South Africa on HD any experiences to share?

[iolaire]

I’m planning at trip in August with my wife for a Safari near Johannesburg and then six nights in the Cape Town area.  We use award tickets so I need to set up everything in advance pre in-center HD dialysis. And of course since this was planned pre dialysis everything was crammed in there.  I need to book the safari lodge and re-arrange our internal flights to allow for in-center HD dialysis. 

At this point our US -> SA flights are fixed, the options are either to cancel (I would get back the miles) or figure out how to pigeonhole in dialysis.  I think it’s doable but I’m not going to have a lot of flexibility on the dates/times without giving up a lot of the vacation.

(I’m very happy that I can still look at trips like this.)

Does anyone have experience with Johannesburg or Cape Town area dialysis centers?  I’m especially interested in any feedback as to how hard it is to schedule treatments and the slot availability.

I did see positive reviews on Global Dialysis for some centers, but I’m hoping someone here has some tips.

Also it looks like I'll be choosing between a B Braun or Fresenius Medical Care center in JBN - does anyone have a preference?  I don't other than my center uses Fresenius machines, and my Singapore sessions were at a Fresenius center - but the B Braun center may have better times.

[Tío Riñon]

Greetings.  I hope that you enjoy your trip to South Africa.  Remember to pack accordingly because the seasons are reversed from the northern hemisphere.  I visited in July and although the days were sunny and tolerable, the nights were cold and there was little or no heat.

I can't comment on HD down there because I'm on PD and handled my own treatment, but my nephrologist emphasized that under no circumstances was I to get a blood transfusion while there.  Also, make sure that you have good travel and medical insurance.  They have two types of hospitals in SA:  public and private.  You should go to a private if you want quality treatment similar to the US, but they expect payment up front.  Your insurance company can either make arrangements for you or guarantee payment if you have an emergency.

You will definitely have some memorable experiences in both J-burg and Cape Town.  Leave lots of time to explore the beauty of Cape Town...from the scenic waterfronts to the majestic cliffs, not to mention the chance to experience history from Apartheid to the vision of Mandela.  Please share your experiences from the trip, if you go!

[iolaire]

They have two types of hospitals in SA:  public and private.  You should go to a private if you want quality treatment similar to the US, but they expect payment up front.  Your insurance company can either make arrangements for you or guarantee payment if you have an emergency.

Thanks, I'm basically self pay.  My insurance may consider it out of network, but I'm waiting to see how they respond to my Singapore submission to learn how they will respond.  I'll email a few sites this weekend to figure out the costs, if I ever encounter US level pricing that will be the death of the trip.  In November I'll see if my wife's insurance options with the government have plans that are more global.

[Bill Peckham]

I dialyzed in Capetown, Port Elizabeth and Nelspruit in 1999, I am sure a lot has changed in 15 years. I dialyzed at private clinics that I set up via email which was a bit of a novelty at the time. What I found is that the public health system was under a great deal of stress, public dialysis clinics were over full and would mostly dialyze people once or twice a week. The private centers by comparison were very accommodating and allowed me to schedule treatments in advance to meet my schedule. The treatments were fine, just low amenity situations but really once the needles are in we are all using the same process - dialysis machines and water treatment systems are technology that have been around long enough that there is no reason you can't receive a safe quality treatment. At the time I was charged the equivalent of $180 USD per treatment which is the least I have paid anywhere in the world.


Here is a link to my trip write up http://www.globaldialysis.com/index.php?option=com_content&view=article&id=108000000

[iolaire]

Here is a link to my trip write up http://www.globaldialysis.com/index.php?option=com_content&view=article&id=108000000

Bill thanks for the response, I'm happy to learn that the prices might be low.  Thats one item that is scaring me since this is a longer trip.  I'm still worried that I might not be able to get 50% out of network coverage from my insurance, so five days of dialysis could be a deal breaker on the trip.

Are you associated with www.globaldialysis.com?  One item that would be nice to have is some sort of estimate of dialysis self pay costs by country.

[Bill Peckham]

Here is a link to my trip write up http://www.globaldialysis.com/index.php?option=com_content&view=article&id=108000000

Bill thanks for the response, I'm happy to learn that the prices might be low.  Thats one item that is scaring me since this is a longer trip.  I'm still worried that I might not be able to get 50% out of network coverage from my insurance, so five days of dialysis could be a deal breaker on the trip.

Are you associated with www.globaldialysis.com?  One item that would be nice to have is some sort of estimate of dialysis self pay costs by country.

My association with globaldialysis was only as a user and supporter. Prior to its start the main resource was The List a paper directory of units. globaldialysis's launch coincided with the height of my incenter dialysis travel and was where I first blogged, but yes getting accurate cost information has always been a challenge. You never really know until you get the bill because the people who are willing to tell you "the price" are not the people setting the fees. The exception is at private units where they are very upfront and can actually know what a session will cost.

[aharris2]

Check out Holiday Dialysis International (on-line). It is centered in Italy, affiliated with Fresenius, and will help you arrange dialysis just about anywhere in the world. A few years back we arranged dialysis outside of the US using HDI and everything went smoothly. I did the on-line thing and also spoke to them on the phone (Chiara Frattini - nice , helpful, and spoke English)

Enjoy your trip!

[iolaire]

I'm happy to say I received my first quote for JNB dialysis (private) and it was about $270 per session which sounds good. Also my insurance claim for my Singapore dialysis was approved at 100% and I have the check sitting at home now.  So at this point the trip looks likely, I just need to work through a few of my wife's concerns re health safety in South Africa.  She has some reasonable concerns, but I'm confident the dialysis is dialysis almost any where you go as long as the centers are in a developed area, which the large city's of SA are.

[Bill Peckham]

 


I've always thought that once the needles are in the treatment is the same.

[iolaire]

And now time for a quick trip report on dialysis is South Africa.  Last November I talked my wife into heading to South Africa for a quick safari and then some time in Cape Town. 

Qatar Airways ("the five star airline") had just joined the OneWord airline alliance so we were able to us our American Airlines miles for a One Word Explorer award, the benefit of this now retired award was that it is distance based and you could do stopovers as you desire as long as you fly two One World carriers.  That allowed us to fly business class to Johannesburg via Doha on Qatar, go on a Safari near Johannesburg and then continue on to Cape Town on British Airways.  Nothing too complicated for this type of award but still a great award - especially in light of the fact American retired the award as part of their merger with US Airways.

So I booked our flights in November and then in December started dialysis.  In February I was able to get my Dialysis in Singapore - which is a very modern destination and found the center very similar to my center at home.  But still I had some reservations heading to Africa and getting my dialysis.  But from my research and feedback on the forum ihatedialysis.com ( http://ihatedialysis.com/forum/index.php?topic=30787.0 ) it sounded like the private healthcare system in South Africa is good - but not the public system.  Also throughout the summer I received some calls from the kidney transplant center so I thought by the time the trip hit I'd have a new kidney and need to cancel the trip.  So we bought good travel insurance and waited until the departure day.

Using the website globaldialysis.com I reached out to two centers in Johannesburg via email and only FMC Morningside Kidney and Dialysis Center responded ( http://www.globaldialysis.com/component/centrez2/?centrez2Task=centrez2Details&catid=&centrez2Id=43038 ).  The prices sounded reasonable and they took some orders from my center with out the need for a specific form or an AIDS test like Singapore required.  A few weeks before departure the coordinator at Morningside recommended a Cape Town site and I was able to get spots there.  In general the centers were very accommodating and let me have my preferred times.  I appreciate that since at some centers that means someone gave up a time slot to accommodate me.

Finally the day arrived and we headed out to Dulles and waited for our flight in the stylish Virgin America lounge.  The Qatar Airways business class service was wonderful, not as intimante as first class but the food and service was comparable.  We arrived in Qatar just in time to do the last free city tour of the day.  Braving 104* weather a 8 PM we got to see some of the new downtown that sprung up since 2004.  Then when we returned to the airport for a lounge dinner, then headed to the Marriott for four hours of sleep before continuing on to Johannesburg. 

Our Doha to Johannesburg flight was on the fairly new Boeing 787 Dreamliner.  It was a nice flight, but for couples it doesn't really offer close seating, and when in a bed position the window seats have a fairly tight area for your feet.  My personal feeling is that for couples the older Boeing plains flying to Dulles are nicer.

Upon arrival to Johannesburg we took the nice modern Gautrain to Sandton and walked a few blocks over to the Hilton.  After waiting about 45 minutes for checkin we were offered a decent suite with lounge access.  The excitement for the nap was a stewardess entering our room well we were napping - I guess its hard to figure out when you put someone in room!

So the next morning at 5 am I walked over to the dialysis center.  It looked to be in a business park connected to a hospital so I entered the hospital and they had someone walk me over through the dark business center to the appropriate building.

At the dialysis center I found very modern facility with newer machines. As in Singapore they provide a drink and a snack during the session, which is quite nice. The snack was actually a grilled cheese.  Clearly the labor costs are lower as there are people doing specific jobs, such as serving food, setting up the dialysis machines and cleaning throughout the day.  Overall it was a comfortable center and I was done a bit earlier than I expected so I was back at the hotel prior to Susan getting picked up to go on the Safari - which was good as I'd expect the driver would have had a hard time finding where the center was.

We spent three great nights at the lodge and got to see our fair share of animals!  The highlight was a herd of about seven elephants visiting the watering hole right in front of the lodge.

After our safari we drove back to Johannesburg and I went directly to dialysis well Susan headed to the airport.  Our 7:50 flight had been canceled so we were on a 7 PM flight with me arriving to dialysis at about 1 PM, however I was not hooked up until about 1:45 PM so I quickly realized that I could not do the full 3.5 hour session and cut it short to 3 hours.  Even with that the time to get to the flight was very close.  After I disconnected and walked out onto the street I experienced my first experience of a bleeding arm, so I had to head back for more tape.  Luckily I arrived at the Gautrain just as one was arriving and I got to the airport with maybe 15 minutes to spare. 

In Cape Town, I found a smaller facility, but with the same modern equipment. The snack was a cold chicken salad sandwich, apple, and tea. Not quite as good as the hot grilled cheese, but still much more civilized then at home, where nothing is offered.  The one downside is the center was about 30 or 40 minutes from City Bowl.  Later on the street we saw a dialysis center very close to Long Street and City Bowl, that would have been much more convenient - but harder to schedule since it didn't show up on the Global Dialysis site.

So far I've only seen very good facilities when traveling and see no need to let dialysis keep you at home - as long as your underlying medical issues are stable and you have private insurance that reimburses the session cost.

Once you move to Medicare (after 3 years) they don't cover outside of the US treatment. So far international treatments have been just under $300 per session. (That is about what Medicare pays at home, versus my insurance that is billed $5,400, and then pays a negotiated rate of $1,400.)

In addition to international travel I've had treatments at DaVita centers in Austin, Boise, and Kansas City and they are are comparable to my local center.

Photos attached show the Johannesburg center's checkin, machines, my snack and a few safari photos.

[Simon Dog]

Once you move to Medicare (after 3 years) they don't cover outside of the US treatment. So far international treatments have been just under $300 per session. (That is about what Medicare pays at home, versus my insurance that is billed $5,400, and then pays a negotiated rate of $1,400.)

Great description of your trip - it may make some of us less scared of international travel.  Thanks.

I think medicare is 30 months, though the clock may not start to tick until after a few treatments.     My insurance pays a negotiated rate of $454, however, when I travel domestically it invariably pays the asking price of $5000-$7000 per treatment.   The $7000 was prior to home dialysis (I still use clinics for some travel) and I received some separately billed EPO.  At that rate, I should have rated a snack, glass of wine, and massage with happy ending.

[iolaire]

We just returned from a second trip to South Africa thanks to great low priced coach airfare (under $500) from Washington Dulles Airport on South African Airways via Accra Ghana.  We had a great trip with one wine tour via Wine Flies.  Their tour was great, and far superior to the company we had to use last time because they were booked up.  This time we reserved far in advance to insure we could go with them.  Then we did a Cape of Good Hope tour with daytrippers, that was a great excursion as well.  Finally we got up Table Mountain for their after 6 PM Sunset special when the cable car is half off and spent about an hour and a half watching the sun set.  It was a great trip despite about 24 hours in transit each way in coach.

Two sessions dialysis at NRC CAPE TOWN CBD. I did not use that center last time because its address is entered as "Cnr Bree & Church Streets" and goggle maps doesn't recognize it so it put it out in some random place, but we saw the center so I knew to look for it again this time.  The correct location is at 181 Longmarket St, Central, Cape Town, 8001, South Africa.  Its a small center with maybe 12 beds in a small space.  Price was 1794.4 rand per session or  $133.63 USD.  Had they gotten me the quote sooner they would have liked me to wire prepayment, but it came a few days before we left so I paid cash and the office manager deposited the payment and gave me a receipt.  They would have provided a drink and a snack but each session was right after lunch so I actually turned down both offers of drinks.


Cape Of Good Hope, notice how my fistula is starting to get burned from the sun

[cassandra]

Lovely story, thanx for sharing Iolaire, and I'm mighty jealous. 

It looks and sounds great

Love, Cas

[Stephen Attwood]

Thanks for making the trip to South Africa. I have been here since 1982 and am a naturalised citizen. I have been dialysing since 2006 on PD until this year where I have really joined the IHD crowd doing HD. It is quite a mission to find dialysis units reasonably near to your holiday spot (unless you are visiting one of the big metro's). We went to the Waterberg mountains just north of my home in Pretoria ("just North" was actually 250km or so!) and went to Mokopane for my dialysis session (90 minutes drive: local by our standards). I am glad our private units are on a par with yours in USA. A huge problem here is diabetes resulting in kidney failure. Too much sugar, fat and salt in the diet. Not my problem as since marriage my diet has become vegetable-rich, low fat and very little salt. Women can have that effect. I enjoyed your notes about my new home (actually been here for over half of my life now). Ignore the politics and don't show off your valuables and it's a great place.

[Simon Dog]

Just curious - what is the state of home hemo is South Africa?

[iolaire]

Thanks for making the trip to South Africa. I have been here since 1982 and am a naturalised citizen. I have been dialysing since 2006 on PD until this year where I have really joined the IHD crowd doing HD. It is quite a mission to find dialysis units reasonably near to your holiday spot (unless you are visiting one of the big metro's). We went to the Waterberg mountains just north of my home in Pretoria ("just North" was actually 250km or so!) and went to Mokopane for my dialysis session (90 minutes drive: local by our standards). I am glad our private units are on a par with yours in USA. A huge problem here is diabetes resulting in kidney failure. Too much sugar, fat and salt in the diet. Not my problem as since marriage my diet has become vegetable-rich, low fat and very little salt. Women can have that effect. I enjoyed your notes about my new home (actually been here for over half of my life now). Ignore the politics and don't show off your valuables and it's a great place.

Welcome thanks for your post.  On our first trip we did our safari at Nedile Lodge in Welgevonden Game Reserve, Vaalwater.  My solution for that was a very early dialysis session on Friday in Joberg, drive up to the lodge and get in a game drive that afternoon and three nights at the lodge, returning on Monday after a game drive for another session Monday afternoon in Joberg.  In that case my wife went directly to the airport to kill time in the lounge until our flight, I just barely made the flight, had I be 15 minutes later I would probably have not connected...

[Bill Peckham]

Looks like a great trip again. I'd love to get back, my two weeks in SA is still one of my peak life experiences.