medical college; he now pays Rs 2,000.
The first dialysis he undertook in emergency cost him Rs 3,500.
Many government hospitals and medical colleges have been converted into COVID-19 hospitals, according to Varun Kumar B, a nephrology consultant at Pinnamaneni Siddhartha Medical College in Vijaywada, Andhra Pradesh. His hospital was no exception.
“We received a government circular on March 30 and were told arrangements will be made to shift dialysis patients. However, since the dialysis units of government hospitals were also shut, most private hospitals and nursing homes were full. More than 200 patients, including 55 from our medical college, had to be relocated. It was horrific,” he said.
There are several more patients like Narayan.
Gurutej Singh (named changed), 66, drinks water only thrice a day, mainly to gulp down his medicines. His wife closely monitors his diet, which he has cut down to half.
Singh has been on dialysis for almost two years. He is used to hospital visits thrice a week for haemodialysis. But the routine took an unexpected turn three weeks ago.
“We were informed by the hospital that it was reducing the frequency of dialysis. We go to a charitable hospital in Delhi’s Civil Lines area since we cannot afford private care,” Singh’s wife said.
She added that her husband developed breathlessness and major discomfort the first few days of not getting dialysis at the regular frequency. Then he cut down his water and food intake to cope with the situation.
Kidney failure is an increasing and emerging cause for premature deaths in India. Deaths due to renal failure constituted 29 per cent in 2010–13 among people aged between 15 and 69, according to a 2017 study by the Lancet.
India has around 4,950 dialysis centres. Data from Ministry of Health and Family Welfare suggested that every year, about 2.2 lakh new patients of End Stage Renal Disease (ESRD) get added to the pool of existing patients.
For a population of about 1.3 billion, India has around 1,200 nephrologists.
In 2016, the government launched Pradhan Mantri National Dialysis Programme under the National Health Mission. The scheme offers to cover 100 per cent dialysis expenses for below-poverty-line patients. Non-BPL patients could get treated at district hospitals at a subsidised cost.
In 2019, the Union government announced a plan to provide door-step dialysis services for kidney patients to improve quality of life of those on dialysis and bring down the overall cost of treatment.
In the current scenario, however, government agencies, local administration and the hospitals are grappling to find a way out. In many cases, hospitals and government bodies are relocating machines and staff.
“The units that were shut down, including the one at our medical college, had machines and equipment now lying unused. So we set up a separate dialysis centre with the help of government officials by relocating the resources. It took us almost 10 days,” said Varun.
The arrangement and procurement of medical items, related drugs and PPEs is an additional issue.
But relocating dialysis units is not the best way to deal with the situation, according to Vivekanand Jha, executive director of the George Institute for Global Health, India.
“Patients and dialysis staff need to have a separate entry and exit so that they can access the unit while ensuring social distancing. Eventually, it is the responsibility of the healthcare system to cater to the needy," said Jha. He added investments will have to be if a system has to evolve.