Kidney Disease: How adequate, accessible are dialysis machines?

By Hadiza Mohammed-Aliyu, News Agency of Nigeria (NAN)

The issue of decaying, obsolete, unserviceable and in some cases the lack of basic equipment in hospitals and clinics across the country has

forced many patients to seek for help for their health conditions from other sources or remain helpless.

Equipment such as chemotherapy and dialysis machines, ultrasound, the Magnetic Resonance Imaging (MRI) and complete theatres, as well as laboratory equipment are essential for the functioning of any health facility and for quality healthcare.

This is because, to attend to any patient, a doctor requires basic equipment to diagnose the ailment before prescribing medication, while some sicknesses may require further investigation and re-examination to ascertain how to go about tackling it.

While there is the lack of equipment in some hospitals across the country, especially in some teaching hospitals, other health institutions have them lying idle and yet to be installed, while some other hospitals do not have competent hands to operate them, a phenomenon that is threatening the country’s health system.

A check by News Agency of Nigeria (NAN) on hospitals in the North East found that activities of insurgents had taken a huge toll on the health sector, with physical structures and equipment in most hospitals lacking, destroyed or damaged, leaving most people hopeless.

In Borno, where cases of kidney disease seem to be on the rise, the state Governor, Prof. Babagana Zulum, recently directed the newly established Kidney Centre to offer free dialysis to patients, but how adequate are the machines, compared with the number of people who require the process as treatment option?

The human kidneys perform many crucial functions, including: maintaining overall fluid balance,  regulating and filtering minerals from blood, filtering waste materials from food, medications, and toxic substances.

Kidney disease is the inability of the kidneys to filter blood the way it should, due to damage and people with the condition may not have any symptoms but may experience fatigue, high blood pressure, loss of appetite, malaise, or water-electrolyte imbalance.

Other common kidney diseases are: kidney damage, abnormal heart rhythm, failure to thrive, fluid in the lungs, insufficient urine production, itching, kidney failure, severe unintentional weight loss, or swelling, and treatments include transplant or dialysis.

Consequently, dialysis as treatment option is the process of removing excess water, solutes and toxins from the blood in people whose kidneys can no longer perform these functions naturally, a process referred to as renal replacement therapy.

The Borno governor gave the free dialysis directive when he recently visited the Maiduguri Specialists’ Hospital where the state’s Kidney Centre was set up early this year by ex-Governor Kashim Shettima.

Zulum, who went round the facility, directed the state’s Commissioner for Health, Salisu Kwaya-Bura, to “put in place measures that would make the dialysis procedure free for patients.

“The goal is to lessen difficulties low-income earners face in paying the N30,000 fee for each dialysis session.’’

The governor also authourised the state’s Ministry of Science, Technology, and Innovation to assemble critical stakeholders in health, education and water sectors “to speedily invite competent researchers or identify, study and expand any existing research into the main cause(s) of kidney diseases that seem to be on the rise in Borno.’’

He said that the state government would finance the research, expected to serve as guide in addressing the causes of rising kidney diseases, rather than limiting focus on dialysis and other forms of treatment.

The health commissioner, and the state’s Chief Medical Director ‎of Hospitals Management Board, announced that the centre had bought consumables to enable the continuation of dialysis for at least six months for more than 3,000 patients.

Meanwhile in Kano, Kaduna, Zamfara, Sokoto and Kebbi States, kidney disease patients have called for the provision of more dialysis machines in hospitals to ease their pains.

They also urged the state governments to invest in the training of health professionals to effectively attend to their needs.

Dr Auwalu Gajida, the acting Chairman, Medical Advisory Committee of Aminu Kano Teaching Hospital (AKTH) said “the hospital is fairly equipped and providing efficient services to patients.

“AKTH just installed a new machine for kidney transplant and so far, we have done 60 transplants”, Gajida said, adding that all the equipment at the facility were functioning and primary patients have been accessing them.

At Federal Medical Centre (FMC) Kebbi, the Head of Clinical Services, Dr Taslim Lawal, told NAN that the centre performed two dialysis daily.

He said that “as a tertiary healthcare service provider and at the same time a primary and secondary healthcare provider, we have functional equipment, depending on the needs of clients.’’

The Medical Director of the centre, Dr Aliyu Balarabe, also said that the facility recorded tremendous achievements in terms of electricity supply, training of staff and generation of internal revenue.

He, however, urged the host community to take ownership of the hospital by investing in it, and partnering to facilitate effective healthcare delivery to the people.

A cross section of patients at the centre expressed satisfaction with the condition and services being provided.

Hajiya Fati Isa, who said she accompanied her husband for dialysis, said “we are enjoying the services of the hospital. You can see the suggestion and complaint boxes, and the management and staff listen to us and assist us even financially when the need arises.’’

In Kaduna, Dr Tokan Baduku, the Chairman, Medical Advisory Committee of Barau Dikko Teaching Hospital, said the hospital has standard and sophisticated functional equipment, offering services to patients.

In Sokoto, Malam Buhari Abubakar, the Public Relations Officer of Usmanu Danfodio University Teaching Hospital (UDUTH) Sokoto, said most of the equipments in the hospital were functioning.

He said “UDUTH has functional laboratories, pharmacy, physiotherapy, radiological equipment and others which facilitate provision of modern services to patients.

“Because of the specialty presence in the hospital, people troop from various places to obtain medical services.’’

In Kogi, Dr Taiwo Jones, the Head of Clinical Services, Federal Medical Centre (FMC) Lokoja, told NAN that the hospital has a functioning dialysis machine but it is becoming obsolete due to overuse.

Jones, however, complained that power outages contributed to the continuous breakdown of the equipment.

In Nasarawa State, Dr Hassan Ikrama, the Chief Medical Director (CMD) of Dalhatu Araf Specialist Hospital (DASH), Lafia,  said three dialysis machines were currently operational in the hospital to take care of patients with kidney problems, adding that the state government was in the process of buying more.

In Benue, Dr Enye Agada, the Head, Clinical Services, Federal Medical Centre, Makurdi, said “management bought new Auto-Analyzers for both heamathology and chemicalpathology.

“The challenge we have with most of the machines is that they are not built for this environment. They need a lot of Air Conditioning (AC).

“We need a lot of energy to cool the machines. As soon as they start showing red light, we put them off. Generally, the equipments are wonderful.’’

In the South West Zone, Prof. Jesse Otegbayo, the Chief Medical Director (CMD) of University College Hospital, Ibadan, (UCH) said  the hospital was witnessing extensive renovation and had acquired some state of the art equipments for cancer and kidney disease treatment.

The CMD, who stressed the need for Public-Private Partnership (PPP), said that “with the help of the General Overseer of Redeemed Christian Church of God, Pastor Enoch Adeboye, we acquired three hemodialysis machines amounting to N30 million which were functioning well and helping people with kidney diseases.”

Similarly, the CMD of Ogun Hospital in Abeokuta, Dr Kayode Olaseinde, said that the facility had undergone great transformation in terms of equipments and other infrastructure in recent times.

He said the fortunes of the hospital changed positively following an inspection visit by Gov. Dapo Abiodun in June during which he decried the deplorable state of the hospital.

Consequently, he said, the hospital took delivery of medical equipments, including anaesthetic machines (2), patient monitors (4), single and double  humidifiers (4l) cardio topographic machine (1) and cardiac defibrillator (2), wheel chairs (6), neo-natal resuscitaire (2), autoclaving machine (1), suction machine, instrument trolley and gurney trolley in the last quarter of 2019.

Although Olaseinde did not mention if dialysis machine for kidney disease was procured, he said all the new equipment had been installed and currently functioning.

Musa-Olomu, the CMD of Federal Medical Centre (FMC), Idi Aba in Abeokuta, told NAN that 70 per cent of equipments in the hospital were in good condition and functioning.

He also disclosed that some other equipments were being expected from abroad.

In Osun, Dr Rafiu Isamotu, the Commissioner for Health, said hospital equipment in the state-owned teaching hospital were in  good condition and in full usage.

Isamotu told NAN  that the state government recently received  some equipment from Germany and Canada,  which he said  had so far improved the health management system in the state.

However, Dr Adewale Taofeek, a doctor at  the General Hospital,  Osogbo, said the state general hospitals had no dialysis machines for kidney disease treatment.

At the Federal Teaching Hospital, Ido-Ekiti, the CMD, Prof. Adekunle Ajayi, said the facility had six dialysis machines serving kidney patients from the state and beyond, while Dr Olorunsola Popoola, a medical practitioner at Ekiti State University Teaching Hospital, Ado Ekiti, said the dialysis machines in the facility were working well and serving patients.

However in Zamfara, a state of emergency had been declared in the health sector and the government said it was taking steps to reengineer public hospitals for greater efficiency.

Part of the plan is the massive provision of equipment and getting qualified medical personnel for the hospitals in the state.

The state’s Commissioner for Health,  Alhaji Yahaya Kanoma, said the government would work with NGOs to address challenges in the health sector, adding that “we are going to facilitate proper coordination and strong partnership with healthcare NGOs to ensure effective health services,.”

Ms Florence Ishaku, the Chairperson of Nigerian Association of Nurse Anaestethists (NANA), Plateau State Specialists’ Hospital(PSSH) chapter, said the hospital was in need of modern equipment, including the dialysis machine.

In Enugu, the Chairman, Nigeria Medical Association in the state, Dr Ike Okwesiri, said that poorly equipped hospitals were common in the country not just in Enugu.

In Anambra, the Commissioner for Health, Dr Vincent Okpala, told NAN in Awka that the state government was doing a lot to upgrade hospital equipment at the Chukwuemeka Odumegwu Ojukwu University Teaching Hospital (COOUTH), Amaku Awka and 17 other hospitals across the state.

In Onitsha, NAN investigation revealed that the dialysis centre at the General Hospital, had been locked while nurses, who were working there, had been dispersed to other wards since June 2019 over issue of shortage of manpower and other concerns.

However, the Deputy Chief Medical Director of the hospital, Dr Nnamdi Ekpelinwa, explained that the hospital was undergoing upgrade by the state government.

He added that the dialysis centre, which was in partnership with MTN, had two functional dialysis machines but was shut by the state government due to unresolved issues with MTN.

“The closure is at the state level and I don’t have details about the issue,” he said.

Consequently, there is the need to tackle the cause or causes of kidney diseases even before they occur, for people to observe and avoid having the disease. (NANFeatures)

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