Timely intervention pays

Ethiopia has one of the best performing economies in Africa and the future looks increasingly promising. The nation is also registering steady progress in meeting its Millennium Development Goals (MDG). However, as the nation is starting from a very low base in nearly all sectors of society and economic life, there is a huge gap to fill in meeting the various needs of a growing population. Health services and particularly, specialized treatment options is one such area of concern.
Although access to healthcare has improved tremendously over the last few years, hundreds of thousands of Ethiopians languish in excruciating circumstance by often treatable conditions, for lack of dedicated treatment centers.
Among the many life threatening diseases which require urgent national intervention is kidney failure and associated conditions such as hypertension.
To find out further about kidney problems and the challenges and efforts to establish a especially dedicated medical center, Capital’s Kirubel Taddese interviewed the founder and director of St. Yared Higher Clinic Dr. Akeza Teame, Specialist in internal medicine and infectious diseases, as well asAddis Melese, a 26 year old teacher who underwent a kidney transplant operation in India through the auspices of St. Yared Clinic Excerpts:

Interview with DR Ateza Teame  

Capital: What is kidney failure?
Dr. Akeza Teame: In order to talk about kidney failure we should talk about functions. Every day, kidneys process our blood to sift out waste products and extra water. The waste and extra water become urine, which flows to our bladder through tubes called ureters. The processed or pure blood will enter the circulation when the waste leaves our body. The waste products can be electrolytes or unwanted chemicals. The kidney also has other functions like controlling our blood pressure.
When we say kidney failure we mean that our kidney is no longer performing its tasks as it should. Some kidney problems happen quickly, like if an accident causes injury. Losing a lot of blood can cause sudden kidney failure. Some drugs or poisons can make your kidneys stop working. These sudden drops in kidney function are called Acute Renal Failure (ARF) and may lead to permanent loss of kidney function. But if your kidneys are not seriously damaged, Acute Renal Failure may be reversed. Most kidney problems however, happen slowly. You may have “silent” kidney disease for years. Gradual loss of kidney function is called Chronic Kidney Disease (CKD) or chronic renal insufficiency. People with CKD may go on to permanent kidney failure. They also have a high risk of dying from a stroke or heart attack. Total or nearly total and permanent kidney failure is called End-Stage Renal Disease (ESRD). People with ESRD must undergo dialysis or transplantation to stay alive. When one of these cases happens the waste products that should leave our body remain and their accumulation results in serious health problems.

Capital: We are seeing cases of kidney failure mostly on youth, is there any relation with age? Generally, what causes it?
Dr. Akeza: Kidney failure is the end result.Other health problems occur to cause the failure. The two most common causes of kidney disease are diabetes and high blood pressure.
For example poorly controlled diabetes and blood pressure can cause kidney failure. Various infectius-diseases like HIV can also cause kidney failure. Some kidney diseases result from hereditary factors. If your family has a history of any kind of kidney problem, you may be at risk for kidney disease. The causes of most kidney failures reported in Ethiopia are unknown but the science itself states that 20% percent of the causes of kidney failure cases is unknown. There is no proved relation between age and kidney failure. Poisons and trauma, and a direct and forceful blow to your kidneys, can lead to kidney disease. Some over-the-counter medicines can be poisonous to your kidneys if taken regularly over a long period of time. Products that combine aspirin, acetaminophen, and other medicines such as ibuprofen have been found to be the most dangerous to the kidneys.

Capital: Tell us about the symptoms of kidney failure and how it can be is detected?
Dr. Akeza: People in the early stages of kidney disease usually do not feel sick at all. As the toxic accumulation builds up in one’s body, problems start occurring. As kidney disease gets worse, the patient may need to urinate more often or less often.
The patient may feel tired or itchy. He or she may lose appetite or experience nausea and vomiting. The patient’s hands or feet may swell or feel numb. He or she may get drowsy or have trouble concentrating and skin may darken. The patient may also have muscle cramps.
Doctors may first detect the condition through routine blood and urine tests. The urine tests is a spot check for protein or albumin in the urine. Healthy kidneys take waste out of the blood but leave protein. Impaired kidneys may fail to separate a blood protein called albumin from the wastes. As kidney function worsens, the amount of albumin and other proteins in the urine increases.
A blood pressure measurement also provides information. High blood pressure can lead to kidney disease. It can also be a sign that your kidneys are already impaired. The only way to know whether your blood pressure is high is to have a health professional measure it with a blood pressure cuff. Ultrasound of the kidney is also used. There are other methods which can be used to detect kidney failure but the above are the major ones.

Capital: After a patient finds out about his kidney disease, what are his options for treatment?
Dr. Akeza: If kidney disease is detected in its early stage we can do a lot to improve the patient’s condition. We can avoid what we call insulting or offensive agents like Advil, which is popular in Ethiopia, and others. When we withdraw such offensive agents and make sure that risks for heart attack and stroke are minimized, since CKD patients are susceptible to these problems, we can reverse kidney disease. If you have diabetes, watch your blood glucose closely to keep it under control. Consult your doctor for the latest treatment. Avoid pain pills that may make your kidney disease worse. Check with your doctor before taking any medicine.
Unfortunately, Chronic Kidney Disease often cannot be cured. Patients with complete and irreversible kidney failure need to undergo dialysis or kidney transplantation. The two major forms of dialysis are hemodialysis and peritoneal dialysis. In hemodialysis, your blood is sent through a filter that removes waste products. The clean blood is returned to your body. Hemodialysis is usually performed at a dialysis center three times per week. It costs 150 USD per dialysis, only three or four medical centers offer this service in Ethiopia. In peritoneal dialysis, patients can perform the dialysis themselves. They can do it at home with more privacy and most importantly, it is cheaper as it is only 16 USD per dialysis. This service isn’t available in Ethiopia. We are trying to have this treatment available in our clinic. Since it is very cheap compared to hemodialysis, it suits most Ethiopian patients. Most Ethiopians don’t get dialysis treatment because the only available dialysis, hemodialysis, is beyond their capacity and requires them to pay 150 USD three times a week.
The dialysis treatment isn’t the ultimate solution. When you do dialysis, you are fine, if not it is back to square one. There are infection risks when you undergo dialysis. The solution is a kidney transplant. A donated kidney may come from an anonymous donor who has recently died or from a living person. Your immune system protects you from disease by attacking anything that is not recognized as a normal part of your body. So after the transplant your immune system will attack a kidney that appears too “foreign.” You will take special drugs to help your immune system so it does not reject the transplanted kidney. Unfortunately for peritoneal dialysis, the transplant treatment is not available here in Ethiopia. Even if the exact number of patients are unstudied, the report I got three months ago shows that only 30 people are using dialysis, since it is very expensive for the majority. Let alone the transplant which takes place abroad and too expensive to afford. Many Ethiopians die because they can’t afford to pay for dialysis.

Capital: Does Ethiopia have enough specialists for kidney disease?
Dr. Akeza: I think there are four or five specialists; I don’t think the others who are working are specialists. Here in our country, some claim that they are specialists after working in that disease for some period but that isn’t the right way.
However, the major issue is affordability, as I explained we are working to make available the peritoneal dialysis which costs only 16 USD. Imagine how many more people can qualify for the treatment. If we can be successful in bringing the treatment here, it surely saves a lot of people.
The other thing we are doing is to send Ethiopian patients abroad so that they can get a transplant. For now the feasible solution we can come up with is sending patients to India’s Indraprastha Apollo hospital. The hospital is one of the largest corporate hospitals in the world. It is the third super specialty tertiary care hospital set by the Apollo Hospitals Group, jointly with the Government of New Delhi, India’s capital.
Addis Melese one of our patient will tell you his experience him self, but before we sent him to India we made the necessary contacts and finalized all the steps. He got the transplant service and came back after successfully treated. What comes after the transplant is a therapy so that our body doesn’t reject the new kidney.

Interview with Ato Addis Melese.

Once you undergo the kidney transplant that doesn’t mean that you are done and cured, there are serious follow-ups you need to attend and medicines to take for the rest of your life. Fortunately, I specialized in infectious diseases, so our clinic follows up on the patients after the transplant but the medicines are hardly available in Ethiopia.
Capital: How did you come to know that you have kidney disease?
Addis: It started with blood pressure. Gradually, it got worse and reached a point where the machine couldn’t even measure it. I was in Awassa, one hospital checked me and find a protein
in urine test. After that the ultrasound showed that my kidneys have shrunk a bit so I was referred to Addis Ababa. I learned in Addis Ababa about my condition and there is only a dialysis solution available in the country and I had to go abroad for the transplant.

Capital: How did you go abroad?
Addis: I tried to collect information on the possibilities. My family and friends were organizing fund raising events so that I can afford the transplant. After that I came to Saint Yared Higher Clinic and they sent me to Apollo Hospital, where I got the transplant. My brother donated a kidney for me. The hospital is one of the best hospitals in the world. It is internationally accredited and most importantly, it gives the service for significantly lesser payment. Not only patients like me who come from developing countries prefer the hospital but also from European countries too patients come and enjoy the service. For me it took 10 weeks but since one first has to be cured from any other infections or diseases, it might take more time for other patients.

Capital: Transplant is very expensive, how did you come up with the money?
Addis: I am a teacher as are my parents so there was no way I could come up with the money on my own. It was a very troubling condition which no one should go through. All of my family, friends and colleagues were very troubled. We decided to sell our house but thanks to almighty God, the people of Wolkite helped me. I work in Awassa so people there too backed me. I and my family owe my life to the people who helped me, especially in Wolkite. With that support I went to India. I spent more than 60, 000 USD, including four checkups I will do starting from the coming weeks and other post transplant treatments. The actual cost for the transplant is around 16 000 USD in the Apollo but in other countries it is triple or more. The average cost for most patients for the transplant is half & million birr, so it is very expensive.
Capital: What is the significance of the post transplant treatment?
Dr. Akeza: The post transplant is very important. God forbid, if kidney the rejection happens, imagine the patient has to go all that trouble once again. If the immune depressant is more than necessary, infections could attack the patient and that too can cause the kidney to fail, so it is a very delicate matter which needs serious follow-ups. The medicines are the ones which are very expensive and unavailable.

Capital: How far is Ethiopia from providing the necessary treatment for kidney patients?
Dr. Akeza: We can come up with the solutions in the near future if the government and other concerned bodies play their role. For example we have so many highly educated and well qualified doctors; we can have those medical doctors work here. They shouldn’t all be Ethiopians, as India is famous for medical tourism, we can imitate that and have the doctors come and work for us in the institutions we establish. It needs the government’s interest and support. Investors should also be aware of the situation. Even only in the economic sense, establishing such institution will save foreign currency.
Addis: We are together working to establish a foundation so that all the basic service like dialysis, the post transplant medicines and treatment are available locally. i hve to pay a lot of money for travel and cheakups so that i can have the post transplant treatment in india. Although the dialysis before the transplant is expencive , that too is given in only three centers. now since the patients’ number is increasing, the centers are giving the service through appointments. We need more centers and other forms of dialysis which aren’t all that expensive. These measures could lead us to establish a hospital where the transplant is possible. We just need to start it, we have similar establishments for other diseases where patients are helped in every step, so we need the same for kidney disease. Anybody who is interested in helping the foundation can reach us through Saint Yared Hospital. We also plan to teach people to avoid or minimize risks of kidney diseases or failure.
Dr. Akeza: Not only for kidney disease but for all others, the best solution is prevention. We need to invest more in prevention. People need to have annual health check ups and examinations, in this way we can avoid those avoidable problems. We are hoping that this foundation we are establishing receives the necessary support so that we can help the patients.Facilitating the dialysis is a much cheaper expense than creating opportunities in which they receive the transplant and then finally, conditions where they get the post transplant treatment and medicines. We also educate on the prevention methods. We ask all concerned citizens and the government to help the foundation by which we make sure that we don’t lose people to kidney failures.