Treatment search

Raise Funds or Die: How Fijians Are Funding Life-Saving Kidney Treatment | Fiji

Ten years ago, at the age of 21, Sashi Kumari was admitted to hospital and told that her kidneys were failing.

She was diagnosed with end-stage renal disease (ESKD), which requires four hours of dialysis twice a week and eventually a kidney transplant.

“I was very scared at the start of my diagnosis,” she said. “I thought about my family, my daughter and the financial burden.”

In the decade since, Kumari, who lives in Nadi in the west of Fiji’s main island, has spent thousands of hours in treatment and tens of thousands of dollars paying for it.

She now has to raise more than FJD40,000 ($19,000) for a kidney transplant abroad, a cost prohibitive in a country with a GDP per capita of less than $5,000.

“At the moment there is no timetable for when I would go to India because I still have funds to raise for that,” Kumari said.

Kidney specialists in the country suggest that more than 190,000 Fijians – around 20% of the population – were at risk of developing some form of kidney disease. Every year, at least 840 people are diagnosed with ESKD in Fiji and around 550 people die from it, 40% of whom die within six months of being diagnosed.

A big factor in this death rate is the difficulties people face in accessing treatment.

Kidney transplants are not possible in Fiji, and so people who need them, and most with ESKD, will eventually have to travel overseas, often to India, for the procedure, paying tens of thousands of dollars for travel, surgery, accommodation and other expenses.

“I was scared for my life”

Unless people are very wealthy, fundraising is one of the only options available to them. A search of popular crowdfunding platforms yields dozens of pages of Fijians desperate for funding for a trip to receive a kidney transplant, or even just the funds to pay for life-saving dialysis.

Salaseini Wainiveikoso, 25, from Tailevu province, is one of them. She needs a kidney transplant and plans to travel to India to get one, but needs at least Fiji dollars 60,000 (US$28,500) to cover the costs.

Salaseini Wainiveikoso on dialysis. Photo: provided

“I found out my kidney function was at 3%,” said Wainiveikoso, who was diagnosed in 2018. “The first thing I could think of was that I was going to die. I was scared for my life. I didn’t know anything at all about kidney failure until I found out I had kidney failure.

The cost of her dialysis sessions three times a week has already pushed her family over their financial limit and forced them to turn to GoFundMe for help.

“I was paying $200 per session, so you can imagine how much was spent on dialysis alone in three years,” she said.

“The financial cost is definitely stressful, even sometimes depressing. I’m afraid to go for treatment but at the same time I need it.

The financial pressure eased a bit when Wainiveikoso started receiving a new government grant in November.

Last July, the Fijian government announced the allocation of 1.5 million Fiji dollars (703,000 US dollars) to subsidize kidney dialysis treatment up to 150 Fiji dollars (70 US dollars) per session.

In private facilities, the fee is around FJ$50 per session, while in public facilities, patients pay nothing.

A nurse monitoring patients in the dialysis ward of the new Kidney Hub Hospital in Nadi, Fiji.
A nurse monitoring patients in the dialysis ward of the new Kidney Hub Hospital in Nadi, Fiji. Photograph: Rob Rickman/The Guardian

“I had no resources and it just crushed me”

But even with the subsidy, access to treatment is limited by lack of resources, says local nephrologist Dr Amrish Krishnan, one of three registered nephrologists in the country, with limited dialysis places and staff to administer the treatment.

To help remedy this, in December he opened Kidney Hub Specialist Hospital in Nadi.

For Krishnan, the desire to start a kidney hospital came from the despair he felt as a young doctor when dialysis was even more difficult to access than it is now.

“For many years I have seen patients with kidney failure because they did not have access to treatment. When I returned to Fiji after completing my masters training in New Zealand in 2015, I broke the news of kidney failure to the parents of a 14-year-old patient,” he said.

“Not having the means to provide dialysis, I had no resources and it crushed me. I cried with them, often in private. I just couldn’t accept it.

While the center is increasing the number of beds available for patients, treatment at the private hospital is still too expensive for some. Krishnan said this was due to the high costs, adding that the hospital helps patients organize fundraisers to get enough money for a kidney transplant abroad.

Dr Amrish Krishnan opened Kidney Hub Hospital to help patients needing dialysis, but treatments are still out of reach for some.
Dr Amrish Krishnan opened Kidney Hub Hospital to help patients needing dialysis, but treatments are still out of reach for some. Photograph: Rob Rickman/The Guardian

Dr James Fong, Permanent Secretary of the Department of Health, said the Fijian government also helps people raise money for treatment by providing medical reports to help patients obtain official permissions to raise funds from the public.

Fong said the ministry has also focused heavily on preventing ESKD, as the overwhelming majority of kidney disease and ESKD cases in Fiji were a complication of non-communicable diseases like diabetes and hypertension. .

Wainiveikoso agrees that prevention is key.

“My advice throughout this journey is that people don’t take anything for granted. Appreciate what you have and eat well. I used to skip meals and eat junk food. Don’t do that,” she said.

“I think staying positive is very important. You don’t really appreciate what you have until it disappears or is taken away from you.