“ That's is not correct Vili. We do not refer patients overseas for dialysis - civil servants or otherwise. If you see the NZ Immigration visa application form, kidney failure is an exclusion criterion. The Ministry of Health has done a feasibility study on dialysis here in Tonga. Costings for peritoneal dialysis (PD) is about NZD $35,000 p.a. and NZD $60,000 for haemodialysis (HD). There's a pool of 50-60 patients with end stage kidney failure requiring some form of renal replacement therapy of which dialysis is one option and kidney transplant is the other.
Ministry of Health gets an annual budget of $20 million to run the different health services. If you do the maths, it's about $3 million p.a. to provide PD to 50 patients. Now you tell me it's OK to spend close to 20% of your budget on just 50 people (0.05% of population) while services for the other 100,000 will obviously suffer as you only have $17 million left for them. In democracy, we talk about equitable distribution of resources. Spending an exorbitant amount of money on a very tiny group of people is not financially savvy. Interventions to benefit a bigger group of people have been proven worldwide to be more cost-effective for low income countries like ours. Interventions targeting close to 100,000 e.g. NCD interventions for obesity as close to 94% of Tongans are overweight (primary level) or strengthening management of diabetes (secondary level) for the 13,000 odd diabetics makes more sense.
Fiji does not have a government funded dialysis facility. It's run privately for obvious reasons of costs when their ministry has a budget 8 times more than ours! Treating people with kidney failure with dialysis is like trying to catch people as they fall off a cliff. It makes more sense to prevent them from falling off the cliff first which is where primary and secondary levels of interventions come into play. Diabetes is a lifestyle disease (often a conscious choice by the patient) and diabetics who develop kidney failure are patients who often do not heed advice and look after their diabetes well. Now you want us to look after them when they don't want to look after themselves. With the health budget, it comes to TOP
$200 per head. You want us to increase this amount spent per head (but only on 50 patients) by 300 times to TOP $60,000 (at current exchange rate for NZD $35,000 for PD)! We cannot compromise care for the majority (100,000) just for a small group of people (50). Other services e.g. immunisation for babies/kids can suffer if we are going to direct close to 20% of our annual budget on dialysis.
Diabetes is a priority area but kidney failure is NOT. We are not a rich country and we need to invest our energy and resources in areas/levels where we can afford those services and get the best returns for our investments! It's called triaging, we forget about those that are going to die now (medic does this when running through battlefield assessing injured soldiers) and invest in those that we can prevent from dying (those who does not have diabetes so that they do not get diabetes and manage those with diabetes well so that they do not develop kidney failure)!
Within the current financial climate, dialysis here in Tonga needs to be privately funded. That's just the reality of life with kidney failure is here in Tonga!
Malo áupito ”