Tonga's Ministry of Health aims to manage diabetes rather than dialysis Featured
17 February, 2017. The Tongan government does not have the finances to provide dialysis treatment but is aiming to address rates of renal failure and kidney disease by managing rates of diabetes first.
Dialysis treatment is currently unavailable in the country despite around 200 people being diagnosed with chronic kidney failure each year, and about a third of those needing such treatment.
This week the Tonga Dialysis Foundation said it has waited for over a year for a government letter of support so private funders could release finances to open a clinic in the country.
Ministry of Health CEO Siale 'Akauola said the majority of kidney disease cases develop from diabetes.
He said the government was focussed on prevention and management of diabetes rather than dialysis.
"That's the focus, to promote good healthy living so that people do not develop diabetes in the first place and then the second one of course, if you have diabetes, then aggressively manage diabetes to a very good level you will never develop renal disease. We've had diabetics who are well managed, they live healthy lives even into their 70s and 80s."
Dr Siale 'Akauola said the government 'in principle' would support a private dialysis facility.
-RNZI
15 comments
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'Oku ou faka'amu ange na'e pehe 'a e feongoongoi 'a e Minisita Ako malolo, 'Akilisi Pohiva, mo 'ene kau 'ofisa ma'olunga kimu'a pea ne toki fai e liliu ki he Ako 'o hange ko e femahino'aki 'a e Minisita Mo'ui mo 'ene kau 'ofisa he 'isiu ko eni ki he taialasisi.
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Malo kaunga pilikimi e fevahevahe'aki mahu'inga 'oku mou fai. Kau eni he fevahevahe'aki lelei mo faka'ofo'ofa he 'oku tau sio ai ki he tu'unga totonu e 'isiu e. 'Oku 'i ai e tui ko e ngaahi felingiaki fakakaukau ni 'oku ha'u mei he ngaahi loto 'ofa mo'oni ki ho tau kakai moe fonua. Fakamalo makehe atu Sione 'i ho'o vahevahe mai ho taimi 'o ke faka'ilo ki he fonua e ngaahi fakamatala mahu'inga fekau'aki moe tu'unga 'oe mahaki 'oe kofuua, pe he ki he TDF mo 'etau potungaue foki. Talamonu atu pea ke toe fakaivia koe mo ho'o kau ngaue 'ehe 'Otua koe 'uhi koe fatongia mamafa 'oku mou fuesia.
Faka'apa'apa atu -
Pea kuo kamata ke ha'ulu tahataha mai e mo'oni meia Sione Latu, ta oku tonu ke fakalelei'i e komiti ke maau kae toki lend mai enau support, faka'ulia mo'oni ee, kaikehe oua toe hela'ia ko e Sione he fakamatala kuo mahino ia kia kimautolu. Tuku atu kenau oo ki falelotu ko e Toketa Lahi 'e ma'u ai.
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Kautama,
Malo hono toe 'omai moe fakamatala ia koeni 'o tanaki mai 'e Sione Latu pea ko hono mo'oni kuo ho'ataina 'a e kaveinga ni pea 'oku tau faka'amu te tau ma'a 'a e mahino tatau moe kakai 'o e fonua. 'Oku mahino mei heni 'a e tu'unga tootnu 'oku 'i ai 'etau Potungaue pea 'oku nau feinga fakatatau ki he ki'i seniti 'oku malava ;ke 'ave kiate kinautolu. 'Oku ongio lelei foki 'a e fokotu'u ia 'a Saia MMoehau kene tataki 'a e taufehi'a 'i he kakai ki he Potungaue 'i he 'uhinga 'oku li'ekina 'a e kakai masiva.
'Ikai kuo mahini lelei he cahecahe 'a Sione 'a e 'uhinga pea kapau tetau sio ki he'etau nofo fakafamili mo'etau patiseti mo hono vahevahe kuo pau ke tau sio ki he lelei 'e ma'u fakalukufua neongo koe kaveinga 'eni ia 'oku toe lahi hono ngaahi pole. 'Oku totonu he taimi tatau ke teke'i ke 'oua 'e fakapolitikale'i 'eni he 'oku tokolahi hotau kakai tapu ange mo kinatolu he'ikia kenau mahino'i 'a e mo'oni ko'eni
oku talanoa mai kiai 'a Sione.
Kapau na'e tuku mai e fakakaukau koeni he toutou polokalama mai 'a e Potungaue pea 'oku ou tui 'e si'isi'i hano fehu'ia 'a 'etau Potungaue. Koe fakamatala 'a Sione 'oku ou tui 'i he'ene fu'u mahino 'e 'si'isi'i hano fehu'ia pea kapau 'oku kei vilitaki ha ni'ihi pea 'oku mahino mai leva 'oku tootnu ke to'o tau ha loholoho kiai.
'Oku malo si'i feinga 'a Saia mo 'ene komiti ka 'oku tootnu ke tau tukulolo kotoa ki he me'a 'oku mahino ange pea toe lelei ki he fakalukufua 'oe fonua. -
Pouti Loa kataki pe kake lau fakalelei tohi 'a Sione Latu 'oku 'ikai ke 'uhinga ia 'olu mahu'inga ange 'a e pa'anga kake lau lelei pe pea ke tau fepupouaki ke ma'u e mahino 'e he fonua ka 'oku 'ikai ko e fakatupu 'amanaki moe faka loto mamahi kiate kinautolu. Fakamalo atu Sione e 'ofa fonua.
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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 -
Koe me'a mahu'inga taha ki ha langa fakalakalaka 'a ha fonua pe 'i mamani koe mo'ui lelei 'a hono kakai, ka ko eni kuo talamai ia kuo fika 1 'a e $? ia he mo'ui 'a e kakai 'o e fonua. Koe ha kuo puke ai 'a e kau memipa 'o e falealea, kau minisita, law lords, tu'i mo hono, fale, kau nopele, pea totongi 'e he kakai totongi tukuhau 'o e fonua hono 'ave kinautolu ki muli 'o fai ai honau faito'o fakafalemahaki kae si'i tukunoa'i pe si'i kau mahaki masiva mo ta'e'iloa 'i Tonga ni ke nau li'ekina, malo pe hono fakamatala'i fakaikiiki mai ka 'oku 'ikai ai hano 'aonga. malo
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'Uluaki fakatulou atu ki he kau faingata'a'ia he mahaki ko'eni 'oku fiema'u kiai 'ae dialysis kae hangee koe tohi faka'ofo'ofa 'a Sione Latu koe palopalema fakaseniti.
Koia, koe kupu'i lea koia koe : "I am just saying that government public health system can't turn its back on the sick. ", 'oku ta'e 'uhinga (mo ta'e mahino) 'hili e fakamatala lelei ne tuku mai 'e S Latu.
Tau pehee 'e "TALI" 'ehe Potungaue Mo'u ke fokto'u ha Dialysis Unit ko'ehi 'oku 'ikai totonu ke tau tafoki mo ta'e tokoni ki ha tau ngaahi kupu kuo nau faingata'a'ia he mahaki fiema'u kiai e dialysis.
Koe ha leva me'a 'e hoko? He kuo pau ke 'iai hono ola. 'E kanomalie ki he ki'i tokosi'i (hopefully) ka kuo pau ke 'iai hono kanotamaki ki he tokolahi he kuo pau 'e 'iai e ngaahi sevesi ki he ngaahi mahaki kehe, pe koe ngaahi center he ngaahi motu 'e tu'usi moe ha fua pea pau leva ke fai e tafoki mei he kakai faingata'a'ia, ka koe kakai kehe foki 'eni ia, pea toe tokolahi ange.
Pea 'e toe fai pe lea tatau. ""I am just saying that government public health system can't turn its back on the sick. "
In other words, "Damn if you do, and damn if you don't".
'Osi fakamahino mai 'e Sione Latu koe palopalema fakaseniti. Koia 'oku fokotu'u atu ke to'o katoa mai e ngaahi taki tahakilu koia ki he ngaahi vahe 'o 'ave ia tokoni ki he dialysis unit ko'eni. Fokotu'u pe he koe me'a ia 'oku talanoa mai ai 'a Sione Latu ke 'oange ha seniti.
Faka'osi, 'oku 'uhinga koaa ki he haa e pehee "PRIVATELY FUNDED". Kapau 'oku privately fund, koe ha e 'uhinga 'oku toe fakatatali ai ki he Potungaue Mo'ui? -
Malo 'aupito Sione Latu hono 'omai e fakamatala faka'auliliki mo mhau'inga ko ia ke lau'ilo kiai e fonua pea ke tefito ai e fai tu'utu'uni 'ae tokotaha kotoa. He ko hono mo'oni, 'oku 'ikai fu'u mahino mai mei he respond 'ae Potungaue Mo'ui pe ko e haa e makatu'unga lelei 'oku 'ikai ke nau support ai e kole 'ae kautaha Tonga Dialysis Foundation.
Ko 'eku ma'u ki he issue ko 'eni ko e proposal 'ae Tonga Dialysis Foundation ne fakahu ki he pule'anga ko e taumu'a ki ha "PRIVATELY FUNDED" dialysis facility ke tu'u 'i Tongai. Ka koe 'osi eni e ta'u 'e taha 'oku te'eki fai mai ha tali.
'Oku ou tui 'oku tokolahi e kakai tenau fiema'u e dialysis facility. 'Oku 'osi mahino pe ia 'oku mamafa pea 'oku 'ikai ke financially feasible ke fai e dialysis 'i Tonga ni. Ka he'ikai foki ke tau lava 'o fakamahu'inga'i fakapa'anga ha mo'ui 'a ha taha. Even if they did not heed the advice of their doctor. No one wants to have failed kidneys.
I am not anti prevention. I am just saying that government public health system can't turn its back on the sick.
Faka'apa'apa atu -
'Oku tau fiefia he'etau ma'u ha kakai loto lahi mo to'a pehe hange ko e kau toketa kuo nau 'asi mai 'o fakamatala mai e nunu'a 'o e ngaue ta'eteuteu. 'Ikai ngata ai 'ikai ke mou fanongo ki he kakai mei tu'a 'oku 'iai 'enau 'asenita kehe ka e fakahu mai he me'a ki he mo'ui. Totonu ke tau ako mei he fo'i 'aliaki ta'eteuteu, kaakaa mo fanongo ki he kakai ta'etaukei he mala'e, 'a 'Akilisi Pohiva. Na'a ne liliu e fakamaaka 'o e sivi ko 'ene fanaongo ki he fiema'u 'a Siaosi mo Piveni ka e tukunoa'i e fale'i ia 'a Dr Pongi mo Dr Fasi. Kuo a'usia 'e Tonga ni e fakahisitolia 'i Mamani 'a e to tokolahi taha 'i ha sivi pea hola ia ka e tuku kia Penisimani ke ne tata 'ene fakaveve.
Talamonu atu ki he ngaue 'a e kau toketa loto lahi mo fai totonu ko eni. Faka'amu ange ke mou Minista mo Palemia mai.