At the JPMC, a patient who comes to seek treatment for renal failure ends up spending up to Rs800 per visit even though dialysis charges are only Rs300; the rest includes transport fares and other expenses.

One of the major areas of concern when it comes to health care, are dialysis centres operating in various hospitals and private medical facilities, located around Karachi.

Kidney dialysis is a medical treatment administered to patients suffering from end stage renal (kidney) failure.

The three major facilities in Karachi that offer round the clock dialysis facilities, are the Jinnah Post-Graduate Medical Centre (JPMC), Civil hospital (CHK) and the Sindh Institute of Urology Transplantation, SIUT located just opposite the CHK.

Civil Hospital has only six dialysis machines that are operated by the SIUT. The hospital claims that the facility operates on a twenty-four hour basis and the dialysis solutions are being made readily available. However, no specialised doctor was available for comment at the time of visit.

SIUT claims to be doing one hundred thousand dialysis treatments annually. “All treatments, medicines and dialyses are provided free of cost,” says Dr Sohail, one of the medical supervisors present at SIUT`s dialysis centre. Patients are known to come here from all around Pakistan and belong to all age groups; however they largely hail from the middle and lower income groups.

In Pakistan, the most well known reason for kidney failure is high blood pressure. However, when asked, Dr. Sohail explained that there are many other complicated medical situations that can lead to acute renal failure such as gastroenteritis which can lead to massive fluctuations of the human body`s electrolyte balance and a huge loss of water from the body hence damaging the kidneys. Dehydration is a major cause of renal failure.

One of the less commonly known causes of renal failure is excessive blood loss during childbirth. In some cases, pressure exerted on the kidneys during labour pains and delivery can cause acute renal failure.

Twenty five year old year-old Shabana`s kidneys failed due to multiple pregnancies and delivery related complications. Another patient was a ten-year-old girl, undergoing treatment since the last six months.

Incorrect diagnosis of patients exacerbates the problems and causes further complications. Dr Abbas of SIUT explained that ten-year old Shabana had been misdiagnosed as suffering from heart disease by doctors at a state-funded medical facility. However her symptoms were that of renal failure, which was further aggravated due to incorrect diagnosis.

Hepatitis patients, as per international standards, are treated separately. The water that they consume and their dialysis fluid, along with hospital clothing, is dealt with separately as there is always a danger of cross contamination.

Dialysis solutions are being produced locally and administered to the patients according to their need. “Powdered salts are imported and then mixed with treated (reverse osmosis) water,” says Dr. Ejaz, “mixing of various salts creates the right composition.”

Dialysis solutions are composed of two sub-solutions. Solution A is an acid concentrate and Solution B is bicarbonate. These solutions need to be mixed correctly, in the right concentration, according to the height and weight of the patients. It is the correct mixture of `A` and `B` that goes into the body and purifies the blood.

Most officials and doctors complained that in many cases, patients do not come for follow up treatments. Reasons cited for this are many, the first and foremost being financial constraints. At the JPMC, a patient who comes to seek treatment for renal failure ends up spending up to Rs800 per visit even though dialysis charges are only Rs300; the rest includes transport fares and other expenses.

In fact frequent traffic jams and long-distance travelling due to the absence of medical facilities within close proximity are also major reasons that prevent patients from seeking the required treatment; thus they suffer rapidly deteriorating health.

While addressing these problems, Dr. Ejaz, a senior doctor at SIUT proposed some remedial measures that can be taken by respective authorities in order to ease the extreme hardships faced by Karachiites. “Treatments should be made available at town level, and the government should establish dialysis units at all state funded hospitals,” he suggests, implying that this facility would greatly reduce the loss of essential time and money, as treatments would be available more readily, round the clock.

These measures are definitely worthwhile, as these would indeed solve many of the issues that patients currently face, from rising costs of medical treatments, to increasingly sophisticated treatment modalities and ever burgeoning problems of civic transport.

Dialysis units at the aforementioned two public sector hospitals are not in good shape and because of their small size, and lack of trained medical professionals, they have not been able to serve the wider community to their full potential. It is an urgent need of the hour for the upcoming provincial government in Sindh to give health and education sectors the attention they deserve.