“ Fakamalo lahi ki he ngaahi lea fakalotolahi. Íkai foki ko ha meá faingofua eni í he ngaueánga kete talaange ki ha tokotaha with kidney failure óku íkai lava é he potungaue ó toe fai ha meá maána. Óku ongo he taimi lahi á e faingataía óku nau tofanga ai. Fakaámu mai óku lahi e kií peesi óku tuku mai he Puleánga kae lava hono tokonií á e faáhinga koéni. Koe kií $20 million óku tuku mai ki he Minisita moe CEO ke na fakapotopotoí áki é na leleitaha ki he lelei fakalukufua ó e toko 100,000!
Kole muá keu respond ki he tukuakií é he TDF á e Ministry í he delaying tactic. I'm part of the Taskforce within TDF the Minister directed that should look into logistics of setting up a dialysis service here in Tonga. TDF had sought the endorsement of the Ministry to facilitate:
- campaigning for public donations and you're aware, the Crown Prince Tupouto'a is the patron of TDF.
- donors like the LDS Church will only come on board if Ministry is involved as well.
- duty/tax free for consumables used for dialysis.
The Ministry has serious reservations about integrity of leadership of TDF as secretary and treasurer positions have changed several times. Since Ministry will be associated with TDF and Crown Prince name used in seeking public donations, we wanted to make sure there was accountability and transparency in terms of how funds are to be used - auditing etc.
We had reservations about SUSTAINABILITY of project. LDS Church will be on board for say only 3 years then what? Project relied heavily on manufacturing companies benevolence is sending containers of near expired dialysis fluids. This was possible through contacts of one of directors of TDF with his doctors in US and manufacturing companies e.g. Baxter, there!
There was no back up plan. One of big risk of peritoneal dialysis (PD) is infection. If the peritoneal catheter/tube becomes infected with associated peritonitis (infection of lining of abdominal wall), then often we need to remove catheter (tube), give peritoneum a rest ?4 weeks before re-inserting a new tube. When resting the peritoneum, you need another form of dialysis which is usually haemodialysis - HD (through blood) for that particular period of time to keep patient alive. There was no provision for this in their proposal. We can't be sending patient for temporary HD for say 4 weeks to NZ (it would cost about NZD $12,000).
We had done an informal survey looking at home setup of patients with kidney failure as we do home visits for certain diabetic patients and the results aren't that good especially when the biggest worry is infection. PD is almost a 16+ hour per day process if you're doing 4 cycles/day. TDF was looking at a centralised clinic where PD is offered but you can't expect a patient to be spending 16 hours away from home every day (7 day a week). This proposal is not workable. The home situation here for most patients isn't good. I don't mean to be condescending but fuú fakaófa e anga nofo í he ngaahi ápi é niíhi and doing dialysis in those homes would be extremely difficult and risky. With due respect, Mr Saia Moehau, lives here in a hotel with air conditioning and a clean environment. This is NOT what most homes are here in Tonga.
I have been directed to advise TDF that they are free to go ahead with their private dialysis clinic but Ministry of Health would not lend its endorsement until these issues are cleared or dealt with professionally. We are willing to lend technical support - putting in dialysis catheter, doing laboratory tests and technical advice etc but right now the Ministry of Health is reluctant to be involved until these issues are resolved.
Kou tui pe é mahino atu á e naínaí e Potungaue koe úhi koe ngaahi issues pelepelengesi á e ngaahi issues kou highlight atu í ólunga. TDF insists on our endorsement to get funding in through public donations and for donors to be involved. In their proposal, one of the directors is to be paid $50,000 for consultancy fees when funds are raised! These are some of the small things we're worried about when the Ministry's name is associated with a project where public funding is involved. With the TDF's proposal, one 2 litre bag of dialysis will cost the patient TOP $16 (including overheads) so it's 2 bags/day and therefore $32/day or $224/week or $872/month. This is a still a lot of money for most families (but doable I guess!).
Average life expectancy of diabetics on dialysis is just over 2 years. Other services like dealing with heart attacks need to be improved as major cause of death is heart disease. If we are to do coronary angiogram and angioplasty (balloon and stenting to open narrowed/blocked blood vessels), we are looking at spending NZD $22,000 for such services. All services to maintain someone on dialysis e.g. heart, vascular etc need to be improved which again is going to tax our small budget. We can't provide dialysis and ignore other areas that keep those patients alive. We replace kidney function but they drop dead from a heart attack. TDF's proposal has not addressed some of these intricate issues!
We wish TDF all the success in their endeavour and they are most welcome to go ahead and set up the clinic. We will assist with technical support but until the issues I've raised are sorted out, the Ministry will not go ahead with a FULL ENDORSEMENT.
Kou fakaámu pe é ngali mahino atu á e tuúnga óku tuú ai e Potungaue. Íkai ko ha taé fietokoni but need a project that is ACCOUNTABLE, TRANSPARENT and SUSTAINABLE before the endorsement is given.
Malo áupito ”