Friend's mom may need dialysis - options?

[Docno]

Not sure if this is the right forum for this question... My gf lives in a small town in Amnat Chareon province. Her closest friend, a good-hearted girl, subsists by selling home-cooked food in the town's market. Otherwise, she takes care of her mom alone. The mom is close to 70, obese (like the daughter), and has numerous health problems relating to diabetes (almost totally blind and can barely walk); she has had to go to the town's 'hospital' twice in the past couple of weeks. Now the doctors are saying she will likely soon need regular dialysis treatment (I expect twice a week).

The problem is that the closest dialysis centre is a 45+ minute drive away to the provincial capital (or a longer drive to the larger city of Ubon). Given that the lady can't really walk and that the daughter doesn't have a car (or license), I'm not sure how she's going to pull this off. Thought I'd come here for ideas... This sort of situation--someone in a village needing dialysis--can't be that unusual. My gf seems to think that there aren't any long term care facilities (nursing homes) in Amnat Charoen like we have in the west. I don't know (and I presume this family doesn't have savings or health insurance). I'm hoping that one of the TV folks has some experience in this area that they can share. Thanks in advance.

[Rimmer]

Moved to Health Forum

[CobraSnakeNecktie]

Can try oral ingestion of sodium bicarbonate which has been shown to reduce the need for dialysis.

That could increase the time between each treatment. Not sure if this affects most types of dialysis patients or subset etc.

http://www.hkjn-online.com/article/S1561-5413(09)60175-7/abstract

http://www.ncbi.nlm.nih.gov/pubmed/12874466

[Sheryl]

The abive is extremely dangerous advice and should be disregarded.

A patient with renal failure should not self-administer sodium bicarbonate nor try any other methods. Leave that the the doctors who will base her treatment on her specific blood profile.

OP: all Thais are insured, Thailand has universal health care coverage. Those not covered through work-based programs come under the so-called "30 baht" scheme. (Also called "gold card").

Fortunately for your friend's mother, this scheme has covered the costs if dialysis since 2007. So she will be able to obtain it at little or no cost.

However the cost of getting to and from the place, must be borne by the patient and family. They are going to have to work it out somehow. Thousands of others Thais do the same, and often with much longer trips. Out where I am it is 2-3 hours each way.

They take public buses/vans and the like. Some move to live closer by. This would probably be worth their considering since this is going to be a lifelong issue.

[CobraSnakeNecktie]

Sorry I wasn't aware of the dangers of Sodium Bicarbonate.

Does anyone have any sources for that?

Isn't the need for dialysis measured by a blood marker?

[Docno]

Can try oral ingestion of sodium bicarbonate which has been shown to reduce the need for dialysis.

That could increase the time between each treatment. Not sure if this affects most types of dialysis patients or subset etc.

http://www.hkjn-online.com/article/S1561-5413(09)60175-7/abstract

http://www.ncbi.nlm.nih.gov/pubmed/12874466

Thank-you for the suggestion. I'll explore it further... [Edit: I just saw another post warning against this from the self-administration perspective... will clearly have to tread carefully]

Edited May 11, 2014 by Docno

[Docno]

The abive is extremely dangerous advice and should be disregarded.

A patient with renal failure should not self-administer sodium bicarbonate nor try any other methods. Leave that the the doctors who will base her treatment on her specific blood profile.

OP: all Thais are insured, Thailand has universal health care coverage. Those not covered through work-based programs come under the so-called "30 baht" scheme. (Also called "gold card").

Fortunately for your friend's mother, this scheme has covered the costs if dialysis since 2007. So she will be able to obtain it at little or no cost.

However the cost of getting to and from the place, must be borne by the patient and family. They are going to have to work it out somehow. Thousands of others Thais do the same, and often with much longer trips. Out where I am it is 2-3 hours each way.

They take public buses/vans and the like. Some move to live closer by. This would probably be worth their considering since this is going to be a lifelong issue.

Yes, this is exactly the problem ... how to get the mom back and forth to treatment. And like you say, there must be many many other people in the same boat. In the west, we'd often put the lady in a 'managed care facility' (aka nursing home), but apparently that's not an option. I'm not sure a move to a closer location is feasible because mother and daughter live alone in the their house... they would need to sell the place, get a new place, and the daughter would have to find a new way to support them [as mentioned, she currently sells food in the town market]. And two trips a week to the provincial capital would mean two days of lost income for the daughter (she can't do food prep) plus the added expense of transportation. And given that the mother is obese and pretty immobile, transportation itself is no easy matter. Sigh....

[Sheryl]

Actually from what you describe, unless the daughter was no longer able to care for her, a nursing home would not be indicated in the West either. Nursing homes cannot do dialysis, they still have to transport her to and from a hospital for that,

It is possible there is some sort of assistance available to help this family, I do not know, but the person who would know is the Social Worker at the provincial hospital. They should go there and tell her that transport is a problem both in terms of cost and availability of someone to escort the mother and see what she can offer/advise.

Every hospital has a social worker, usually office somewhere on the first floor. They tend if anything to be under-utilized.Often Thais refuse to ask for assistance or apply for benefits that they could get because of fear of losing face. Maybe you can help coax them/walk them through this.

Nothing ot lose, the worst that can happen is that the Social Worker can't offer anything. Though even if there is no govt or private charity help available, a good social worker would at least interview and counsel the daughter to help identify whether/how other family members might be brought into the picture to help.

Good luck.