Big problems

Yesterday I spent some time with a man who was waiting for his wife to complete dialysis at the Regional Health outpatient dialysis center, which is on the top floor of the Aspen Center here in Rapid City. I’ve been in that waiting room before, as I know a couple of people who routinely receive dialysis treatment there. It was late afternoon, nearly 5 pm, which is the time that the center closes for the evening. Of course the posted time doesn't match the time when the employees are allowed to go home, as they will complete all procedures in progress before they clean up and head for home.

What struck me once again was the number of people who go through the place for their procedures. Because kidney disease hasn’t affected any of the immediate members of my family, I think of it as rare, but that is hardly the case. The Regional Outpatient Dialysis Center is fully booked and handles as many patients as is possible with the equipment that they have. Those traveling or temporarily in town who are in need of dialysis might occasionally find treatment there, but often are directed to the center in Spearfish or the Porcupine Center, which is at Sharps Corner on the Pine Ridge Reservation.

Kidney failure, also called end stage renal disease, affects more than 660 million Americans. Of those 468,000 are currently receiving dialysis. Dialysis is required at stage 5 of chronic kidney disease. The patient usually has been suffering from kidney disease for many years before coming to the point where dialysis is required to sustain life. The treatment involves filtering wastes and water from the blood. The artificial filtration must be performed several times a week. For those whose disease has progressed to this point, dialysis is required in order for them to survive. The only other known treatment option is total kidney transplant. There are more than 193,000 Americans who are living with a functioning kidney transplant. The waiting list for kidney transplant is long. With nearly a half million Americans waiting for transplant.

At the time I was in the center’s waiting room yesterday I was struck, once again, by the number of Lakota people who suffer from the disease. End Stage Renal Disease (ESRD) is 1.4 times greater in Native Americans than in Caucasians. The variation by race is even more dramatic in African Americans who suffer a rate 3.7 times greater than Caucasians.

To put the disease in perspective, more than 47,000 Americans die from kidney disease each year. That’s more people than die from breast cancer or prostate cancer. Furthermore, most people with kidney disease suffer from other circulatory diseases including diabetes and heart disease.

In our town, there is a connection between poverty and kidney disease, though it is not a direct cause-and-effect relationship. People living in chronic poverty tend to have less well-balanced diets and tend to have a lower rate of access to health care which may contribute to the development of kidney disease. And the costs of treatment are high, leaving less money for other necessities. The wife of the man with whom I was visiting yesterday was receiving emergency treatment, but is not yet eligible to receive her regular treatment in Rapid City. The nearest option for her is Spearfish which is 45 miles one way or Sharps Corner, which si 72 miles the other way. The cost of gas and the amount of time required for treatment would be beyond the means for this family were they to stay in Rapid City. The plan, for now, is for the couple to be split up with the husband staying in Rapid City and the wife staying with relatives in a home 15 miles from Sharps Corner. There will still be challenges for her, as she has no car and will need to be dependent upon friends and relatives to give her rides to her 6 a.m. appointments and the return 4 hours later to give her a ride back to the house.

It is a less-than-perfect solution, but the best option that the couple can find at the present moment. They have agreed to regular phone calls, including a visit at 4:30 a.m. on dialysis days, though changes in the husband’s circumstances may prevent those phone calls in the near future. Still, the treatments are required for the wife to remain healthy. To discontinue treatment would result in death relatively quickly.

The challenges of dialysis are huge. And, like other families, this is just one of the problems they face. There are issues with increasing expenses and falling income. There have been problems with children and grandchildren. Winters are harsh and transportation is expensive. I have a few problems and challenges in my life. I have never faced anything remotely close to the problems that are stacking up in this particular family.

What struck me so dramatically yesterday as we visited for a few minutes was how many other families are facing such significant challenges. We tend to go through our lives somewhat unaware of the problems of our neighbors until something like this puts us in a place where it is impossible to ignore what is going on. Yesterday it seemed to me that there would be full time employment for a social worker in that dialysis center, would the budget support such a service.

We complain about the high cost of health care, but cutting funding for health care support to the poorest of the poor in our communities doesn’t seem to be an acceptable answer. Without federally-funded health care programs, the majority of the people I saw yesterday would simply die. We don’t like to think of poverty as a death sentence, but in some cases that is not putting it too strongly.

Education and disease prevention are required alongside effective treatment. If you project the problem into the generation of the grandchildren of the people I was visiting yesterday, the numbers become overwhelming.

I became a minister in part because of a desire to help people. Some days I become deeply aware of how small my contributions are in the face of overwhelming problems.

Copyright (c) 2016 by Ted E. Huffman. I wrote this. If you would like to share it, please direct your friends to my web site. If you'd like permission to copy, please send me an email. Thanks!