“My father is COVID-19 positive and is a dialysis patient. He needs urgent dialysis but no hospital is taking the initiative. We tried every possible hospital, both private and state-owned. Please help us,” tweeted Afreen Shaikh. Desperate for help, she tagged the state health minister and other ministers, Bollywood actors and activists before she finally found help. Her 75-year-old father Usman Gani Shaikh admitted to Seven Hills hospital underwent dialysis after waiting for almost two days.
“Nobody was ready to take him. He has high blood pressure and diabetes and was literally suffering. But everyone rejected our pleas,” says Shaikh.
Nilesh Karanje found himself in a similar position as Shaikh last Thursday when Shushrusha Hospital in Mumbai where his father, Gajanand Karanje, had been undergoing dialysis for the last eight years, showed them the door. It has already been five days since Karanje senior took his last dialysis. He has been prescribed three rounds of dialysis thrice a week.
“His face has swollen and we are quite scared what repercussions this sudden stop in dialysis will bring upon his health,” says Nilesh.
A day after Karanje's last dialysis, two nurses and one doctor tested positive at the hospital and since then the entire dialysis unit has been closed down. This, despite the fact that none of the staff who tested positive was from the unit. This left as many as 84 patients in limbo. “We have not been given any alternative where we can get it done,” says Karanje.
Since the government has started to takeover hospitals for designating them as COVID-19 only hospitals, routine services are being closed down and these hospitals are only running emergency services and conducting emergency surgeries. A number of them which had in-house dialysis units have either shut them or asked the dialysis unit operators to move out.
“Many of the dialysis units in hospitals are suddenly being asked to stop and shift elsewhere. This includes hospitals in Andhra Pradesh, Odisha, Gujarat and some other states, too. Moving the set up cannot be done overnight, as the creation of necessary facilities, including for treatment of the water used for dialysis, takes time and operating a dialysis machine requires a specialized skillset,” says Professor Vivekananda Jha, The George Institute for Global Health.
Another impact on all dialysis patients is about the difficulty in commuting to their centres or hospitals given the enforced lockdown across the country. This is especially challenging for those who come from rural areas. They have to travel 50 to 100 kms for their routine dialysis that ranges anywhere from thrice a week to bi-weekly.
Dialysis is a process by which excess water and toxins are removed from the blood in patients whose kidneys can no longer perform these functions naturally. Every twice or thrice a week, a patient is supposed to get dialysis so that the body continues to function well. Missing out on dialysis for a number of days on end can even lead to death in some cases. Moreover, these patients have weak immunity and are prone to catching infections such as that caused by the novel coronavirus.
At present, if at least one COVID-19 positive case is found in a hospital, it shuts down the entire dialysis unit for disinfection and quarantines the staff. Patients, too, are asked to get themselves tested before approaching the hospital for an optional location for dialysis in case the hospital has shut down its own.
“We are being told to produce a negative report of COVID-19 for the services to resume. But that takes time. It takes two days for the private lab to send the person to collect the sample form our home and another two days for the test results to come. This means four days gone anyway. My father has been due for a dialysis for the last five days. His test report is due to come tomorrow,” says Nilesh.
In its guidelines on COVID-19 released by the Union health ministry on April 1, it emphasised that chronic kidney disease stage-5 patients on dialysis are a vulnerable group because of their existing comorbidities, repeated exposure to hospital environment and immunosuppressed state. They are not only more prone to acquire infection but also develop severe diseases as compared to general population, it said.
Swapnil Kate, a 31-year-old dialysis patient who had a kidney transplant in 2010 got himself a round of dialysis on April 13, five days after his last session. His dialysis centre in Mumbai's Andheri area was shut down after a few staff members tested positive for the novel coronavirus.
“I'm lucky to have been allotted an alternate centre,” he says. But Naveen Gadavi's (name changed) mother is still awaiting her next session, after the last one on April 10. “She has been taking dialysis at Shushrusha Hospital thrice a week for the last five years. Suddenly, she was asked to not come to the hospital. Today, we got to know that the facility will be opening tomorrow for the patients. We hope it will open, otherwise I don't know how my mother will survive,” he says, ruefully.
The Brihanmumbai Municipal Corporation has asked the hospital to not admit any new patient and discharge all admitted patients after two nurses tested positive. However, no arrangements were made for dialysis patients.
“The hospital has been sealed and we have followed BMC orders. We are trying our best to disinfect the facility and help patients. There is no confusion at all, the dialysis facility will start at the right time,” said Dr Shilpa Deshmukh, Dean, Shushrusha Hospital.
Kirtikumar Shinde, general secretary of MNS, took up the issue on social media expressing concern over the plight of the patients. “Dialysis is crucial for the survival of a patient. We got in touch with our higher-ups to make sure the service at the hospital is re-instated as soon as possible.”