No dialysis for HIV sufferer
Cape Town - A family has questioned Groote Schuur Hospital’s policy on its dialysis programme, saying doctors are “playing God”, while violating a kidney patient’s right to healthcare, after their young relative was sent home to die.
Nomtha Loretta Mazana, 28, from Gugulethu was discharged from Groote Schuur last week after doctors told her she didn’t qualify for dialysis because she has HIV but was not yet on antiretroviral (ARV) treatment.
“The doctors said my kidneys are badly damaged and will soon give in within weeks or months. They said they can’t put me on dialysis as criteria doesn’t allow it as I am not on an ARV programme ,” she said.
Mazana, who was admitted last Wednesday with severe headaches, said the doctor that treated her had instead advised her “to go to church as she needed to be strong spiritually” when dealing with renal failure.
“The doctor said I must go home, get myself on the ARV programme and see how far that takes me. He said he is not denying me treatment, but the criteria said an HIV patient who has a low CD4 count, like me, and is not on ARVs doesn’t qualify for dialysis.
“I was advised that if ARVs work, then I can come back after six months to be considered. But my worry is that I don’t even know if I will live that long. I feel like I’m running out of time already. I’m scared of dying before my time is up,” she said.
But Darren Francis, the spokesman for the provincial Department of Health, said the policy on dialysis was in line with that of the Renal Society of South Africa.
“It was developed in consultation with renal clinicians and medical ethics experts nationally,” he said.
He refused to discuss Mazana’s clinical details, saying this was a sensitive matter, “but Ms Mazana’s request to be accommodated on the dialysis treatment programme has previously been reviewed and she has received feedback”.
Mazana, who was diagnosed with HIV in 2010, said she was not on ARVs as her CD4 count was high the last time she had it checked a year ago.
HIV-positive patients in South Africa only qualify for ARVs if their CD4 count falls below 500. Doctors at Groote Schuur reportedly found Mazana’s CD4 count last week to be below 100.
Mazana’s uncle, Mlungisi Mazana, said the strict criteria forces doctors to play God.
“The policy removes doctors from their core function, which is to save lives. It is also turning them into gods who can dictate who should live and who should die.
“That’s not how I understand healthcare. If the hospital had exhausted all medical interventions, I would understand why they are turning my niece away. But just telling her to go home to die without even trying once to keep her alive is shocking,” he said.
He said the family was told they could approach the private healthcare sector.
“The doctor made it clear that should she go for dialysis tomorrow she would be fine, but the problem is we can’t afford to pay R60 000 a month for dialysis in the private sector.
“We are stuck and we now have to prepare ourselves for the death of such a young person who has so much potential economically and socially. It is really not fair at all,” he said.
According to the Western Cape Renal Registry, which was set up last year, the Western Cape’s public sector was only able to treat 30 percent of patients in end-stage kidney disease.
About 70 percent were sent home to die due to lack of resources.
Lack of treatment centres in other provinces also meant that people travelled from their home provinces to better-equipped provinces such as the Western Cape and Gauteng to seek treatment. Such measures not only inconvenienced patients, but placed a lot of pressure on provinces that offered treatment.
Stellenbosch University professor Razeen Davids, who heads the renal registry, said the chronic kidney disease was a silent killer affecting one in every 10 South Africans.
Because of its lack of symptoms in the early stages of the disease, not many patients realised they had kidney problems.
Francis said only patients who would ultimately qualify for renal transplantation were accepted into the renal dialysis programme. The overriding criterion for acceptance is “suitability for transplantation”.