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Haiti

At public hospitals, malfunctioning equipment and a shortage of items used in dialysis mean that patient treatments are likely to be infrequent; costs at private hospitals are prohibitive. In a society that relies on imports of unhealthy processed foods and that has suffered a string of natural disasters, many people have diabetes and hypertension, the chief causes of kidney disease.

PORT-AU-PRINCE, HAITI — Rachelle Marcelin squirms in her chair as sharp pains shoot through her lower belly. She is one of dozens of people in the hospital’s small waiting room seeking kidney dialysis. Most have been here for many hours.

Marcelin says she is waiting to hear a doctor call her name, but she knows that it is unlikely.

Marcelin comes to Hôpital l’Université d’Etat d’Haïti (HUEH), a public hospital in Haiti’s capital, Port-au-Prince, once a week for dialysis. She has been living with chronic kidney disease for three years, and she began treatment shortly after her diagnosis.

But Marcelin’s treatment has been irregular. Dialysis machines at the hospital are often out of service, and at times she can’t afford to pay for a session.

She occasionally depends on relatives, neighbors and friends to fund her treatment, but she fears that she won’t live much longer if the dialysis machines keep breaking down.

“I always feel burdened by this disease,” she says. “Waking up in the morning, I realize I’m still alive, and surviving the next day seems to be too much to hope for.”

Patients in Port-au-Prince with chronic kidney disease are struggling to receive adequate health care. Dialysis, a procedure that cleans the blood when kidneys don’t function properly, is offered at HUEH, which serves residents of Port-au-Prince and neighboring cities. Dialysis is also offered at private hospitals, but it is too costly for some. For those who receive dialysis at the public hospital, malfunctioning equipment and a shortage of items used during the procedure mean that treatment is infrequent.

Globally, 200 million people have chronic kidney disease, according to a 2014 study published in the Transactions of the American Clinical and Climatological Association. In Haiti, an estimated 300,000 residents suffer from diabetes, an indicator of kidney disease. No statistics on the number of Haitians living with kidney disease are available.

Chronic kidney disease occurs when the kidneys are unable to remove waste products and excess fluids from the body. This happens for a number of reasons. Some people are born with defects that can interfere with the functionality of their kidneys. Some people inherit the disease.

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Many Haitians have chronic kidney disease, but treatment at public hospitals is often inconsistent, while treatment at private hospitals remains financially out of reach for most of the country.

Marie Michelle Felicien, GPJ Haiti

Diabetes and hypertension also increase the risk of developing chronic kidney disease, because kidneys can be overworked either by filtering high levels of blood glucose or by uncontrolled blood pressure. Hypertension is the leading cause of death among Haitians, according to Fondation Haïtienne de Diabète et de Maladies Cardio-Vasculaires, a local medical foundation. Two million Haitian adults are living with hypertension.

If consumed regularly, processed foods, which often contain high levels of sugar and salt, can lead to these diseases, says Maurice Mainville, executive director of HUEH. Haiti does not produce enough food to feed its population. As a result, locals largely rely on food imports from the United States and Brazil. More than half of these imports are processed foods, which are cheaper than locally harvested organic foods. In Haiti, organic foods are out of reach for some because of financial constraints.

Recurrent natural disasters also have put a strain on the government and the people. Hurricane Matthew hit the south of Haiti in 2016 and caused damage of nearly 500 billion Haitian gourdes ($8 billion), equivalent to 32 percent of gross domestic product. Annual government expenditures on health care account for 8 percent of the country’s gross domestic product.

Though there is no cure for chronic kidney disease, early detection and proper dialysis treatment can improve life expectancy, depending on a patient’s medical history and condition. In Haiti, the problem is that a lack of income prevents some people from seeking treatment at private hospitals, which many consider pricey but efficient. Health insurance is not required by the government, and most Haitians don’t purchase health coverage, making it even more difficult to get treatment.

The cost of one dialysis session at HUEH is 2,000 gourdes ($32), while a session at a private hospital ranges from 6,000 gourdes ($96) to 15,000 gourdes ($240).

HUEH receives at least six patients with chronic kidney disease every month. But patients say that they are not getting proper care and treatment because dialysis machines fail to function for weeks at a time. The hospital has eight dialysis machines, but during interviews with staff in October 2017, five of them were not working.

Mainville says the hospital needs about 2 million gourdes ($33,000) each month for the maintenance and servicing of the machines. This would ensure that each patient is treated for every scheduled dialysis session, he says. But the government gives the hospital about 780,000 gourdes ($12,500) per month.

Ismaël Anestil’s mother was diagnosed with chronic kidney disease three years ago, when he was 15. Since then, he has been accompanying her to the public hospital for treatment. Doctors have instructed Anestil’s mother to attend two sessions a week. But he says it’s been difficult to fund the treatment because his father, who was the breadwinner of the family, has died.

“Costs [for treatment] are far higher than our financial means,” he says. Family members abroad send money to assist with the treatment, but Anestil says that if the cash does not arrive on time, his mother may miss sessions for weeks on end.

Others miss their sessions because they have to buy some of the items used during the dialysis process from pharmacies. These items include dialyzers that cannot be reused and can cost up to 6,000 gourdes ($96) each. For 66-year-old Roudolphe Laguerre, who isn’t working and who is receiving treatment at HUEH, this is a financial burden. He says his children help him purchase these items so that he does not miss his treatments too frequently.

Mainville says he hopes the government will invest in quality health care, but it is also important for Haitians to develop healthy dietary practices and exercise routines to prevent diabetes, high blood pressure and chronic kidney disease.

 

Sylvestre Ndahayo, GPJ, translated this article from French.

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