Morocco lacks resources to treat kidney patients

2006-12-14

Thousands of new cases of kidney disease are diagnosed every year in Morocco. But because of the country's limited medical resources, many patients don't get the care they need.

By Sarah Touarhi for Magharebia in Rabat -- 14/12/06

[Sarah Touarhi] Moroccan public hospitals only take a limited number of people with kidney disease.

Each year around 4,000 new cases of renal insufficiency, or kidney failure, are seen in Morocco. The country's weak medical infrastructure, lack of doctors and the way cases are taken on poses a serious problem for treating kidney disease.

According to the World Health Organisation, the annual death rate from intrinsic kidney and urinary tract disease was one million people worldwide in 2002. According to Kidney International, the official journal of the International Society of Nephrology, today more than one million individuals worldwide are alive on maintenance dialysis, a number that is projected to double in the next decade.

Early treatment has a high success rate, but many people are not able to get treatment until they are in the final stages of the illness. "The majority of patients are on limited incomes and have no health insurance. Each day, I hear of the death of a kidney disease patient who was not receiving treatment due to a lack of funds. Kidney dialysis centres have limited capacity," Abdelilah El Kabbaj, vice president of the Moroccan association of kidney disease patients, said.

According to nephrologist Amale Bourquia, the majority of patients do not seek treatment until they have reached the terminal phase and are forced to undergo periodic kidney dialysis treatment.

More than a year ago, the health minister set up a national register for chronic terminal renal insufficiency. An inquiry in April 2005 revealed there is a lack of equipment and human resources in the country.

There are just 131 kidney dialysis centres in Morocco -- 12 at universities, 37 public ones, nine are part-public, 71 are private, and 2 are military. There are 131 nephrologists, 665 nurses and 373 care assistants, as well as 21 general practitioners shared across 10 centres with nephrologists and 11 centres without nephrologists.

According to the Moroccan Health Ministry, 4,845 patients are currently being offered kidney dialysis -- which is 162 per million people in the country. El Kebbaj says that Morocco is far behind Tunisia -- which is 570 per million, Egypt -- with 340 per million people, and the United States -- which is 1,160 per million people -- in terms of treating kidney patients.

El Kebbaj says those on limited incomes are the hardest hit. The price of a single private session is 600 to 800 dirhams. A patient needs two to three sessions per week, as well as medicines. Thanks to their relatives sharing expenses, some kidney disease sufferers manage to collect the money needed to pay for their dialysis sessions in private hospitals.

This is not a solution, El Kebbaj says. He feels that only the introduction of a medical assistance regime for the underprivileged can save patients. "My family cannot provide the funds for dialysis over the long term. I need 5,000 dirhams to survive while I’m unemployed," Anas Farrane, who has suffered from renal insufficiency for two years, said.

Bouquia thinks that transplants represent the only good solution. "Transplants are proving essential as the first-choice alternative for the treatment of chronic renal insufficiency, both in terms of survival results and quality of life."

In Morocco, the only organs transplanted are kidneys and corneas. Rabat University Hospital has conducted 51 kidney transplant operations and Casablanca University Hospital 45. However, there are legal impediments holding back the development of transplants in Morocco, based on the fear that organ transplants will become a commercial operation as in India and Brazil.

Only persons related to the patient, including spouses, can offer kidneys for transplant. The organ must be donated free of charge and consent to the removal of the organ must be declared before a judge in court.