Mulago lowers cost for dialysis treatment by 60%

By Vicky Wandawa

He was once an influential marketing manager, but today, 59-year-old Arthur Mutegaya is living on handouts as he fights for his life.

With a forlorn expression, he starts his narration in a husky voice. “This kidney issue is one of the worst diseases because it costs a lot of money…..” he says as his voice fades.

Mutegaya was diagnosed with kidney failure in 2011 and has since depleted all his savings to finance his dialysis treatment. Dialysis treatment replaces the function of the kidneys, which normally serve as the body’s natural filtration system.

“I have failed to find out how I developed this condition. I lived a healthy lifestyle, but one day, I woke up with swollen feet. Numerous tests were done and I was diagnosed with kidney failure,” he says with a blank stare.

Initially, Mutegaya had been advised to undergo dialysis treatment thrice a week at about sh300,000 per session, but due to the financial burden, he dropped to two and shortly after, settled for once week.

However, he almost lost his life and thus, decided to have the treatment twice a week.

However, sometimes he cannot afford it.

“Money has to be paid before sitting on this chair. I have spent over sh200m since I started dialysis treatment,” he says.

Just when Mutegaya thought he could not go on, the good news came that the Government was to slash costs of dialysis treatment at Mulago Hospital, which he now calls his second home, considering his numerous visits there.

“Since I heard about the reduction in costs, I have been looking forward to its implementation,” he says.

“I arrived yesterday, hoping to pay much less, but I was reminded by the doctor that the lower charges commence at the end of April, which is some days away. I will be extremely happy if the Government keeps its promise.

“Otherwise my days on earth are numbered,” Mutegaya hopelessly adds.

However, although dialysis decreases mortality, Dr. Robert Kalyesubula, a kidney specialist at Mulago, notes that the ultimate solution for Mutegaya is a kidney transplant, which assures at least 10 to 15 years of life and costs between sh70m and sh100m.

“If only I could get a transplant. But I do not have that kind of money,” he says.

Annet Namugga, a nurse, says in the days when Mutegaya could afford dialysis treatment thrice a week, he used to go to Mulago by himself.

“But his finances dwindled and he sometimes spends more than a week without treatment. Now he is confined to a wheelchair because his body is too weak,” says Namugga.

Kalyesubula notes that worldwide, kidney disease remains one of the most under recognised causes of illness and death because of the lack of awareness among medical personnel, as well as the general population.

Death is mainly caused by the fact that people seek medical care when it is too late. According to the World Health Organisation, Uganda’s kidney disease prevalence is about 4%.

In a survey carried out by Kalyesubula in 2006, the commonest causes of kidney disease were hypertension, diabetes Mellitus, glomerulonephritis and HIV/AIDS.

“Currently at Mulago, we have 35 patients undergoing dialysis, but the figure keeps on changing as some die and more are admitted,” says Kalyesubula.

The current mortality rate on dialysis is 25% per a year. So, out of 10 patients with kidney failure on dialysis treatment, two to three of them will die.


Mulago’s renal unit

Mulago has an established outpatient clinic running on Tuesdays for general patients and another on Thursday morning and Friday afternoon for the private department.

“We see over 500 patients in the clinics per year,” says Kalyesubula.

He adds that there is a renal ward, 4C, where up to 60 patients with kidney disease are admitted per month and provided with free medical care.

The dialysis unit, which had six machines, recently acquired 10 new ones through the Ministry of Health in partnership with its Japanese counterparts.


Treatment costs too high

Thompson Masereka, a nurse, explains that dialysis consumables, which are the supplies needed during treatment are very costly.

“Each set goes for about sh150,000, plus hospital fees of 90,000, and other medication, amounting to about sh300,000 per session. At the start of dialysis, the patient has to undergo five consecutive days of treatment and then three days per week for life, unless they undergo a kidney transplant. Each month, the renal unit receives between five and eight new patients.

“Each day, we counsel about 10 patients meant to embark on kidney treatment, but only two turn up each week because of the high costs involved,” Namugga explains.

Hospital plans to slash costs

Kalyesubula says the hospital will reduce the costs for dialysis treatment at the end of April.

For a patient to undergo dialysis, they require a number of items (referred to as consumables) like a catheter to move the blood from and to the body and the dialysis machine, as well as concentrates to clean the blood.

“These are all bought from the open market, and the cost depends on where the patients make their purchases. Ultimately, the patient parts with between sh270,000 and sh300,000 per session,” the consultant explains.

However, starting April, the costs will fall by 60%, because the Government will have a central pool for the required materials, and provide them at a reduced cost. Therefore, a patient who has been parting with about sh200,000 will part with sh60,000.

Currently, it is only about 5% of the kidney patients who need dialysis who can afford it, leaving the rest on their deathbeds.

The hospital’s director, Dr. Banterana Byarugaba, said: “When we built an oxygen plant, the money that would have been used to buy oxygen was diverted to buying consumables for dialysis machines and that is why we are going to have cheap dialysis treatment.”

He explained that the hospital used to spend sh800m on buying oxygen per year.

Dialysis treatment in the private sector

Several dialysis centres have been established by private partners. Panorama Medical Centre and Case Medical Centre each have five dialysis machines.

“However the treatment costs are higher than those at Mulago — between sh400,000 and sh500,000 — because of costs such as rent and salaries,” Kalyesubula explains.