May 17, 2012
Pohnpei, FSM—Pohnpei’s blood sucking machines take a break only on Sundays. Monday through Saturday at least one of Pohnpei’s five dialysis machines works to strain the waste products from the blood streams of patients whose kidneys would do the job if only they could.
Kidneys fail for a variety of reasons including gout, but in Pohnpei, Type II diabetes is the leading cause of kidney failure and expensive dialysis treatments are the only solution after that happens.
Dr. Johnny Hedson, Pohnpei’s Chief of Medical Services wants the people of Pohnpei to know that Type II diabetes is completely avoidable. As Benjamin Franklin said, “An ounce of prevention is worth a pound of cure.”
Type II diabetes is not anyone’s destiny. It can be completely avoided through proper diet and sufficient exercise.
Dr. Hedson says that even after a person is first diagnosed as having Type II diabetes the disease can be managed but that many people in Pohnpei don’t manage the disease even after they have been diagnosed. Management of the disease is on a continuum. In the early stages a person can control the processing of their blood sugars through diet and exercise. If that isn’t enough there is an oral medication that can be given that increases the efficiency of the body’s insulin. He said that even then a person need not be on the oral medication for life. If a person changes his or her lifestyle to include a healthy diet and sufficient exercise the need for the oral medication can be eliminated.
But some people still mismanage the disease by not being consistent with their medications. When that happens ultimately they will find themselves dependent on direct insulin injections. He said that an insulin dependent patient can “put off their death for a long way down the road” if they manage their disease with vigilance by monitoring their blood sugars properly and handling their insulin injections in a timely manner. Even then and probably especially then, proper diet and sufficient exercise are important to put off kidney failure until years later.
Gout is a hereditary disease that allows uric acid crystals to build up in the blood stream producing inflammation and painful kidney stones. A person is or isn’t predisposed toward gout. It’s not a matter of choice. Gout depends on genetics.
But the majority of kidney failures in Pohnpei are the result of a combination of improper diet and lack of exercise that leads to Type II diabetes, the type of diabetes that is not genetically inherited; the kind of diabetes that a person can choose to have or not to have depending on their lifestyle decisions.
The function of kidneys is to filter everyday waste products from the blood stream and funnel that waste to the excretory system. Without functioning kidneys waste builds up in the blood stream and a person will die.
A person can live with only one functioning kidney and kidneys can be transplanted but Dr. Hedson says that the Department of Health gave up on the idea as a solution because it is cost prohibitive.
“Even in the Philippines it costs $70,000 just for the transplant but there’s more expense after that,” he said. After a transplant a patient needs to take medications to keep the body from rejecting the transplanted organ. The medications alone cost about $2000 a month per patient. One person in Pohnpei had a transplant and that person is still on the medication several years later.
In Pohnpei hemodialysis is the only treatment available for a person whose kidneys have failed.
Hemodialysis is a process whereby the entire blood content in a patient’s body is filtered by a machine outside of the patient’s body. A person on dialysis will need the expensive treatment every other day for the rest of their life. Without it they will die.
When asked the average age of the 10 patients who receive hemodialysis treatments in Pohnpei Dr. Hedson said that if he had to guess, which he would have to do, he would guess that the average age is in the low 40’s.
Dr. Hedson is worried about the increasing use of its five dialysis machines.
The human cost of Type II diabetes related kidney failure is very high. “Most (dialysis patients) don’t last five years,” Dr. Hedson said. “We lost two people within the last three months.”
He said that once dialysis becomes necessary a patient’s quality of life goes down significantly. Three days each week a dialysis patient must spend a significant part of their day at the hospital hooked to a machine. Just about the time that a patient recovers from the general feeling of “un-wellness” that follows hemodialysis treatment they have to go back for another treatment.
The treatment is also very expensive in terms of dollars and cents. There is no insurance program in the FSM that covers the expense of dialysis treatment.
Each of the dialysis machines costs over $30,000, a small price compared to the price of some other medical equipment. Each time the machine is used for a hemodialysis treatment it costs $123 excluding the cost of medical personnel and utilities costs. Dr. Hedson said the actual cost for each dialysis session is closer to $140.
The two most expensive items on the list of supplies needed for one hemodialysis treatment are the coil (the filter) which costs $26 a piece, and a medication called Epogen which costs $45 per dose. Dr. Hedson said that Epogen is given to dialysis patients to increase the efficiency of their red blood cells after the treatment. The other $52 worth of supplies is for various kinds of needles, syringes, tape, bicarbonate, acetate and a laundry list of other supplies including vinegar and bleach.
It costs just over $22,000 per year to administer dialysis treatments for just one patient. Dr. Hedson said that last year Pohnpei State Hospital spent a total of approximately $70,000 for dialysis treatments. This year the cost will be closer to $220,000 to treat the ten people who currently receive the treatment three times each week.
Pohnpei State’s Department of Health spends more on average per patient on an annual basis than in the South Pacific and its average annual per capita health spending is less than $200. “Compare that to the U.S.” Dr. Hedson said “They (their hospitals) spend an average of $7,000 per patient. That figure should tell you the challenges we face in Pohnpei.” He also said that in the U.S. it costs approximately $300 per hemodialysis treatment.
Dr. Hedson said that last year the Department of Health provided health care for over 32,000 people with a budget of approximately $6 million, a per capita health care cost of $187.50. Most of the Department of Health’s budget came from U.S. Compact Health Sector grants which are on a declining scale until 2023 when those grants will disappear altogether.
Dr. Hedson said that developing a plan to deal with the high cost of dialysis treatments in an environment where funding is on the decline is going to be a tough decision for leaders to make. He said that the Department of Health cannot simply cut off the expensive treatment because people will die of renal failure. “There are moral questions the leaders will have to decide,” he said.
Of course the best solution would be if Type II diabetes were wiped off the map in Pohnpei through healthy diets and sufficient exercise.