The proposed Dialysis for Life program was big news in August when Dr. Wayne Trebbin of WORTH – World Organization of Renal Therapies – in Massachusetts, USA, came to Belize to talk with medical officials and associations representing dialysis patients here about proposals for making badly needed haemodialysis treatment available to the over 80 patients currently in need.
However, hope has dimmed vastly since then, as Dr. Trebbin has grown frustrated with the slow pace of developments on this end, after the Ministry of Health failed to meet a September 21st deadline to refine the Memorandum of Understanding (MOU), which had been drafted in August, and after it had turned in mere sketches for the dialysis unit, not meeting the expectations of WORTH that professional floor plans would have been submitted weeks ago.
“If the basics cannot be done efficiently, how will we be able to run a top flight operation in the long run?” Dr. Trebbin questioned in his latest correspondence Thursday morning.
“Time lost equates to lives lost,” Trebbin stressed, adding that, “At this point, we are not certain about the commitment in Belize.”
Dialysis patient, Jose Miguel Cruz, one of the founders of Belize Advocates for Renal Therapy (BART), and the public relations representative for the Kidney Association of Belize (KAB), visited Kremandala Thursday morning, expressing deep concern that Belize risks losing this golden opportunity to save lives.
“It looks like we are not going to have a center if something is not done in the next week or so,” said Cruz, who told us that he spoke with Trebbin only yesterday. “If they can come up with a reasonable explanation and get everything on the go, he is willing to reconsider. If we don’t; they move on.”
Cruz, a father of six, now 40 years old and blind, lost both kidneys, which turned polycystic, three years ago – a hereditary condition he acquired from his mother’s side of the family. Without dialysis, he dies.
Cruz is fortunately 1 of 21 people receiving subsidized dialysis treatment through a government agreement with the Belize Healthcare Partners Limited, formerly Universal Health Services (UHS) – the only medical facility that currently provides dialysis treatment in Belize. Cruz calls it “a monopoly.”
Still, patients have to meet expenses for transportation, medication, blood replenishment, and emergency fees. One medication they have to buy, said Cruz, is Adelac for pressure.
According to Cruz, at a meeting 3 weeks ago with KAB, 84 Belizeans were said to be in need of dialysis; 64 are living without any assistance, fending for themselves with very limited resources.
“It’s pay or die,” said Cruz. “You know how many BBQ’s you have to sell and how much rice and beans before you can raise $680 profit? I know!”
Cruz takes dialysis Mondays, Wednesday and Thursdays, traveling from Central Farm in Cayo to Belize City to undergo the mandatory, life saving regimen.
According to Cruz, Government pays $680 per patient, an increase from the $489 that it used to pay before Universal Health Services was changed to the new ownership – that after US$10 million of a Taiwan grant to Belize was used to settle the hospital’s debt. BHPL does not want to negotiate the price, Cruz alleged.
He reports that Government is paying Belize Healthcare Partners $150,000 a month, but it would take two months’ worth of service for GOB to meet its commitments under the WORTH project for renovations.
The cost per patient, said Cruz, would be only $8 under the WORTH program, which would include five dialysis machines each at the Karl Heusner Memorial Hospital and five at La Loma Luz Hospital – one being set aside for emergency treatment at each location. The 10 units would be able to treat 64 patients.
“The additional services they would get for that $8 is beyond a miracle,” said Cruz. “Here is a situation where we can get treatment for 64 patients at $8 a pop. Government is paying $680 for 21 patients.”
He added that the Panamanian nephrologist who was at UHS left with the change in ownership, and there is neither a nephrologist nor a dietician to attend to their needs. A doctor does not see them unless there is an emergency, said Cruz.
At the start of October, after the Government of Belize failed to meet extended deadlines, Trebbin articulated his disappointment via e-mail that the September 21 deadline for the signing of the MOU had not been met. The 10-day extension had still not been met and no explanation had been forthcoming for the failure, he pointed out. CEO Allen responded saying that sketches had been provided instead of floor plans only because the KHMH staff had “misunderstood” what was to be provided. He did not address the failure to finalize the MOU, however.
KHMH CEO, Gary Longsworth, told our newspaper that the KHMH had last week forwarded revised drawings with more details to the Ministry, and he is not aware if those had been sent yet to WORTH.
For his part, Dr. Trebbin has stated that Belize’s delays in meeting its commitments reflect badly on the proposed prognosis for the project. He added that WORTH would still consider building a dialysis unit at La Loma Luz Hospital, which, we are informed, had met its end of the bargain.
“To this end, we will now defer building a unit at KHMH. I am sorry that we have come to this point, but we cannot afford to waste time and energy in a project not likely to succeed,” he communicated to the Ministry of Health’s CEO, Dr. Peter Allen, who is currently abroad for two weeks.
After we spoke with Cruz Thursday morning, Amandala contacted the Director of Health Services, Dr. Michael Pitts, who Allen had flagged as their “point man” for the WORTH initiative. Pitts told us that that he was at the time in a meeting, discussing the same WORTH initiative with a team that includes a representative from BART, Emerson Guild, Cruz’s associate.
The Ministry of Health, said Pitts, is in full support of establishing the dialysis center at KHMH in association with extended services at La Loma Luz.
Pitts, who claimed that his Ministry has been working to meet its commitments, said that the Ministry had invited WORTH to Belize in mid-August to discuss the proposed MOU, and space has already been identified at the KHMH for the dialysis unit. However, he said, there had been some back-and-forth about the infrastructural plans that the Ministry had submitted to WORTH.
Pitts also told Amandala that the Ministry of Health has brought in a nephrologist from Cuba (Dr. Garcia), and a dietician has also been brought on board.
When we asked him what would be the dollar value of the Government’s contribution to the project, Pitts said that he could not yet say, as the infrastructural plans had not been finalized.
The initiative was formally proposed on March 23, 2009, when Trebbin wrote Ambassador Nestor Mendez in Washington, DC, expressing interest in building dialysis centers in Belize.
“We are able to supply, without charge, dialysis materials, instruction of staff, and continued quality assurance,” offered Trebbin. “We do not ask for payment from your country for services, but only cooperation in allowing us to set up the unit. We will not expect payment from patients as we do this for humanitarian reasons.”
Cruz said that for two months, they had been trying to get the Director of Health Services, Dr. Pitts, into a meeting to discuss the logistics, but he never has the time. Now he has taken his appeal to Prime Minister Dean Barrow, asking him to intercede.
“We lost 4 patients last month,” Cruz lamented, stressing that Belize deserves a better health care system.
“These people need to do their jobs or go home,” said Cruz.
According to Cruz, BART (Belize Advocates for Renal Therapy) is hosting a press conference at 9:30 a.m. at the Belize Institute of Management, as it continues to agitate for Government to seize the opportunity to bring Dialysis for Life to reality in Belize for those 84 patients in need – a number he projects will grow in the months and years ahead.