Dialysis At Your Doorstep

Mobile dialysis unit serves the dialysis needs of patients at their doorstep. Is it practical enough to survive? Sonal Shukla tries to find the answers

The idea of taking dialysis to patients rather than sick patients trudging to the hospital seems to have gained momentum in Indian healthcare. Only recently, the Mumbai Kidney Foundation in association with Naminathji Jain Foundation has furthered this cause by introducing a mobile dialysis unit (MDU) service in the limits of greater Mumbai. Mumbai's PD Hinduja Hospital is also exploring the option of MDU service in the suburbs of Mumbai. For starters, the concept of MDU was first introduced in India by Bangalore's Manipal Institute of Nephrology and Urology (MINU) in 2003.

A Need Indeed

A patient having permanent chronic dialysis has to visit the dialysis centre two to three times a week. For a paralysed or invalid person, going all the way to the dialysis centre is inconvenient. A dialysis van can reach him and the procedure can be performed either in the van or at his/her house. The concept of dialysis on wheels or MDU has thus taken root in cities like Bangalore and Mumbai. "A large number of our patients are elderly and people with physical disabilities. For this section of patients to come three times a week and spend four to six hours in the hospital for dialysis, wading through the chaotic traffic in Bangalore is difficult. Also, many of them do not have any family members who can accompany them and hence they were finding it extremely arduous to have dialysis," explains Dr H Sudarshan Ballal, Director, MINU. Between its main centre and peripheral units, MINU conducts about 4,000 haemodialyses per month and 350-400 patients flock for haemodialysis and another 50 for peritoneal dialysis.

MDU is also a useful mode for dialysing people with acute renal failure in smaller hospitals and nursing homes where dialysis facilities are not available. According to Dr Umesh Khanna, Chairman of Mumbai Kidney Foundation, an MDU unit has a wider reach, catering to the genuine needs of the patients. For an acutely ill patient in the peripheral nursing homes with no facility of dialysis, the MDU provides a satisfactory option.

MDU is already an accepted phenomenon in developed counties like the US and the UK. However, the Indian healthcare industry only recently discovered the benefits of this concept, with Manipal Hospital taking the lead. "The logistics and the technical expertise were not available in India before. Also, the expenses involved in maintaining this unit for chronic haemodialysis has been the reason for the delay," opines Dr Ballal. It costs more to run a mobile dialysis van, including critical care facility, than carrying out dialysis in the centre.

In Dr Khanna's opinion, the fear in the minds of people as to whether dialysis can be done at home without the back-up support of the hospital is one major reason for the delay.

Clockwise: Mobile dialysis van service recently launched in Mumbai; A view of inside of the van

Functioning

‘Dialysis On Wheels’ of Manipal Hospital

The procedure for mobile dialysis is almost the same as dialysis centre, involving four hours. The MDU includes a vehicle equipped with all the machinery and accessories required to perform a standard haemodialysis. This includes dialysis machine, recliner, power backup, and a water tank with water purified through reverse osmosis (RO). It has a fully automated and remote controlled dialysis chair, which works like a dialysis bed and in addition there is a monitor deliberator and an artificial respirator.

It also carries accessories and equipment required to handle emergencies. "It has in-built life saving equipment and there is a senior dialysis technician and a dialysis doctor accompanying the mobile van, so it is an almost fully functional unit," explains Dr Anil Suchak, President, Mumbai Kidney Foundation.

The investment for all these facilities is around Rs 20-25 lakh. "Our van has cost us around Rs 20 lakh including the infrastructure, air conditioning, installations, dialysis machine, dialysis chair, the ventilator and monitor," says Dr Khanna.

Feasibility

Dr Bharat Shah, Consultant Nephrologist, Lilavati Hospital, Mumbai, believes, "MDU is double the cost of the centre unit because it needs more machine and manpower." Are such facilities financially viable for hospitals? Industry experts believe that in the first few months, if the unit runs smoothly, then it can be very well accepted by the fraternity. Dr Alan Almeida, Consultant Nephrologist, Hinduja Hospital feels, as an MDU is an extension service where one is not providing dialysis within the hospital but also looking further, it should not be looked at from a profit angle by big hospitals but as a service to citizens.

"For the unit and the patient, the MDU should not be more than twice the cost of dialysis at the hospital. Initially, when done by an NGO the cost can be subsidised. But as it becomes popular, trusts which are already helping dialysis patients may come forward to help the MDU," adds Dr Khanna.

If the benefits are multiple, why is this concept not gaining popularity? According to Dr Almeida, the concept will pick up well in a place where parking the MDU vehicle may not be difficult.

Experts hold that this concept can certainly be more popular in bigger cities and towns, but probably would take a much longer time to reach the rural masses. This is because it may not be cost-effective to provide dialysis in rural areas, unless there is significant contribution from the insurance companies or the Government healthcare to subsidise it. "Obviously, this will have to be a private public partnership with the Government, as most of the healthcare in rural India is still Government dependent. Unless we can work out the economical logistics of setting this up in the rural areas, it may take some time for this facility to reach them and the treatment cost would be a major barrier," opines Dr Ballal. Manipal Hospital is already in dialogue with many smaller hospitals and nursing homes that do not have full-fledged nephrology and dialysis service to offer, especially to patients with acute renal failure.

Hinduja Hospital is considering the idea of an MDU which will mostly be operational in the suburban areas of the city. "It is a new concept and every new concept takes time to pick up. For the hospital, it will be like a further extension of the dialysis facility," informs Dr Rasika Sirsat, Head of Nephrology, Hinduja Hospital.

Future Prospects

The success of this concept would depend on the demand. Given all the limitations of this concept, we must echo Dr VN Acharya, Former Head, Department of Nephrology, KEM Hospital, Mumbai: "Today we are talking about prevention of diseases, but what about patients who are already suffering from renal failure? MDU has been started as an experiment in Mumbai. Instead of criticising it, let us give it some time and let us see how we can go about it."

ehm@expresshealthcaremgmt.com