by Michael Gladish
I am writing to expand on points I made in a brief interview with CBC Radio on Monday concerning the absence of kidney dialysis in Yukon. The lack of dialysis has far-ranging implications for the health and well-being of everyone living with acute kidney failure. For patients not fortunate to receive a donor organ, kidney dialysis is not only a treatment, but life support.
The only treatment readily available in Yukon is peritoneal dialysis (PD). The other treatment type, hemodialysis, is not available.
Patients on PD are able to undertake their treatment without direct support, as they can perform the treatment on their own and are able do it anywhere. However, if they experience problems, specialized care is unavailable in Yukon.
Specialized care becomes particularly problematic for patients for whom PD is not a viable treatment and who require hemodialysis. That requires a facility equipped with dialysis machines, specialized nurses and technicians to support the dialysis treatment
Some physicians tell patients their only choice is to move out of Yukon as dialysis is not available here. If Yukon’s Department of Health and Social Services condone this, they abrogate their responsibility to provide appropriate and caring treatment for patients. It could be perceived as relinquishing treatment and costs to another jurisdiction and a failure to acknowledge a shortcoming in our health care. It’s essentially sweeping the problem under the carpet.
Accessibility to appropriate dialysis treatment close to the patient residence can have a positive impact on treatment outcome and quality of life. Relocation places added emotional and economic stress at a time when patients are most vulnerable. The lack of dialysis is a deficiency in the present Yukon health-care system that needs serious consideration. There are good reasons to address this concern with a degree of urgency.
The Kidney Foundation of Canada publication “Facing Facts 2013” states that of new kidney failure patients, 53 per cent are people over the age of 65. More and more Yukon residents are retiring and choosing to remain in Yukon. So, for this group, kidney failure and accessible treatment can be a major concern.
People with limited income – among them retirees – may be unable to afford the cost of moving, or the cost of housing in larger centres. So, when forced to relocate, they can become marginalized.
Diabetes is on the increase, particularly among aboriginal peoples. It is one of the leading causes of kidney disease and accounts for 35 per cent of cases. Yukon has a large and growing aboriginal population.
PD patients who experience a failure of the peritoneum would no longer be able continue PD. Inevitably they would become dependent on hemodialysis for their treatment.
It would be unfair to uproot people from the community in which they have spent all their lives – causing them to lose the support of family and friends, sell their home, and even give up their jobs – just because they have a disease. Some might easily construe this act, however unintended, as discrimination.
I believe that it is incumbent on Health and Social Services to address the issue of accessibility to dialysis treatment before it becomes a crisis.
Why is there no dialysis unit in the Yukon while the Northwest Territories has three? The British Columbia Renal program provides kidney care and treatment to Yukon. So it may be a decision of the B.C. renal program not to offer dialysis and not one of Yukon Health and Social Services. It may also be that dialysis has not been of urgent concern to Yukon Health.
Establishing and operating a dialysis clinic need not be all that expensive. Yukon will soon have three hospitals into which a small dialysis unit could be incorporated. Each could be initially equipped with one dialysis machine and given the capacity to add more as demand increases. Nurses are already employed by the hospitals. Some nurses could be offered the opportunity for dialysis training, thus ensuring the necessary specialized support for a dialysis unit.
In conclusion, access to dialysis treatment will become more important to Yukon health care in the near future. An aging population, increasing incidents of diabetic-related kidney disease and the predominance of PD patients with potential peritoneum failure will inevitably result in more patients needing dialysis.
Yukon Health and Social Services and our government leaders must dedicate the resources necessary to investigate how this lack of dialysis capacity will affect kidney patient treatment and quality of life. Hopefully our government will acknowledge my remarks in a positive vein and move to correct a serious deficiency and create a first-class health-care system, one in which we can be proud.
Michael Gladish lives in Whitehorse.