Tyranny of dialysis travel kills Aborigines

[okarol]

Tyranny of dialysis travel kills Aborigines
Sue Dunlevy From: The Australian June 22, 2011 12:00AM

INDIGENOUS Australians are choosing to die rather than travel huge distances to undertake renal dialysis to treat their kidney disease, an alarming new study commissioned by the federal government has shown.

A draft copy of the study by the George Institute for Global Health, obtained by The Australian, finds indigenous Australians are eight times more likely to die from chronic kidney disease than non-indigenous.

The number of people from central Australia receiving maintenance dialysis more than tripled from 62 to 209 between 1999 and 2009, and an extra 35-40 new patients need the treatment every year, the study found.

However, the most alarming finding was that 42 indigenous people in central Australia had decided not to undertake dialysis -- a decision that would hasten their death. A further 89 were undecided about whether to have the treatment.

"For people in remote communities, lack of access to dialysis services closer to home is a key determinant of uptake of RRT and adherence to treatment regimes," the report says.

The study was commissioned by Indigenous Health Minister Warren Snowdon last year after a senior indigenous community leader from Ernabella, in the north of South Australia, was told she would have to travel to Adelaide for dialysis treatment, despite Alice Springs being much closer to her home.

An Adelaide-based psychology expert, Bernard Guerin, likened the practice to sending an Australian patient to Guatemala for treatment.

The problem arose because South Australia was refusing to fund interstate dialysis treatments for indigenous residents living in remote areas of the state that are relatively close to Alice Springs.

The government has received the report but it has not yet been released publicly.

An early draft of the report shows the study found home-based dialysis treatment is not sustainable in indigenous communities.

The researchers suggest that better options would be renal-ready rooms available at local health facilities, and mobile renal bus services.

http://www.theaustralian.com.au/in-depth/aboriginal-australia/tyranny-of-dialysis-travel-kills-aborigines/story-e6frgd9f-1226079518608

[MooseMom]

Why would home-based dialysis modalities not be sustainable in that part of the country?  Could it be that it would be logistically too difficult to get the supplies out there?  There ARE a lot of supply runs involved.

I wonder why the ESRD rate has risen so high in that population.  Is it just better detected, or is there some other disease vector at play?

Could someone explain South Australia's refusal to fund this?  Is it up to the individual Australian states to fund dialysis?  Cannot the central government do something?  I'm not au fait with Australian medical politics, so if someone could clear this up for me, I'd be grateful.

[RichardMEL]

A few comments with the caveat that I am a layman.

First of all, our health system is bizarre in some respects. The states actually run the hospitals and health systems on a statewide basis (eg: dialysis) *BUT* things like the universal health system (medicare - which is different to the US one), the PBS (pharmaceutical benefits scheme - which subsidises meds) etc are all handled and funded by the feds. So there's a disconnect.

Earlier this year there was a move by the current federal govt to take over the health systems in each state(ie: the public hspitals, dialysis etc). This was knocked back by the states (I can't remember why but basically came down to a share of tax revenue being given back to the states, or something like that).

So it kind of leads to a disjointed system where some states will fund stuff and others won't. Bizarre, I know.

One thing that this article didn't state but I understand is very common in the indigeenous communities - that it may not just be travel that is the issue. I have spoken to a number of nurses (and others) who have worked in Alice Springs (middle of the country), Darwin etc  where there are large indigenous communities, and SOME folks tend to be VERy unreliable, or "go walkabout" as it were, and do not care to keep to dialysis  schedules even if they can get there.

I believe one factor in the higher incidence of kidney disease in the indigenous population is dueto large amounts of drug and alcohol abuse in those communities added by poor conditions (some communities are little more than camps, which may make things like home dialysis not practical for things like access to clean water, power etc).

It is a very complicated, difficult and sad issue from many perspectives.