I’m keen to go to mainland China to immerse myself in the language and get more fluent. The problem is: how reliable is dialysis over there? Here’s what I’ve found so far.
Like me, you’ve probably heard stories about poor quality water, not using new consumables (eg reusing [your own] lines and dialysis cell in subsequent runs, injecting with used needles), and more. I feel very safe in my unit because I know how seriously they take both infection control and the efficiency of each dialysis session. In fact, I take it for granted; likewise, when I have travelled around Australia, the UK and Europe.
So, what’s it like for the locals in China? Answer: not so hot. At least 240 renal patients per 1 million people worldwide receive dialysis treatment regularly. But according to Wang Haiyan, an expert at Fudan University’s School of Public Health, only about 45 patients per 1 million people in China benefit from dialysis. Kidney disease experts estimate that the renal failure rate in China may be as much as 300 cases per 1 million, indicating that many of these patients are not getting the treatment they need.
The medical infrastructure and the funds for Reliable-Dialysis-For-All is simply not there. In big cities like Shanghai, it’s not so bad, where up to 90 percent of people who can get dialysis have between 10% and 50% of the cost paid by their social insurance. These patients receive on average, 2.6 treatments per week each of about 4.4 hours in length. Which is a little short of what we expect in many western countries. What’s harder, the remaining 10 percent are self-payers, who receive less frequent dialysis and are less well as a result.
However, in more remote areas, half or less are covered by insurance. In these areas, dialysis quality and infection control measures are often traded off for a lower cost service. The result is higher levels of hepatitis C and other infections and a shorter lifespan.
No one talks about those that can’t afford any dialysis at all…
(This is not unique to China. Other countries without a national health system have the same problem. Many uninsured dialysis patients (often recent immigrants) in various cities across the US have nowhere to go. Their very survival relies on the grace and favour of local hospitals that are prepared to take them on, at least for an interim period.)
So what about holiday dialysis for visitors? Many people I know won’t dialyse in China. They dialyse in Hong Kong, fly into China to do their business, sightseeing, etc. and fly back for the next session.
However, I would really like to test the local system. Luckily I have a friend in China who can find out exactly what the deal is for dialysis on the mainland, especially in big cities like Beijing and Shanghai. I am pretty sure it will be OK for a short visit – a week or so… maybe. I hope to arrange to go there for Chinese New Year late in February. We are in the early days of setting things up: my unit’s people will speak to your unit’s people, etc.
I’ll let you know more as things progress.
Postscript: further news about the problem in funding dialysis for communities, like me you may have been following the difficulties for Grady Hospital’s Dialysis Unit in Atlanta, USA over the last few months. With no dialysis funding available for undocumented immigrants, Grady outpatient dialysis unit was closed on 4 October 2009, affecting 40 dialysis patients, some of whom have already died.