Govt brings hope to dialysis patients

When Ester Shityeni was breastfeeding her six-month-old baby, she had no idea she was facing a chronic kidney disease (CKD) which would land her in a dialysis unit bed.

Receiving four-hour treatment at Oshakati State Hospital, Shityeni (36) spoke to Namibian Sun shortly after the commissioning of the 12-bed dialysis unit at the biggest northern referral hospital by health minister Dr Kalumbi Shangula.

With the expansion of this service, Shangula said the hospital is now better positioned to serve patients suffering from kidney disease, ensuring access to life-saving dialysis treatment, drastically reducing waiting times and removing the need to travel long distances to seek care.

Since its completion in July, the unit has already treated more than 65 patients, with 35 of them being new patients.

When Shityeni was diagnosed in July 2021, she had to stop breastfeeding. “When I carried the baby on my back, my heart would beat extremely fast and my feet would swell. My blood pressure was also very high when I visited the clinic at Omuntele,” she recalled.

She was referred for blood tests at Onandjokwe Hospital in the Oshikoto Region, which revealed that she was in the final stages of CKD.



Global health challenge

According to the World Health Organisation (WHO), Namibia is ranked 73rd globally for deaths resulting from kidney disease. The country has a total population of just over three million people and has more than 300 confirmed cases of CKD.

Shangula said CKD is a significant global health challenge. Worldwide, it is estimated that approximately 10% of the population is affected by CKD, representing a substantial healthcare burden, especially when it progresses to end-stage renal disease (ESRD) and associated complications.

“Haemodialysis plays a pivotal role in the management of chronic renal failure. It provides a means to clean the blood of patients whose kidneys can no longer perform this essential function. It also enhances the quality of life and increases the survival rate of patients with ESRD,” he said.

The health ministry allocates over N$100 million each year for dialysis services, primarily due to the nationwide scarcity of public facilities.



Delayed treatment

Shityeni is three months into her haemodialysis treatment. Although she was diagnosed in 2021, she did not start treatment immediately.

“I never thought it would come to this, even though I’ve had health issues ever since back in 2021 and the doctors kept warning me that my kidneys were failing. Months ago when they told me they wanted me to start treatment, I said no. I hoped to recover on my own terms,” she said.

“But as months passed, I got terrible cramps and I had to be rushed to hospital. I soon learnt my kidney function was deteriorating.”

Shityeni admitted that she had very little knowledge of the disease prior to her diagnosis, and believed the myths she heard that haemodialysis treatment kills people. However, her family supported her and she was taken to a social worker for therapy.

She said the social worker informed her about the treatment process and what to expect once she starts. She was also informed about the mental resilience she would need to commit to the sessions.

When Shityeni went back to the hospital, doctors informed her that her serum creatinine was extremely high. They explained to her that when the kidneys are not working well, the serum creatinine level goes up.



Little to no symptoms

In an interview with Namibian Sun earlier this year, Kim Crymble, Ongwediva Medipark’s kidney transplant unit manager, said the kidneys do many other important jobs too, such as help control blood pressure, keep the bones and heart healthy and help in the production of red blood cells, which are used to carry oxygen around the body.

She said CKD sees your kidneys becoming unable to perform normal functions. “Your kidneys lose most function and, as a result, fluid and waste build up in your body. Kidney disease usually develops slowly, with very few signs or symptoms in the early stages. Many people do not realise they have a problem until their kidney function has decreased to less than 25% of normal. This damage usually occurs slowly and often it is not reversible,” she warned.

Shitenyi said while she still does not have clear knowledge as to what might have caused her kidneys to fail, she was told by doctors that she drank too many antibiotics, which might have been a contributing factor.

“I had knee problems for a long time, so I drank a lot of antibiotics to keep the pain away. The knee would even start itching. It became infected and it was amputated this week. As we speak, I have a fresh wound,” she said.

According to Crymble, late symptoms of CKD include itching, muscle cramps, fatigue, too much or not enough urine, foamy urine, blood in your urine, swelling, nausea or vomiting, trouble catching your breath, or trouble sleeping.



High costs

There’s a high-cost burden on dialysis patients due to the high transport costs involved.

Shityeni lives in Odimbwa village in the Omusati Region’s Etayi constituency, and coming to the hospital - about 50 kilometres away - is a costly exercise. “It’s difficult to keep coming on people’s accounts,” she said.

Shityeni needs about N$150 daily for a return trip. This amount she must multiply for the three trips she makes a week on Mondays, Wednesdays and Fridays, which translates to a monthly cost of about N$1 800 just for transport.

For her, the money she receives from the government disability grant is the difference between life and death. It helps her pay for her weekly haemodialysis, but she still falls short of the recommended three-times-a-week regime, she said.

Shityeni pointed out that her biggest concern is food costs because she has been prescribed a new diet to live with the disease.

“It looks difficult and you feel worried. But don’t fear. To be honest, if you accept the disease, listen to doctors’ instructions and avoid alcohol and certain foods, you will be fine and live a normal life like other people with chronic diseases.”