Of kidney and money
13 July 2009
When he was diagnosed with typhoid, 55-year-old Pema Wangdi didn’t know that he had a kidney problem. It was in September, 2008, when he learnt that his kidneys stopped functioning.
Today after eight months of dialysis and kidney transplant, he is healthy and strong. He carries with him the experiences of having a kidney transplant and its procedures.
To start with, a thorough checkup of the donor is carried out at the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) in Thimphu. The donor is then sent with the patient to Christian Medical College (CMC) in Vellore, India, with valid documents.
“But the officials at CMC don’t even look at the documents we carry from here,” Pema Wangdi said. Upon arrival in Vellore, the donor is once again thoroughly checked. Even before the compatibility of the donor’s kidney with the patient’s body is confirmed, the cost amounts to Nu 30,000 to Nu 40,000.
And after all the checkup, the donor is rejected without examining the kidney’s compatibility.
“Why don’t they reject the donor after cross-checking his kidney?” he asked. “There is no say if the kidney is incompatible.”
Pema said that, if the documents Bhutanese patients carried from Thimphu were valid, a lot of money could be saved. “Even a boy has to prove that he is the son of his father through deoxyribonucleic acid (DNA) tests.”
According to him, the checkup at JDWNRH and sending the donor to CMC are a waste of resources because CMC has the right to check the donor again for fitness according to their own rules and regulations. Some tests are not available in JDWNRH.
Medical Superintendent, Dr Pandup Tshering, said, “We have no authority to make them accept the fitness test done here.”
Another kidney patient said that the procedures were too long at CMS. “Now we need thram numbers, DNA tests and other details that were not required before,” he said. “This is happening because there is no undertaking between the Bhutanese hospital and CMC.”
“There is an MoU between the Bhutan government and CMC for treatment. But there isn’t one for kidney transplant since there are strict rules of the Indian government to prevent organ trafficking that we need to comply with,” said a health official.
Delay in timely checkups
After recovery from the surgery, a patient has to stay six more months at CMC to see whether the body accepts the new kidney.
Three months later, the patient has to go back to the hospital to check if the medicine level balances with the immune level. The next checkup is in six months time. And another checkup is after one year.
“They (Bhutanese health officials) delay our periodic checkups, which is as good as not doing the surgery in the first place,” said a man, who was discharged from CMC five months ago.
“It is up to the treating physician at JDWNRH who has to check the patient and decide if he or she needs to be sent back for review,” said Dr Pandup Tshering.
Different medications?
“I have taken a re-birth,” said Tashi Namgay, in his mid-twenties, who underwent a kidney transplant. But according to him, there is a problem with medication.
“The medicines in Bhutan come from Kolkata and the ones we are told to have in Vellore are different,” said Pema Wangdi, who orders medicines from Vellore.
However, according to Dr Pandup Tshering, the trade names for the same medicines are different since they are produced by different companies. But they look at the pharmacological or chemical composition of the drugs. So as long as the chemical compositions are the same, there is no difference in their function.
The cost on the government
Within this financial year (2008-2009), there have been 12 patients undergoing kidney transplant. On average, a kidney transplant and related treatment costs Nu 800,000, which is all borne by the government. According to Pema Wangdi, the final test costs Nu 12,000 for patients sponsored by the government. But for privately funded patients, the cost is Nu 5000.
BY KUENZANG C CHODEN
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I really feel sad and it hurts me when i find the persons with the kidney failures, btu hope less, nothing i can do to them. Almost 2years now i have also loose my aunts wth kidney patients. She was just in twenties. So any way what to do we are born to die, and nothing can stop us from dying. So sad
I totally agree with KUENZANG C CHODEN that life is not easy for patients with Kidney disease.
I write this comment just to clarify certain things from a bio-medical service provider perspective.
You have said “after all the checkup, the donor is rejected without examining the kidney’s compatibility”.Consider this, if a sportsman has obvious fracture in long bones does he need to even face fitness test? Similarly, if a person is considered generally unfit why waste money doing specific tests?It does look like CMC is right.
You have written ““But the officials at CMC don’t even look at the documents we carry from here,” Pema Wangdi said. Upon arrival in Vellore, the donor is once again thoroughly checked.” CMC has very high standards both clinical and laboratory.When we go there,do we expect to be treated based on clinical notes of doctors from outside or do we expect CMC doctors to clinically examine us in detail?
Obviously we do expect to be seen in detail. Every center of excellence trusts its laboratory’s quality.Outside lab reports give an indication to abnormality but usually confirmation is done in center’s own lab.I agree that this is burdensome to the poor,but I understand when we deal in tertiary care one cannot take risks.They have to aim for high quality.Repeating test done outside in that sense is acceptable.
Not following the protocol and bypassing few steps could be disastrous to the patient. It would mean the recipient has not benefited and also that donor has lost a kidney uselessly.Therefore the need for follow up too.If not is not the cost of surgery a total waste too.Isn’t it?
One has to understand that tertiary care in Medicine is very costly.Even many Indian doctors cannot afford private tertiary care for themselves.In this context Bhutan Government is trying its best to help few of its Kidney patients by spending lots of money.I appreciate the Government for it.Even if it did not do so,I do not think one can criticize the policy as the opportunity cost for the Government is very high.
12 patients would suck up quite a bit of the resources that need to be spent on health of large communities of people in Bhutan. So I do not even blame the doctors in Thimpu if they wait and watch and try to avoid an unnecessary follow up visit if they can evaluate the problem well.That should be acceptable to people of Bhutan.
I do not want to hurt the sentiment of patients from Bhutan.They should be thankful that they are getting sponsored for treatments that many people in the world cannot afford in one of the best medical institutes in the world i.e.CMC Vellore, which practices state of the art medicine with sound ethical and moral principles.
At the rate our govt. is spending on kidney transplant and the time the patient has to spend in Vellore, far away from family members when they need them the most, i think it is better for the Govt. to have a kidney hospital started in Bhutan and train the doctors for that purpose. It will cost at first but in the long run, it is better for the govt and the patients too.
@ugen
It is not that easy to start a kidney hospital with world class facilities.Secondly the cost of running such units is very high too.It will be very difficult for Governments to offer such services.
Think of all that you can do in Bhutan with such money.Many people die not with Kidney disease but they die because of simple infectious disease.
Bhutan should focus on primary health system and strengthen its referral services through provision of secondary level hospitals in places other than Thimpu.