For the past six years, Mohammadkutty had a fixed routine. The 54-year-old undergoes dialysis three days a week at a center attached to the Government Family Health Center at Thanalur in Kerala’s Malappuram district.
“For the first year and a half, I was undergoing dialysis in a private hospital. I came to this center when I ran out of money but still had to find Rs 15,000 per month for related expenses and travel. We live on five cents of land (one cent equals 435.56 sqft), and have no source of income,” says Mohammadkutty, a diabetic for 25 years and high blood pressure for the past eight years.
Riding on the back of rising lifestyle diseases like diabetes and hypertension, Kerala has seen an unprecedented increase in the number of dialysis patients since 2020. According to the data presented by Health Minister Veena George in the state assembly, the number of dialysis patients has increased. From 43,740 in 2020 to 1,93,281 in 2023 – an alarming growth of 341 per cent in three years. This number doubled to 91,759 in the first year and then to 1,30,633 in 2022.
This increase in the number of patients has led to the emergence of dialysis centers in village panchayats like the one in Tanalur, which was established in 2019. Currently, 105 hospitals under the Kerala Health Department, ranging from district hospitals to family health centers or FHCs (earlier called primary health centers or PHCs), besides tertiary care hospitals, have dialysis units. Apart from government centers, there are about 200 private dialysis centers across the state.
Apart from Thanalur, FHCs in Erattupetta in Kottayam, Valavannur in Malappuram, Marakkara in Malappuram and Uruwachal in Kannur also have dialysis centers working with the help of charities.
According to state-wise data from the Prime Minister’s National Dialysis Program (PMNDP), as of October 31, Kerala has 107 dialysis centers and 1,271 functional dialysis machines. Gujarat, a much larger state, topped the list with 272 dialysis centers and 1,286 dialysis machines. In comparison, Uttar Pradesh has only 78 centers and 884 machines.
Dialysis center in villages
FHC at Thanalur was one of the first such grassroots government-sector hospitals in Kerala to start a dialysis centre. After Malappuram District Panchayat put forward this idea, Tanalur Village Panchayat took the initiative.
“We formed the Tanlur Panchayat Kidney Patients Welfare Society with 230 members,” says V Abdul Rasak, vice-president of the panchayat. “The center was set up on the FHC premises with resources mobilized from the Panchayat, MLA Local Area Development Fund and sponsorship.”
While the cost of a single dialysis in a private hospital ranges from Rs. To run itself, the center depends on the goodwill of its patrons – crowdfunding, charities, or expatriates.
The Tanalur center started with six patients but now has 36 patients working in three shifts.
“Most of them are from the Panchayat area. We have 21 more patients on the waiting list. If we have to accommodate a new patient, the existing patient must die or undergo a kidney transplant. A survey conducted last year showed 57 dialysis patients within the panchayat area,’ says Rasak.
Keeping in view the demand, another private dialysis center with 40 patients is operational within the panchayat limits and a third one is in operation.
Eight kilometers away, Valavannur FHC has a dialysis center with 24 patients, with 38 more in the queue. Apart from these, the nearby municipal town of Tirur also has private and government centres.
Despite these local dialysis centers, the state’s heavy disease burden threatens to overwhelm the system.
About 100 km away, the Alive Makham Charitable Society in Puthuppadi village in Kozhikode has also reached its capacity. The center, which opened two years ago, has 20 patients, with 12 on the waiting list.
“They now have to rely on other centers elsewhere,” said its coordinator Mohammad Mustafa.
For patients, meanwhile, there is another huge financial cost – loss of livelihood. “Many (patients) are earners between the ages of 40 and 60 … three dialysis sessions a week, they may not be able to go to work. Even the person caring for the patient cannot go to work. This has had a huge impact on our families in Kerala,” says Dr MK Mohandas, Head, Department of Nephrology, Government Medical College, Thiruvananthapuram.
48-year-old N Baiju is the dialysis machine installed at the Tanalur centre. A diabetic for the past 15 years, the sole breadwinner of the family, Baiju, an autorickshaw driver, has been on dialysis for a year. Neither he nor his wife can go to work while undergoing dialysis three times a week.
“My two children are students and the auto rickshaw loan is outstanding,” he says. “Friends have formed a committee to help us and we are totally dependent on such help. 5 million rupees are needed for the transplant and efforts are being made to find both money and a matching kidney.
Lifestyle diseases will increase
According to health experts, the major factor behind the explosion in dialysis patients is the high prevalence of diabetes in the state. According to the Indian Council of Medical Research-India Diabetes-17 (ICMR-INDIAB-17) study, the prevalence of diabetes in Kerala is 23.6 percent – twice the national average of 11.4 percent.
Dr Mohandas of Thiruvananthapuram Government Medical College says, “In 60-70 per cent of patients, diabetes is the leading cause of kidney failure and in the remaining patients it is hypertension.”
“With lifestyle diseases unchecked, the number of kidney patients requiring dialysis will continue to rise in Kerala,” he warns.
Dr. Nephrologist of Aster MIMS, Kannur. According to Bijay Antony, the number of dialysis patients has been increasing at an alarming rate in the last two decades. A patient usually needs dialysis 8-12 times a month and spends at least 15,000/month towards it.
“In 2004, when I joined the government medical college in Kannur as a nephrologist, the number of dialysis patients in a month was less than 200, but in the next year, the number of dialysis patients in the same medical college increased to around 3,000 per month. decade Despite dialysis facilities in Kerala, we see that many patients find it difficult to get a slot every week. The only relief is that dialysis has increased the survival rate of kidney patients,” he says.
Apart from lifestyle diseases like diabetes, high blood pressure and obesity, doctors see “drug abuse for pain and gastric problems as a major cause of kidney failure”.
In June, the state health department launched a survey to identify lifestyle diseases among 1.77 crore people above 30 years of age. As of last month, nearly half of the 3.2 million people surveyed, or 1.5 million people, had risk factors. Lifestyle causes disease. In the survey, 4.30 lakh people were found to have high blood pressure, 2.86 lakh had diabetes and 1.69 lakh had both diabetes and high blood pressure.