A state of fear overwhelms the 18 patients of the Damanhour National Medical Institute Hospital (DNMI) Peritoneal Dialysis Unit (PDU) since the dialysate-providing company stopped supplying the northwestern Egyptian hospital with the agreed upon quantities. The preferred supplier confirmed suspension of all its production lines, not just that of the dialysate, and says it is seeking to resolve the crisis as soon as possible.
Dialysis is a method used to remove water and excess waste from the kidney with patients who have renal failure.
A state of fear overwhelms the 18 patients of the Damanhour National Medical Institute Hospital (DNMI) Peritoneal Dialysis Unit (PDU) since the dialysate-providing company stopped supplying the northwestern Egyptian hospital with the agreed upon quantities. The preferred supplier confirmed suspension of all its production lines, not just that of the dialysate, and says it is seeking to resolve the crisis as soon as possible.
Dialysis is a method used to remove water and excess waste from the kidney with patients who have renal failure.
The DNMI is the only hospital in Egypt that treats poor patients and those covered with health insurance, where treatment cost is as low as L.E. 2,000 a month (US$286) compared to that of private hospitals which is as high as L.E. 25,000 (US$3,575) a month.
“If PD sessions stop, I will die”
Mustapha Na’im, a 72-year-old patient, says he needs peritoneal dialysis (PD) four times a day and that regular hemodialysis is no longer useful considering his age and advanced condition.”If PD sessions stop, I will die,” says Na’im.
Na’im says treatment had been regular until two weeks ago when the DNMI halved the allocated quantities of the dialysate for him and other patients, which used to suffice for four sessions a day. The hospital compensated through two hemodialysis sessions to withdraw urine from the body. If not disposed of, a patient’s urine can become mixed with blood and cause poisoning and death.
A violating supplier
Dr. Wala Esheba, the treating physician at the DNMI, says 18 patients from all over the country visit the the dialysis unit as it is the only such facility that treats PD patients at the expense of the state, in addition to those covered by health insurance.
Esheba says her hospital contracted Otsuka Pharmaceuticals, a Japanese multinational, to supply 10,000 containers of regular and concentrated dialysate a month. But two months ago Otsuka suspended supply and when the DNMI demanded the company adhere to the contractual terms, Otsuka’s official said there were no raw materials and the company could not fulfill its obligations. DNMI then reduced the allocated quantities per patient as its stock fell worrying low.
A temporary solution
Esheba underscores that Otsuka was the only company that produced dialysate containers in Egypt. The dialysate allocated for each patient, says Esheba, used to cost the DNMI L.E. 2,000 (approx $285) a month, and when Otsuka stopped production, the DNMI did tempotarily consider importing. But at a cost of L.E. 25,000 ($3575) per patient per month, the option wasn’t feasible.
The DNMI then faxed the General Authority for Educational Institutes and Hospitals, to which it is affiliated with, informing it about the crisis. According to Eshaba, the authority gave the hospital license to shop elsewhere.
The crisis, explains Esheba, “was big since Otsuka was the only company (ED: in Egypt) that produced dialysate, which prompted the DNMI to communicate with several companies that had already suspended dialysate production. Indeed, an agreement has been reached with Nasr Pharmaceuticals to re-produce and supply the necessary amounts.”
“The legal way to source dialysate from another supplier takes a long time, considering that there are only imported fluids, which is difficult to implement due to their high cost,” she added.
A machine that could save millions
“The fact that Otsuka has ceased production affects not only the 18 patients, but also the other groups of children aged three and younger, the elderly, and cardiovascular disease patients since they can only be treated through PD,” says Dr Abdulfattah, the DNMI nephrologist. “Renal failure can be treated through kidney transplant, hemodialysis or continuous ambulatory peritoneal dialysis which is the best way to remove harmful toxic substances from the patient’s blood four times per day.”
But Dr. Abdulfattah says he himself has developed a machine that could save millions of lives and solve the crisis. And very cheaply. The doctor claims he has devised an ambulatory device that costs two pounds to produce, saving millions, which would allow patients to treat themselves, and save on expenses of equipment, doctors and hospital fees as well as water units, maintenance, medical tests and medications. The device, says Abdulfattah, has been tested on more than one patient and proved effective. “But at the end of the day it too needs dialysate,” adds the nephrologist.
Otsuka claims “force majeure”
Otsuka’s distribution spokesman, Dr. Hazem Zaqzouq, said all the company’s production lines were indeed down due to a “force majeure,” without elaborating further. “There were two other companies involved in the dialysate supply tender which started three years ago but no container whatsoever has been supplied so far, and Otsuka took upon itself to supply the DNMI’s entire needs,” Zaqzouq told Correspondents.
Zaqzouq underlines that Otsuka, out of its “desire to save patients’ lives,” has gathered 240 containers with a concentration of 1.7 millilitres and 170 containers with a concentration of 4.25 millilitres to deliver to the the DNMI unit.
“The prices of Otsuka’s containers are way below those of the imported ones. The price of a two-liter container with a concentration of 1.7 ml is L.E. 9.25 ($1.32) compared to L.E. 40 ($5.72) for the imported one, and the price of a two-liter container with a concentration of 4.25 ml is L.E. 9.5 ($1.36) compared to L.E. 90 ($12.87) for the imported one. Each patient needs four containers a day,” says Zaqzouq.
Zaqzouq promised that Otsuka would re-supply the agreed upon quantities during the coming weeks when the production line is re-operated.
Patient fears continue
In spite of the DNMI’s attempts to contain the crisis and Otsuka’s promises to solve it, a state of fear and anticipation overwhelms patients like Na’im, who continues to get less than the usual prescribed dose for the last two weeks.
