Patients lament high treatment costs as kidney disease ravages Borno, Yobe, Kano and Jigawa

There are growing concerns over rising cases of kidney related diseases in Borno, Yobe, Jigawa and Kano states.

Findings across the four states revealed that more people are increasingly coming down with the disease, and being hospitalized across the four states.

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People suffering from the disease in the states have also lamented the high cost of treatment, particularly those with the chronic kidney diseases, and kidney failure.

Even in states where the government offers free dialysis sessions, patients are still overwhelmed with the cost of medicines and others incurred during treatment.

According to the Chief Medical Director of the Yobe State University Teaching Hospital, YSUTH, Dr Baba Waru Goni, studies have shown that about five percent of the general population may have chronic kidney disease worldwide, and particularly Nigeria.

He said common causes of the kidney failure are hypertension, diabetes and chronic kidney infection also called chronic gloromio nephritis. 

He said, “That is to say when the kidney becomes infected, and is not properly treated, the infection would be smouldering the kidney, and the person may not know until after 15 to 20 years then the kidney will now begin to fail.

“Our concern is what we call chronic kidney disease, because acute kidney failure due to either injury, blood loss, can fail but once you treat it, it will pick-up to function again.”

Kidney disease accounts for most number of hospitalised patients in Yobe

In Yobe, patients suffering from kidney disease took most of the bed spaces in both the male and female medical wards of the Yobe State University Teaching Hospital, YSUTH, Damaturu.

Yakubu Mai-Mamman, 25, was diagnosed with kidney failure about four months ago.  The reporter met him sitting on his bed battling to breathe with the support of an oxygen hose inserted through his nostrils.

He said he was into painting business and was using his earnings to support his siblings after they lost their father before he came down with the disease.

He said life has been difficult since he started suffering from the disease, adding that he has done 25 dialysis sessions so far and could only feel relief and sleep after undergoing dialysis.

While thanking the Yobe State government for providing patients free dialysis sessions, he lamented that patients continue to bear the brunt of high cost of medicines and consumables.

He narrated that he spent about N50,000 on drugs and in running some tests in the first month of his admission. 

Abba Bukar, a 53-year-old patient, said he had lived with kidney disease for 22 years.

He described the dialysis process as the only option but very painful as patients spend three to four hours on the machine.

Bukar lamented that some patients were leaving the hospital because they couldn’t afford cost of drugs.

He said in his own case, one of his elder brothers was footing the bills for all his medications.

Another patient, 36-year-old Hamma Yau, said she has done more than 100 sessions of dialysis. 

She said she was rushed to the hospital this time with swollen stomach after fluid was found in her abdomen. 

She is now doing well after her third dialysis session was conducted at the Yobe State University Teaching hospital.

But her husband Yakubu Isa said he was paying 25,000 for each of her dialysis session at the Federal Medical Centre Nguru before he was introduced to the free dialysis service by the Yobe State government. 

He said in Gashua, many people are battling the illness, adding that even with the free dialysis some families cannot afford transport money to the treatment centre not to talk of cost of drugs.

He commended the government for the free dialysis service it is rendering and urged philanthropists, business men and non-governmental organization to emulate the gesture.

He however added that establishing a free kidney dialysis centre in each of the geopolitical centres would reduce the burden on patients.

He said dialysis is just a remedy but it is the last hope at the moment because majority of the patients and relatives cannot afford the high cost of kidney transplant which is the final treatment.  

Challenges managing kidney disease sufferers – Expert

Aliyu Abdukadir, a nephrologist supervising kidney failure patients at the YSUTH, said one of the major challenges health workers face in managing kidney disease is that most kidney failure patients do not report to the hospital until they exhaust all their options at home.

He said another problem is patients or relatives’ refusal to accept dialysis. 

He advised patients to report to the hospital whenever they fall sick, adding that it would help in early detection which could help in slowing the progression of the disease.

He added that poverty was also contributing to the prevalence of the disease, as sometimes doctors send transport money to kidney failure patients to come for treatment.  

Burden of disease in Yobe

The Chief Medical Director of the Yobe State University Teaching Hospital, Dr Baba Waru Goni, said Yobe is one of the states with the highest burden of kidney failure in the northern part of the country.

He said that communities especially among the fringes of River Yobe which connects to Hadejia-Jama’are and Lake Chad have been found to have high prevalence of kidney failure.

According to him, the burden compelled the Yobe State government to approve standing payment of N5m monthly which translates to N60m annually for free haemodialysis of patients with kidney failure. 

He said the free dialysis was meant for indigenes and even non indigenes that are residing or working in the state.

He said dialysis is done at the cost of N20,000 to 30,000 per session elsewhere.

“You can imagine the cost if we are not doing for free. A patient needs at least two dialysis sessions in a week, so you are talking between N40,000 and N60,000 a week.

“For an average income person or for low or even middle class, whether civil servants, farmer or trader, that is a huge amount and it would drain on individuals, family and the communities resources, so this free service is helping our people a lot.”

He explained that the hospital runs an average of 3500-3800 free dialysis sessions in a year.

“They are not mere figures, to give their breakdown, we are doing at least 15 free dialysis sessions in a day, 80 in a week, 320 in a month which translate to about 3,500 to 3,800 in a year.

“The free dialysis started in 2017 and since then there is not a single day it is not done for our patients in this facility.”

He said in addition, the Yobe State government also sent a high powered delegation to Eurology and Nephrology centre in Al-Mansura, Egypt, a World Health Organization (WHO) certified centre for kidney transplant with a view to commence kidney transplant in the state.

On cases and death recorded annually, the CMD said he cannot determine the exact figure but a record obtained by the emergency unit of the hospital revealed that out of the 4,320 emergency cases of general illnesses recorded in 2021, there were 200 deaths and majority which is about 20-25 percent were those with kidney failure, and there were more patients with kidney failure even on admission. 

There are two kidney treatment centres in Yobe State, YSUTH FMC Nguru. 

Dr Goni said there are 11 dialysis machines at the YSUTH, out of which eight are currently functional and three reserved as back ups. 

Status of kidney disease research in the disease

The CMD said the Yobe State government has constituted a committee of research headed by the Vice Chancellor of Federal University Gashua FUGA, Professor Maimuna Waziri.

He said Waziri who is a professor of chemistry had done preliminary research on the soil and water of communities along the River Yobe where she found that there were high content of heavy metals in the water. 

The research revealed that heavy metals which comprise of lead and Cadmium have been found to be very high in the water and soil, and 1000 times above the WHO acceptable level in those areas with high prevalent of kidney disease.

However, he said there is need to extrapolate the research to look at the blood level of people residing in that community and compare them to other communities elsewhere to ascertain if they have heavy metals content.

But when contacted on phone, Professor Maimuna Waziri said she needed more time to speak on the status of the research as she was attending to some official issues.

Dr Suleiman Mohammed Maina, a Consultant Nephrologist with the University of Maiduguri Teaching Hospital, said a baseline survey conducted on the disease by his team few years ago, revealed that majority of kidney patients visiting the hospitals are from Gashua town.

He said the survey, which was conducted at the Federal Medical Centre Nguru, indicated that Gashua had 50 per cent of the total number of patients; Geidam 10 to 15 per cent, Bursari 10 to 15 per cent while the other parts of the state shared the remaining. 

Some patients die at home in Kano because of cost of treatment

In Kano, some of the patients and their relatives said many have been dying while some remain at home in severe pain for the fact that they don’t have money for treatment which include dialysis and other injections that supports them to survive. 

When Daily Trust on Sunday visited the Dialysis centre of the Aminu Kano Teaching Hospital (AKTH), many of the patients cried out that they undergo dialysis twice in a week and it costs them huge amounts.

One of the patients, Alhaji Babangida Abdullahi, who comes for dialysis twice a week from Hadejia Local Government Area of Jigawa State, said he was a middle-class man before the cost of treating the illness brought him down as he was forced to sell most of his properties.

“It is not easy suffering from the pain of this disease and the cost of treating it. As you can see, I can hardly talk much because of my breath. I hardly breathe the way other people do.

“Since the past 10 to 11 months, I have been coming here for dialysis and I spend over N30,000 on each dialysis and injection, and I do it twice every week. This does not include the cost of transportation,” he said. 

Abdullahi called on government and philanthropists to support treatment for kidney disease because they and their families are suffering untold hardships with the cost of treatment.

A civil servant, Ibrahim Sibu Ayagi, whose wife battles the disease and could not speak to our reporter, said it has been long he enjoyed his salary and even lived comfortably ever since his wife was diagnosed of the disease.

He said, “Unless you are financially capable to do the dialysis and continue to receive the injections, you won’t survive. Many of the patients I know stopped coming for dialysis and they eventually died.

“My wife normally receives dialysis two times in a week and you know for every session there must be payment. As a civil servant it is not easy for me honestly.

“Apart from the payment of over N20,000, sometimes you have to change dialyser which is also expensive, sometime the central line too, and it is also expensive. This is not to talk of drugs, and there is one injection that you have to also take twice in a week, otherwise the person’s blood pressure will go down and it’s highly dangerous. The injection alone is N8,500. You see it is not easy.”

While calling for support for sufferers, he said they often wait long on queues to do dialysis as the dialysis machines in the hospitals were inadequate. 

The coordinator of the School of Nephrology Nursing at the Aminu Kano Teaching Hospital, Saminu Muhammad, said “There are other hospitals that do dialysis below our price but you know sustainability is the problem. Another issue is that there is a belief among patients that AKTH is the best, so you will see people coming from Lagos, Kaduna, Jigawa and other places.”

He said some patients’ kidneys die because not all of them could afford the treatment.

On prevalence in the state, Muhammad said availability of diagnostic facilities has shown improved testing rate of the disease.

He said people with hypertension and diabetes were also at the risk of having renal diseases.

In addition, he said pregnant women if not properly cared for before and after birth could experience kidney disease.

He advised people to exercise, drink adequate water, avoid non prescribed drugs, adding that they should also eat healthy.

The expert added that there is also great  need for more support for the centre in order to reduce the long queues during dialysis. 

Rising cases in Jigawa

Bilall Muhammad, 23, a resident of Unguwar Lemo in Fagge local government area of Kano State, said his ordeal with kidney disease has been daunting, but that dialysis at the Rasheed Shekoni Specialist Hospital in Dutse, Jigawa State, has helped tremendously.

Muhammad, who had spent about two weeks in the hospital said prior to his second coming to the hospital in less than 12 days, he could barely recognize anybody, as he was unable to talk for three to four days.

Even though his expectation to be discharged from the hospital has not materialized, he said he had every reason to thank God for his recovery.

But another patient, Malam Shuaibu Muhammad, was not that lucky as he died just at the time he was expected to undergo the dialysis process. This is in-spite of the optimism of one of the late Shuaibu’s son, Abdulrahaman, earlier in a chat with Daily Trust on Sunday by his father’s bedside that his father, who had survived the previous medical efforts would still survive. He died hours after the chat.

In an emotional tone, the younger Shuaibu recalled that his father, a big-time farmer and businessman from Chamo Ward in Dutse Local Government Area, was diagnosed with the disease about nine months ago and had in the process expended a fortune in the process of seeking medical care. He disclosed that the family had spent well over N500,000 in their bid to seek medical care for him.

Unfortunately, the fate of Shuaibu is what many patients of kidney disease, otherwise called chronic kidney disease (CKD) have been suffering at the hospital.

According to a medical officer at the hospital who sought anonymity, very negligible number of patients who are brought into the hospital survive the disease because of the lateness in seeking medical attention.

Speaking on the prevalence of kidney disease, a former Head of Internal Medicine at the hospital, Dr. Kabiru Abdullahi, told Daily Trust on Sunday that the hospital was overwhelmed by cases of kidney disease not only in Jigawa State, but also from the neighbouring states of Yobe, parts of Bauchi, and which require urgent and regular dialysis.

Dr. Abdullahi, who is also a nephrologist (kidney disease specialist), said the hospital records between 15 and 20 persons for dialysis in a week, which translates to an average of 60 to 80 cases in a month.

“The staff working in that department are very active, everyday sometimes at night dialyzing dialysis patients. Some people don’t understand haemodialysis; they think dialysis is a cure for chronic kidney disease, it is not so, it is an ongoing process. When a patient comes with a chronic kidney disease and we dialyze him or her say three times, some individuals having become healthy, would go home and just relax.

“After a while the disease would come back again. So, kidney transplantation is the main way of treating CKD, but dialysis, which ever type it is, is an ongoing process, we can initiate it by doing the first one within the first one week and do three times within the first six days and the remaining sessions we call it maintenance. May be in a week, we can do twice a week, and in some individuals thrice, depending on the recovery,” he said.

He said the disease is an expensive one and requires a lot of money, for management. According to him, many patients die as a result of lack of resources to keep up with the treatment, and even affluent patients sometimes lose their life savings due to the expensive nature of the disease. 

TETFund approved N36 million for research on disease

Following concerns and high mortality from the disease, the federal government, through the Tertiary Education Trust Fund (TETFund) last year approved the sum of N36m to a team of research scholars to carry a research into the causes of the disease with a view to finding solutions to it.

The head of the team, Dr. Mohammed Isa Auyo, told Daily Trust on Sunday that though the research ought to have commenced in January last year, the team only got the tentative approval letter in August, which led to the delay in releasing the grant.

Auyo, who is the Head of Biological Sciences at the Federal University Dutse, as at then confirmed that the university would soon receive the N36m grant money to kickstart the research.

He however expressed fears that the money might not be enough as a result of the rise in the exchange rate of the US dollars. He added that the research involves the importation of so many foreign components, some of which were very expensive.

“You cannot go back to request for more funds, so with the way things are now, we may have to seek the assistance of both Yobe and Jigawa state governors and possibly Kano to help bankroll it.

“Apart from the equipment, we are going to buy consumables, reagents, bottles etc, and all of those are also produced outside, so it is going to be difficult, but nevertheless we will carry out the research, and remember it is going to run for two years,” he said.

In addition, he said the team would engage two hospitals each from the states within the research areas of Yobe and Jigawa and possibly in Kano, as well as engaging the services of some medical doctors and possibly lab technicians in those hospitals.

Auyo explained that he was inspired to engage in the research as a result of the loss of close persons to the disease.

Investigate Borno’s rising cases – Residents

Residents of Borno State have lamented the growing cases of kidney failure in the state. They also urged the government to investigate the causes of high prevalence of the disease.

Checks across hospitals revealed a large number of patients were undergoing one treatment or the other.

A bereaved resident, Abdulazaaz Tukur, said this year alone he has lost two of his friends as a result of chronic kidney disease.

He said, “Everyone is worried over this trend in Maiduguri. I also have about three friends currently undergoing dialysis thrice a week at University of Maiduguri Teaching Hospital (UMTH), and I think the state government should just declare state of emergency in the sector to solve the problem. 

“Many people are saying it is because of the borehole water we drink but there is no proof to this, so we are seriously in need of help to save the lives of these innocent people.”

Ibrahim Ummate, a Professor of Medicine, Nephrology and Coordinator, Kidney Centre (UMTH), noted that the situation is worrisome and alarming compared to what their colleagues in other parts of country attended to weekly.

“Yes, many things are believed to cause kidney disease but we have not researched indepth, we are just speculating. Just last week, the Borno State government released some funds for us to research into the root causes of chronic kidney disease and to submit our report within a year.

“The governor has identified that our people are suffering from kidney disease, and he has equally released funds so that experts can embark on research and hopefully we are going to make our findings known at the end of the timeline.

Prof. Ummate said the hospital occasionally admits between 5 to 7 patients every day, which is more than 40 patients a week.

“This is quite large and much more than what our colleagues see in other parts of the country,” he said.

Recently, the state Commissioner for science, technology and innovation, Dr Babagana Mustapha Mallambe, said the state government is ready to fund the research.

Governor Zulum had in December asked the ministry of science to coordinate the research working with ministries of health and water resources.

“As part of response to the alarming record of kidney failure affecting citizens of Borno, the Borno State government invites research proposals from experts with verifiable track records who will reliably examine the principal causes of kidney diseases and failures and to recommend practical steps towards addressing the causes,” the governor had said.

Ojoma Akor (Abuja), Zahraddeen Yakubu Shuaibu (Kano), Ibrahim Baba Saleh (Damaturu), Mohammed Abubakar (Dutse) & Olatunji Omirin (Maiduguri)