Dialysis: The surest path to poverty in Nigeria

There is a radio program I like to listen to whenever I am opportune to be less busy- it is titled ‘Buharinomics’. It is an in-depth analysis of the Nigerian economy under President Buhari’s   administration and how it affects our daily lives. The program is delivered in Hausa Language, using simple terms and examples that […]

There is a radio program I like to listen to whenever I am opportune to be less busy- it is titled ‘Buharinomics’.

It is an in-depth analysis of the Nigerian economy under President Buhari’s   administration and how it affects our daily lives. The program is delivered in Hausa Language, using simple terms and examples that people with a poor knowledge of economics, such as myself, can understand. In recent times, the debate about petroleum subsidy removal and the subsequent increase in the price of petroleum as well as the hike in electricity tariff, has dominated the discussions invoking a variety of emotions among Nigerians around the world.

A majority of civil servants, like myself, in Nigerians identify as middle class, whatever that means. In Elnathan John’s book ‘Be(com)ing Nigerian: A guide’, he describes it as being able to afford three square meals, having a car that necessitates frequent trips to the mechanic and a generator that requires you to switch off the AC before pumping water into the tank when the taps are dry. Or in most cases, switching off the generator at 12am, because the cost of the money you are burning on petrol and diesel alone is enough to give you insomnia. Middle class Nigerians are therefore, barely a few kilometers shy of the poverty benchmark and these days, it looks like even those few meters are being threatened.

I like to say that, in Nigeria, most of us are just one chronic illness away from being broke. Especially if that chronic disease is End Stage Renal Disease (ESRD). ESRD also known as Kidney failure happens when the kidneys have stopped working well enough for patients to survive without dialysis or a kidney transplant. Most patients require an average of two to three dialysis sessions per week with the cost varying from centre to centre. The average cost ranges from N15,000 to N30,000 for the first session to N7000 to N15,000 for subsequent sessions. What this means is that, if one has kidney failure and requires dialysis for survival pending when he or she is able to afford or get a donor for a transplant, a patient can spend up to thirty thousand or more per week for an indefinite number of weeks! There are patients who have been on Dialysis for more than 5 years in this country with no help from the government! Imagine that!

Alhaji Usman* is such a man. Previously, he was a business man with five shops in the market. and could be referred to as ‘rich’ by Nigerian standards. He owned two houses, two personal cars, and two SUVs that were used for commercial purposes. His six children went to private schools and he could afford to travel for the occasional Hajj and Umrah from time to time. All this changed when he was diagnosed with Kidney failure due to Diabetes, ten years ago. Now in his sixties, he looks like a ninety-year-old man, gaunt and frail. Three of his cars and four of his shops have been sold off to fund his endless dialysis bills. An earlier kidney transplant carried out had failed and left him in severe painful, emotional and financial distress. His face and feet have acquired the perpetual fullness and swelling associated with kidney disease, looking odd on his thin chest and abdomen. The atmosphere is almost always grim whenever I visit the dialysis centre. A long list is made for those registered for dialysis in the hospital. There are about six machines to the hundreds of patients waiting. Some will make it to the list and some will not. While some will die before it gets to their turn. This is for those patients paying medical bills out-of-pocket.

As for those with health insurance, their story is even more appalling. In the UK, Dialysis is free for its citizens and those who have attained resident status under the NHS. In Nigeria however, patients are allowed up to only six free dialysis sessions under the National Health Insurance Scheme (NHIS). What this means is that, as a military person, director, cleaner, or any civil servant working for the Nigerian government and who is therefore a beneficiary of the NHIS, if you are diagnosed with Kidney failure today, the government feels you are only entitled to six dialysis sessions. After that, you may feel free to: a) heal miraculously through spiritual superpowers or b) consult your Babalawo or c) fund the rest of your sessions until you have exhausted your non-existent savings or meagre pension and all your relatives have grown tired of contributing money and have therefore reached the painful decision to allow  you die.

In Nigeria, only a few states like Katsina, Borno and Yobe offer free dialysis to their respective indigenes in the state specialist hospitals. Their efforts are praiseworthy and should be emulated by other states. However, for a populous country like Nigeria, where the incidence of End Stage Renal Disease is on the rise, it is simply not enough. For example, in Katsina there are two centers that offer Dialysis services: the FMC and the State Specialist hospital. While it is free for Katsina state indigenes in the specialist hospital, it costs N38,000 for the first session (because of the cost of consumables), N16,000 for the second session and N28,000 for maintenance. Let us analyse this critically. This means that: 1) All other patients with ESRD who live in Katsina but are NOT indigenes of the state are automatically disqualified from obtaining free dialysis. I understand that the state government wants to discourage influx from other states which will lead to overcrowding but how do you disqualify someone who, for instance has come to Katsina, for work or school and is now sick, based on his indigent status? 2) The state specialist hospital will therefore be overcrowded and will now require that ‘you know somebody’ before getting on the list!

Apart from Government owned facilities, there are also a few organisations like the Beatitudes Kidney Foundation who have partnered with US based NGOs to provide relief for patients with kidney disease in the eastern part of the country. Some private health organisations (which are profit driven) are also helping to bridge the gap by offering dialysis services at a higher rate to those who can afford it.

The question to be asked is- why is Dialysis expensive? The cost is said to be high because the basic consumables used are not produced locally and we are well aware of the current rate of Foreign exchange in the market. So how come it is cheap in low income countries like Niger, Cameroon ad Benin republic? So much so, that some Nigerian patients are faking names and crossing the borders into these countries to seek treatment. What do these countries have that we lack? Why can we not push for policies that will make Dialysis free for all citizens of these country irrespective of the state you reside in? Why can dialysis not be covered fully under the NHIS? What exactly is the problem?

The cost of dialysis in health care management is a crucial topic that continues to be debated. Whichever way you look at it, whether you are middle class or among those who just wake up one fine day and buy Ferraris for their kids, the cost of continuously having a procedure that keeps you alive will eventually dig a whole in your pocket. Even for those who can afford a transplant, the physical and financial risks are high. The cheapest transplant in Nigeria is about N2m excluding drugs and it is significantly higher outside the country. Even with that, you may still have to slaughter a ram as sacrifice to God, so that your body does not reject it.

What about if you are among the millions of poor people in Nigeria who live below N500/day?

The Lord remains our strength.