The urgent need for dialysis treatment in Tonga to save lives

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Dialysis treatment at home

By Kalafi Moala

 

Nuku’alofa, Tonga – It is a life and death story that could have gone the other way, and Saia Moehau at 55 years old would not be with us today. But he is alive and well, having gone through dialysis since 2014, and with a new kidney transplant, he continues to run his businesses and enjoy life here in the kingdom.

Saia Moehau

But the cost, both mentally and financially, has not been without its usual complexities for someone who had kidney failure and who could not be treated in his home country.

Two of the common causes of kidney failure include diabetes and high blood pressure. And diabetes in its various forms is one of the most dangerous killer diseases in Tonga.

Saia Moehau, of Hofoa, Tongatapu, was suffering an illness that could not be treated in Tonga. He was facing a condition that could end his life. He did not know he was having kidney failure even though he suffered extreme exhaustion and showed physical signs of something fundamentally wrong with his health.

His doctor and chief health counselor was in Los Angeles, and he had to get there before something tragic happens.

“I knew I was sick, and yet I had hope that I would find a solution. I needed to get a proper diagnosis, so I can seek treatment. I had to go to the United States,” Saia said.

It was in Los Angeles that Saia after tests, discovered he needed to start Hemo Dialysis treatment due to kidney failure, and in his own words, “resulting from hypertension and alcohol abuse.”

Hemo Dialysis is a procedure where a dialysis machine and a special filter called an artificial kidney, or a dialyzer, are used to clean the blood. The entire blood is circulated outside the body in this machine, which cleans and returns the blood to the body.

“I started Hemo Dialysis treatment in May 2014 in Los Angeles. This was not an easy journey for me both mentally and financially,” Saia said.

“But because of work back here in Tonga which was very critical for my financial support during all these hard times, I requested to shift my treatment to a mobile dialysis system called Peritoneal, which I used while traveling out from the US for a period of 3 years.”

“Later, I changed to another mobile dialysis system called NxStage Home Hemo. This was portable and I was fully trained and approved by my doctor that I am qualified to do my own dialysis treatment at home.”

“This enabled me to start traveling back home since January 2015. I spent a week in the US and 3 weeks abroad every month until I finally got my kidney transplant in October 2019 at the famous Mayo Clinic in Arizona.”

Saia said that apart from traveling back and forth between the US and Tonga, he went with this dialysis system as far as Singapore, China, England, Germany, Australia, New Zealand, Fiji, and Samoa.

Kidney failure in Tonga

During the early stages of Saia’s dialysis treatments he did research on 2 things: why people are getting kidney failures and what was the most affordable dialysis treatment system?

“I found out that the number one cause for kidney failure is diabetes followed by hypertension. And the most affordable dialysis system would be ‘manual peritoneal dialysis system’,” Saia said.

“Then I did another research on diabetics in Tonga and I was shocked to find that around 80% of the population living in Tonga do have diabetes of some sort.”

“In 2015, an average of 150 to 200 diabetic patients with kidney failure die every year, although it is estimated there may be more than that. But this number has been consistently reported in the past several years.”

Saia said: “This motivated me to seek options of how I can help to prolong lives of my family, friends, and people living in Tonga with kidney problems. I first talked to a few people here in Tonga who may be interested and the support was overwhelming.” As a result, the Tonga Dialysis Foundation was registered on 11 February 2015.

Saia said this project was started during the Government of Prime Minister ‘Akilisi Pohiva. Dr. Saia Piukala was Minister of Health at the time.

 “We did a proposal to Cabinet and one to Parliament on how we can afford dialysis treatment in Tonga, but it all went back to the discretion and directions of the Minister of Health,” he said.

 “We had donors lined up to help, including the Church of Jesus Christ of Latter Day Saints. One Australian donor donated and shipped to us 12 dialysis machines costing almost AUD$1m.”

“All these donors wanted at the time was a letter from the Government of Tonga saying there is no dialysis treatment available in Tonga, and that they support dialysis treatment urgently needed to help save and prolong lives.”

“But, to make a long story short, Government at the time did not support the project. Their main concern was sustainability. We humbly respected their decision. But later got connected with a group from Salt Lake City, Utah during the same Government.”

“We introduced them to the Ministry of Health and to the Queen of Tonga, but somehow our connections with them got disconnected and they are doing it themselves with the Ministry of Health.”

“I know these people as we’ve met a few tims back in Los Angeles and Salt Lake City, and I wish them all the best. Their intentions are great and we look forward for the borders to open so they can come in and do their stuff.”

“All we wanted is for something to happen that would help our people and we will help them in anyway if they need our assistance at anytime.”

Saia said that he was scheduled to meet with NxStage Home Dialysis people by mid-2020 to discuss how they are going to help, “but unfortunately, Covid 19 was in our way and am just waiting for the borders to open in order to make that happen.”

“I shared my own experience and that stirred the interest of its corporate and I am very hopeful for their help,” Saia said.

What is proposed to be done?

Saia said that from the beginning what their foundation proposed to Government is to provide US$1 million (about $2m Pa’anga) per year to run the dialysis treatments in Tonga and to ensure sustainability, which was an issue of concern to Government.

“If this Government or any future Government wants to work with us, based on our proposal for dialysis treatments to happen in Tonga, and to remain sustainable, the same amount is needed each year. We are not after anything fancy, all we want is to save lives,” Saia said.

“I am sure there are other options Government may well look at, but for us, we are also looking at the option of doing our own commercial dialysis treatments facility and charge people to dialyze. This is still in the pipeline,” he said.

Asked whether the Government, and especially the Ministry of Health is supportive and cooperating in the effort to get dialysis treatment to Tonga, Saia said “the current Minister of Health is very supportive.” 

But he says, they have not discussed this project in detail due to Covid-19 being more the priority right now.

“I will initiate more discussions with the Ministry of Health once Covid-19 is out of the way,” Said said.

“Government must play a big part in this initiative, otherwise nothing will work if we are up for free treatments,” he said. “We cannot be so arrogant to expect someone out there to come and do it free for us. That is not going to happen. We have to show the outside world what we are contributing to the plate, and they will come in with the rest of what is needed.”

“Government can set this as a priority and they can easily ask one of its donor partners to help. But this all depends on what is the real priority of the Government of the day.”

Health and education have always been heralded from Government to Government as the priorities each year. There has not been any recorded death due to lack of education, but there are over 200 deaths a year from kidney failure.

The incredible factor that makes Saia’s story so powerfully real, is that he is a survivor of kidney failure, through dialysis, and then eventually a kidney transplant. He knows what he is talking about. He says there is so much hope, but we must make the effort and prioritize the saving of lives.

“Someone may come in and do dialysis commercially, and that is one of the options we are considering, but we would need foreign partners to keep it sustainable,” he says. “We are currently in dialogue with some.”

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