Dialysis in Gaza: A shrinking lifeline for kidney patients

Rawan, 20, receives dialysis four times a week at Al Shifa Hospital in Gaza. Photo credit: Lara Aburamadan

Rawan, 20, receives dialysis four times a week at Al Shifa Hospital in Gaza

As well as being the largest medical complex in Gaza, the Al Shifa Hospital in Gaza City is certainly the busiest. Serving a population of 1.8 million people, and providing many specialised medical services not available at any other hospital in Gaza, Al Shifa often struggles to cope with the high demands placed upon it.

After you enter the hospital and wander through the numerous wards and hallways, you find an old building that houses the Renal Services Department. Here, patients receive the treatment they need for illnesses which have affected the functioning of their kidneys.

In one room, at the end of a long corridor, a number of patients lie on beds, hooked up to the dialysis machines. They sit with pale faces while receiving their treatment, and each one has their own story to tell.

Education interrupted

Rawan Al-Mabhouh, a 20-year-old woman from Bait Lahia in northern Gaza, started receiving dialysis six years ago. She has to visit the hospital four times a week for this treatment. Rawan has a joyful spirit, and loves singing and dancing.

“I was infected with the St. Louis Encephalitis (SLE) virus when I was 12 years old” she told us.“The virus attacks my body functions and my blood, and it caused my kidneys to fail. Each time I come to the hospital I spend four hours receiving dialysis. Most of the time when receiving the treatment I feel weak and I can’t hold anything, but I’m trying to get over the weakness. The electricity often cuts out while doing the dialysis, and I feel tired.”

For patients like Rawan, the dialysis services provided at Al Shifa are literally a lifeline. “I can’t imagine what would happen without the hospital. My life is here, I’d be shocked and we’d be lost” says Rawan. “I have made many friends in the hospital, including with the nurses and workers in the department. They treat us very well and take good care of us.”

“During the war, I suffered a lot because I struggled to reach the hospital. No transportation was available, and the ambulances couldn’t come to us. It was dangerous. We were under attack and afraid and my home is far from here.”

Rawan’s illness has affected her access to education, too. “I was admitted to the intensive care last year and I stayed there for 15 days. In the end I have had to repeat the whole year. I hope to continue my studies. I am in the last year of high school and I hope to go to university.”

But Rawan’s biggest wish? “To receive a kidney transplant,” she says, “and to be a normal person like other girls. I wish I could find a donor.”

Medicine shortages

Sixty-year old Shabaan Al-Ejla, has also been receiving dialysis for six years, and he faces different challenges to Rawan.

“I come for dialysis for three days every week, for four hours” says Shabaan. “We always have shortage of the medicines I need, and there was once a shortage which lasted for six months. Over these six years, my blood became weak and for each four sessions I need one blood unit. I might have taken 100 blood up to now.”

“Transportation is another problem. Sometimes I have to come to the hospital the night before my appointment, sleep here, and undergo dialysis the next day. Other times I finish at midnight and can’t find public transport to take me home, and I don’t have enough income to pay for taxis. I always feel tired after I finish dialysis.”

Dr. Abdallah Qishawi, director of the Renal Services Department says that 35% of patients live in the north of the strip and they struggle to find public transportation to their home late at night, and like Shabaan usually cannot afford to take private transportation. Gaza’s fuel shortages also reduce the capacity of ambulances and cars to transport patients.

Struggling for resources

Dr. Qishawi told us that the Renal Services Department is increasingly stretched. “The number of patients is increasing. We currently have almost 357 patients, many of whom who come three times or more for four hours every week for dialysis. We divide patients into four sessions per day. Sometimes we have to run five, with the last session starting at midnight.”

“There are no other centers providing dialysis in the north, so we provide dialysis for patients from Gaza City and the whole of northern Gaza at Al Shifa. We do our best to provide good facilities for our patients, however we received around five new patients every week.”

The problems caused by a high caseload are compounded by a lack of equipment, due in large part to Israel’s eight-year blockade and closure of Gaza. “Despite this increased number of patients, we have a shortage of dialysis machines. We have a few broken machines, but there are no spare parts to fix them due to the blockade,” says Dr Qishawi.

We have broken dialysis machines, but there are no spare parts to fix them due to the blockade

The latest data from the Ministry of Health confirms that about 48% of the essential disposable medical equipment needed to provide renal services in Gaza are at ‘zero stock’ – meaning that they have either completely run out, or tare at imminent risk of doing so. “Moreover, frequent electricity cuts are a major problem for dialysis services. Though we have a generator for the whole hospital but sometimes it takes a few minutes before it switches on after the central electricity cuts. This may cause blood clots for the patients, and it also effects the machines.”

“We also face a shortage of human resources – nurses and doctors.”

Despite these challenges, doctors at Al Shifa continue to develop and expand the services they can offer to kidney patients. “Two years ago we started to conduct kidney transplant operations, and up to now 25 patients have received them.”

(Source / 19.02.2016)

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