Most in need of dialysis don't get it

Cost and shortage of technicians to man dialysis units is denying treatment to many

Although there are many dialysis centres run by hospitals and charitable institutions, the City is facing a crunch of trained technicians and nurses. On World Kidney Day, Deccan Herald takes a look at the problem.

According to international guidelines, the technician-patient ratio at any dialysis centre should be 1:3. The reality is far graver. Narayana Hrudayalaya, which has 28 dialysis machines in its hospital and eight more in Chinmaya Mission Hospital, requires 10 technicians and an equal or more nurses.

“There is an absolute shortage of trained manpower for dialysis. Even if we want to start five dialysis units in the City today, we cannot do so as we won’t get people,” said Dr Lloyd Vincent, Director of Dialysis Services and senior nephrologist, at the hospital.

At the Institute of Nephro Urology, the government-owned hospital at Victoria Hospital campus, there are six technicians for 22 dialysis machines. They are assisted by 20 students undergoing a two-year diploma dialysis technician’s course. But on most days, two technicians would be on leave to finish off the government holidays, which they have to complete within a month. Also, compared to the day shift, night shift has less staff, says a source at the hospital.

Institute director Dr G K Venkatesh, however, said the burden on the institute had come down, with the 16 district hospitals having opened dialysis units, including K C General Hospital and Jayanagar General Hospital.

“Our focus is more on treating emergency, transplant or complicated patients rather than maintenance dialysis, since the district hospitals can take care of that,” he said.

More training courses

Such is the need that the hospital is now recruiting people from neighbouring states. “Nephrology in Karnataka started late, compared to, say Tamil Nadu. So, there are few dialysis technician training courses available in the State,” he explained. To address the problem, Narayana Hrudayalaya recently started RGUHS-recognised three-year BSc dialysis training course with an intake of 20 students.

The hospital is not alone in starting a course to tide over the trained staff shortage. St John’s Hospital has been running its BSc dialysis training course for technicians with an intake of five students along with a one-year certificate course in renal nursing.

However, Dr Gokulnath, head of nephrology, St John’s Hospital, agrees that there is indeed a need for trained manpower. The hospital has 35 machines and performs 3,000-3,500 dialyses every month.

With such severe shortage, there are cases where trained technicians are shared by various dialysis centres. “One of our dialysis technicians works in a hospital. So, technicians go to different hospitals and get to earn a hefty amount,” said M V N Raj, honorary director, Bangalore Kidney Foundation.

Regulation

Further, there is no supervisory body constituted by the government, that would check the quality of dialysis given to patients, let alone the high cost. “There are around 35,000 dialyses conducted in Bangalore every month in roughly 124 centres. However, there is no government body to ensure that patients get proper dialysis,” said Dr Gokulnath.
He added that the government should constitute a body similar to the one that supervises ethical and legal organ transplant.