Kidney patients living on hope

Foundation helps cover the cost of treatment for those with renal failure in the Philippines

LIFE SUPPORT: Michelle Dalay Resuello undergoes dialysis twice a week at Northern Mindanao Medical Center. Photos: SUPPLIED

When Michelle Dalay Resuello, 27, found out she was suffering from stage 5 kidney failure, she was shocked. Looking back to that day in March 2016, she smiles and says: "I was having a routine physical as I was planning on working abroad and needed proof to show I was healthy.

"The doctors told me I had been born with one kidney and it was failing."

Little did she know how much her life would change. Within a few days of checking into the Northern Mindanao Medical Center in Cagayan de Oro, the Philippines, her body began to shut down.

Dark brown spots appeared all over body. Her doctor explained she might not survive more than a few days. "I prepared myself and accepted my fate," she said. "My family came to be with me and offer their support. I had little strength and at one point I could not see or walk without assistance."

Her aunt Josephine Tilap, who works as nurse at the medical centre, had her placed on kidney dialysis and within two days she stabilised. She was instructed to receive two dialysis sessions per week.

I arrived in Cagayan de Oro four days after she had been admitted and by the time I saw her she had greatly improved. Most of the dark brown spots had disappeared and she said she felt much better.

Her aunt Josephine said her condition was still very serious.

"Michelle will need a minimum of two dialysis treatments per week to stay alive. She was very lucky because there was a point where we all felt she might not make it, " Josephine explained.

I asked what her chances of survival were.

"If she continues on the dialysis and changes her diet, she can survive, but what she needs is a kidney transplant," she explained.

"Since the transplant is expensive, few people can afford the cost of the transplant and the cost of the ongoing medication following the transplant."

By undergoing dialysis at least two times per week, those with kidney failure can survive until the funds are raised for the transplant.

I asked what the cost of the transplant would be for Michelle. "One million pesos (US$25,000), plus ongoing medication for the rest of her life," she replied.

"We will get her on the government insurance plan, PhilHealth, which would pay close to half of the total."

With PhilHealth assistance the cost of the operation and post-operation treatment is estimated at $12,000, but additional costs for continuous treatment on anti-rejection drugs throughout her life will continue.

The funds raised would be used for the transplant and medication for Michelle. It is estimated that $25,000 would be needed for the operation and recovery period and to cover her post-op medical needs for at least five years.

In comparison, a kidney operation in the United States can cost from $250,000 to over $1 million plus post-operation costs and medicine each month.

Josephine explained that time is very critical now, not only for Michelle but for the 70 other patients undergoing kidney dialysis at the Northern Mindanao Medical Center.

Although she undergoes dialysis two times per week, she needs the transplant as soon as possible. She is very weak and is on a restricted diet to lessen the strain on her damaged kidney.

If the funds can be raised for her treatment, she will have a second chance and live as normal a life as she can. She has a very positive attitude despite the pain she has been through. She remains hopeful that the funds can be raised to help her with a kidney transplant.

An estimated 10,000 Filipinos develop kidney failure each year.

Of this number, only 73% receive treatment due to the cost of the treatment and their ability to get to the hospital.

Looking at what leads to kidney failure, the main cause is diabetes (41%), followed by inflammation of the kidneys (24%) and high blood pressure (22%).

Those affected are predominantly male (57%) with an average age of 53, but it is not uncommon for patients to be in their 20s.

In order to survive there are two options: dialysis or a kidney transplant.

About 10% of the population worldwide is affected by chronic kidney disease (CKD), and millions die each year because they do not have access to affordable treatment.

According to a 2010 Global Burden of Disease study, CKD ranked 27th in the list of causes of the total number of deaths worldwide in 1990, but rose to 18th in 2010. This degree of movement up the list was second only to that for HIV and Aids.

Over 2 million people worldwide currently receive dialysis or are awaiting a kidney transplant, yet the number may represent only 10% of people who actually need treatment.

In middle-income countries, dialysis or kidney transplants create a huge financial burden for the majority of patients. In another 112 countries, many people cannot afford treatment at all, resulting in the death of over 1 million people annually from untreated kidney failure.

In Thailand, the number of patients with end-stage renal disease who need dialysis and/or a transplant has more than doubled during the past two decades.

A few months after Michelle began her dialysis, her treatment was cut back to one just one session, according to what PhilHealth will cover. If patients wish for additional treatment, they must pay for themselves.

Soon after she lost her strength, she was unable to sleep and was in constant pain. Her strict diet led to her weight dropping close to 40kg.

She was readmitted to Northern Mindanao Medical Center in May 2016 for over a week, but it was not until early August that she was placed back on two dialysis treatments per week.

"I am much better now with the second dialysis," she said.

Michelle's cousin, John Mark Dalay, 31, has offered to be her kidney donor, since Michelle's father feels he would be a better choice as he is younger.

"When John heard my father could not be my donor, he said he would donate his kidney to me."

Michelle receives dialysis treatment each Wednesday and Saturday. The waiting area outside the dialysis room is always crowded with patients and family members who accompany them. At least 30 patients undergo dialysis every day. Each treatment last four hours.

Kidney dialysis is a life-support treatment that uses a special machine to filter harmful waste, salt and excess fluid from the blood. The dialysis process replaces many of the kidney's important functions, restoring the blood to a normal, healthy balance

"I see so many patients undergoing dialysis who, like me, cannot afford the cost of the transplant," said Michelle.

"When I first found out I had just one kidney and it was failing, I first thought that it couldn't be true."

"I decided not to give up and that with time the money can be raised for the transplant."

In August I set up a non-profit foundation to help Michelle and other women in the Philippines who need help.

The Philippine Women's Transplant Foundation Inc, based in the US, was set up to help raise funds for Michelle's transplant. Once the funds are raised for her and the transplant is done, the foundation will continue to help other women in the Philippines who need financial assistance.

"There are so many others who need financial help like me," said Michelle.

"My dream is to help others and make their wish come true to be well again after I have my transplant."

When I returned to Cagayan de Oro in late October, I was allowed to take photos and video of Michelle during her dialysis treatment. The 10 dialysis machines are in use 12 hours per day, with each patient undergoing four hours of treatment. It is estimated there are over 70 patients undergoing dialysis treatment each month.

In addition there is a waiting list of 100 patients who need dialysis treatment at the hospital.

A new building is currently under construction that would increase the number of dialysis machines to reach those on the waiting list.

After one of her dialysis treatments in early November, Michelle and her parents met with a representative of the renal department.

She asked not to use her name in this story. She explained it was not only the funds needed to have the transplant but the ability to sustain the treatment process after.

"After the transplant, the patient must take anti-rejection drugs to ensure their body does not reject the new kidney," she said.

"The first several months are more expensive, but with time the costs will go down as the medication is adjusted according to how their system reacts to the transplanted kidney."

"The approval process of this hospital can take months, which includes the doctors and hospital board members. The patients must be able to show that they can sustain the costs of the anti-rejection drugs for the remainder of their life."

Since the immune system protects the body against foreign invaders such as bacteria and viruses it also recognises the transplanted organ as a foreign invader and will try to reject it.

To counteract this, anti-rejection drugs, called immunosuppressive agents, are prescribed to assist in this rejection response.

These medications are used to keep the transplanted kidney or other organ healthy. It is important that the patient take these medications as prescribed. Failure to take the drugs will cause the organ to be rejected.

The medication includes Prednisone, Imuran, Cellcept, Myfortic, Rapamune, Neoral, and Prograf. Taken on a daily basis these medicines can be adjusted in their dosage. These anti-rejection drugs will be used for the remainder of the patient's life.

Side effects include hair loss, stomach problems, diarrhoea, low red blood cell count (anaemia) and white blood cell count, and low platelet count.

Since 2012, there have been 34 successful kidney transplants at Northern Mindanao Medical Center.

HELP: Children show their support for Michelle. A non-profit foundation is assisting with Michelle's treatment.

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