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Dedication

This web site is dedicated to the memory of
Valda England
 

Around the world

By Bill Peckham

This article was originally published in  Nephrology News and Issues

(Pictures pending)

"After connecting in Johannesburg we flew to Nelspruit where I had excellent dialysis early Thursday morning at their nice, two-chair private unit. By 11 a.m. we were driving north, following faxed instructions along progressively deteriorating roads until we found ourselves on a deeply rutted track, our way blocked by a giraffe. This was a situation I had not encountered in my 20 previous years of driving; after a few minutes the giraffe moved a couple feet to the left and I drove the last kilometers to Sabi Sabi's River Lodge, our home for the next two nights." October 28, 1999

That passage from my travel journal describes a highlight of my three-month trip around the world. The dialysis in South Africa had been a pleasant surprise. I had been in Africa for 10 days and had four treatments. Already I had seen elephants, lions, hippos, and rhino. My encounter with the giraffe was the first of many animal encounters during our stay (my mother had joined me in Capetown for the Africa leg) at the beautiful Sabi Sabi resort. I was just three weeks into a great adventure. 

The journey started in Europe. I traveled for a week with a friend I've known since grade school who now lives in Florida. I have dialyzed in Europe several times for longer periods over the last four years so I expected that setting up just three treatments would be a snap. As it turned out arranging dialysis in Amsterdam and Monte Carlo was the biggest challenge I faced organizing the trip. After many overseas telephone calls I managed to arrange one treatment in Hilversum, which is just outside Amsterdam. It was a nice unit. (Next time I plan a trip to Amsterdam, I'll telephone the Hilversum unit first.)

I ended up at the Monte Carlo unit after trying to set up dialysis in Nice. The Nice unit is operating at capacity. In the end, the Monte Carlo unit made room for me, actually staying open beyond their normal time so I could get my full run. I dialyzed for four and half-hours during my trip. At my home unit in Seattle, I dialyze for four hours and forty-five minutes, but I thought I would shave 15 minutes while on vacation. I didn't think it would make much difference. I was wrong. By the time I returned to Seattle right before New Years, I was feeling under dialyzed. It took about a month of dialysis back home to get back to feeling like I was before the trip. On a shorter trip, I don't think I would have noticed. But over three months, that 15 minutes matters.

I set up the treatments in Africa over the Internet through Ted Pope, who operates several private dialysis units. I dialyzed at his Port Elizabeth and Nelspruit units. Mr. Pope also arranged my dialysis at a private unit in the Capetown area. I would return to South Africa tomorrow, if I have the opportunity. The units may use a mix of machines, lack TVs, and you need to bring your own Epogen(r) and Calcijex(r), but the dialysis is just as effective as anywhere else.

The dialysis units that I visited accommodated just two to four patients at a time. South Africa's public medical system is under a great deal of stress; their public dialysis facilities are at or above capacity. This makes scheduling a treatment difficult. For this reason alone, the private facilities are a good alternative. The private facilities allow you to schedule treatments in advance so that you can plan activities, flights, and car rentals with confidence. Private units are also generally cheaper. The units I dialyzed at charge under $200 U.S. each treatment.

I paid for my treatment in U.S. dollars and was reimbursed by my private insurance (Medicare does not pay for dialysis outside the U.S. and Canada). However, Mr. Pope mentioned that he would be willing to put together a package for uninsured dialysis patients traveling to South Africa. At the current exchange rate for South African Rands, dialysis would cost under $400 a week (three treatments). That compares to $1,300 and up in Europe for a week on dialysis.

Dialysis in Australia, at public units, costs about $500 a treatment. It is one of the most expensive places in the world for dialysis. The good news is that I found and dialyzed at two private units. The Noosa unit is semi-private but they set their own fees. They charged about $340 per treatment. The Noosa unit is brand new. It opened in September so when I visited in November, they were still settling into their new space. Noosa is on Australia's Sunshine Coast, which stretches along the Pacific north of Brisbane. If you like to golf, lie in the sun, or just rest and relax this is the place to do it.

The administrator mentioned that patients staying longer then a week could get a 10% discount on their treatments. I was visiting for just two treatments. I hope next time I visit I'll stay long enough to earn the discount.

At the next unit I did get the discount. I spent five weeks in Cairns, which is on the far north Pacific coast of Australia. In Cairns, I experienced what I can only describe as resort dialysis. Here is a passage from my travel journal:

"Dialysis is what has made my stay in Cairns for my vacation. I think it should be called resort dialysis. The Cairns Private Dialysis Centre stands apart from every other unit in the world that I have visited for several reasons, not least of which are the views patients are treated to. The unit is on the 12th floor of the tallest non-hotel building in Cairns and uniquely at the Cairns Private Dialysis Centre, the dialysis chairs face floor-to-ceiling windows. ...You can see piers where reef tour boats leave daily and (voyeuristic patients note) there is the back of a tall, four-star hotel dominating the center of the view. It is the first unit I've been to that has needed and has binoculars for patient use. They have six stations with modern machines and reclining chairs. Most nights, Debby and Cathy have had just one other patient and me. This is dialysis with concierge service. Debbie picks me up and drops me off when I need a lift. Dialysis treatment times are flexible to accommodate the many tourist activities you're visiting (in) Cairns to experience. Food is ordered off menus from one of the near by restaurants. Italian one night for dinner, Chinese the next, it's your choice." November 18, 1999

After I made that entry in my travel journal I learned that most patients really do get a face or foot massage during the run (they mentioned it but I thought they were kidding). I spent five weeks in Cairns, the gateway to the Great Barrier Reef, exploring not only the Great Barrier Reef but also the Daintree Rain forest. The rainforest to the north of Cairns is thought to be the oldest ecosystem in the world. Visiting the rain forest was a window on the world of the dinosaurs; snorkeling on the reef was a window into an even stranger world.

The weather during my stay was not ideal for snorkeling or scuba diving; it rained and was windy during much of my stay, which hurts visibility, but I did manage a couple scuba dives and a few days of snorkeling. It was just a taste; I'll hope for perfect weather during my next visit. I think the unit and the range of activities available in the area makes Cairns an ideal spot for a dialysis patient to vacation abroad. A Canadian patient who moved to Australia started the unit. After settling in on home dialysis, he started the Cairns Private Dialysis Centre so that his "mates'' could come visit. The cost of treatment was $350 U.S. for the first three treatments and $300 for the subsequent treatments. The staff will make every effort to accommodate an uninsured patient to keep unreimbursed costs down. One way to get the cost down is to take a couple friends with you. Three people scheduling dialysis for the same days could probably work out a deal.

Public dialysis facilities around the world are under financial pressures, while the ESRD population continues to grow. Consequently, there seems to be less available capacity for visitors. Finding space where and when you want to go is a challenge and may require you to be flexible in your plans. On the other hand, the financial pressures also make visiting patients desirable as revenue sources. So never assume the answer will be no. Private facilities are much more entrepreneurial; they are ideal for the traveling patient. When available a private unit would be my first choice for treatment when traveling. Each year, additional private units open creating an expanding range of travel opportunities. As for me, I hope to be in Turkey this September to celebrate my 10-year anniversary of being on dialysis.

(We also have other travel stories)

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