Kidney Patients in Cuba Are Fighting Off Death
with almost no transplants and limited hemodialysis
HAVANA TIMES – They have never been formally told that it will happen, but the threat is always looming: at some point, their hemodialysis sessions could be reduced to just two a week instead of the three they currently receive, which medical specialists recommend as the indispensable minimum treatment. If that happened, there would be no one to complain to.
Hemodialysis is a life-saving medical procedure that uses a machine and a special filter called a dialyzer to clean your blood when your kidneys stop working properly.
The main source for this article knows that, faced with such circumstances, he would have no choice but to adapt and do everything in his power to survive… just as he has done over the past several years. His story, which he only dares to tell on condition of anonymity for fear of reprisals, could to some extent be that of any of the dozens of patients who each week visit the hemodialysis ward at the Carlos Manuel de Céspedes Hospital in Bayamo, the most important hospital in Granma Province.
After years of sharing twelve hours of sessions each week, their life experiences eventually begin to blur together, particularly when, as is the case now, the future looks increasingly uncertain for everyone.
“There are days that are very difficult. This is an illness that takes a toll both physically and mentally, and under Cuba’s conditions it becomes even more terrible. Not long ago, one of the patients who came to my ward took his own life. We have watched others gradually deteriorate until they died, without the possibility of a definitive solution, such as a transplant,” he said.
Things are getting worse
For most patients with kidney failure, a transplant would be the definitive solution. A study published this year by the Medical University of South Carolina in the United States, which compared the clinical outcomes over more than a decade of a group of transplant recipients with those of another group undergoing dialysis therapy, concluded that the former “show a greater likelihood of remaining alive […and] improving their quality of life.” In addition, improvements in surgical procedures and technology have made the outcomes of these operations increasingly positive. “Of every 10 patients who receive a new kidney, eight will retain kidney function three years after the operation,” the study noted. That center alone performs between 250 and 300 such surgeries each year.
It would seem like the reality of a parallel world when compared with the situation in Cuba, where organ transplants have been almost completely suspended and services such as hemodialysis are barely managing to keep operating.
In 2022, the last year in which the Ministry of Public Health (MINSAP) officially reported transplants, only 12 such operations were performed on the island: 11 kidney transplants and one liver transplant. That represented a decline of more than 90% compared with 2019, when 206 organ transplants had been successfully performed.
As late as 2022, MINSAP was still considering the possibility of restarting its national transplant program. In February of that year, Dr. Yennis Rodriguez Lino, head of the Nephrology Department at Manuel Ascunce Hospital in Camagüey, told the Cuban News Agency that they had resumed the process of evaluating candidates for new organs, who are placed on the waiting list as part of a process repeated every year. The last kidney transplant at Manuel Ascunce had taken place in March 2020, largely thanks to assistance from other medical centers because of the deterioration of its diagnostic equipment.
In general, the sporadic transplants performed in Cuba since 2022 have been possible thanks to medical supplies brought in from abroad. In mid-2022, the solidarity group Puentes de Amor provided supplies for eight operations benefiting children hospitalized at William Soler Hospital in Havana. It was a commendable effort, but clearly insufficient to meet the country’s demand, not even that of the growing number of pediatric patients.
From time to time, appeals for help from mothers of children who need a transplant to survive appear on social media. In September of last year, a mother from the city of Moron, in Ciego de Avila, warned that she was unable to donate part of her liver to her eight-month-old baby, despite their compatibility and the fact that it was the only treatment that could save the child’s life. “That operation is not being performed in Cuba,” she had been told at William Soler Hospital. “It’s like a death sentence. Right here, some time ago, a one-year-old girl died waiting for a transplant,” she said through tears.
More recently, a mother from Las Tunas also posted a video asking for help to save her 10-year-old daughter. At the pediatric hospital in that province, doctors had only been able to diagnose the girl’s illness and identify a possible treatment, but they admitted they were in no position to do anything more.
The situation in the hemodialysis wards offers little cause for optimism either. A few days ago, the platform Nio, in reporting a crime, highlighted the case of patients receiving treatment at Manuel Ascunce Hospital in Camagüey, where more than 150 patients have only 12 artificial kidneys available to them. The possibility of spacing out sessions, which remains a looming threat in Bayamo, has already become a daily reality there, several followers told the content creator. “Patients who previously received three four-hour sessions a week are reportedly receiving only two sessions a week now. The situation reportedly worsened this week, when some sessions allegedly had to be shortened from four hours to three.”
Just a year ago, that same ward was treating 170 patients and had 17 machines. Comparing those figures with the current situation reveals two equally troubling realities: rising mortality among hemodialysis patients and the continuing deterioration of the infrastructure that serves them.
A former nurse from that ward, who also requested anonymity to share her experiences, explained that the crisis had been developing for some time but had worsened this year to the point of becoming almost unsustainable. “Many nurses, biomedical technicians, and even service staff have resigned because of the low salaries and excessive workload. That center bears no resemblance to the one inaugurated in 2008. Back then, we had 20 stations [artificial kidneys] with the most modern technology and plenty of spare parts. By the time I left there some time ago, the equipment was being kept running only by ‘cannibalizing’ [dismantling for parts] machines that had stopped working. As much as we wanted to, we had no way to provide good service. And from what acquaintances who still work there tell me, things have only gotten worse.”
What it takes to stay alive?
Our interviewee in Granma Province has vivid memories of the shaking that has overcome him during his most recent hemodialysis sessions. “Single-use materials are being reused, such as cannulas, tubing… and even though they are washed, traces of components from previous treatments remain and end up being injected into the next patient. That is what causes shaking, which is a very difficult and dangerous experience for those of us who suffer through it.”
Every session has become an obstacle course that tests the will to survive, he said.
It starts with the lack of something as vital as vitamin concentrates, which are needed to replace vitamins lost because of the illness itself and its treatment, or having to be punctured with cannulas (needles) that have been sharpened over and over again and that, despite the staff’s efforts, practically no longer have a bevel, turning every session into torture.
But if he had to identify the biggest obstacle in his path, or at least in the path of his fellow patients who come from other municipalities, he would point without hesitation to the transportation problem.
Since President Donald Trump imposed an oil blockade on the island last January, MINSAP ordered fuel consumption to be reduced to a minimum, directly affecting the hemodialysis program. Traditionally, patients were transported free of charge by taxi from their homes to the hospitals where they receive medical care. Three round trips a week were reduced to two, on Mondays and Fridays, to pick up patients in their municipalities of residence and later return them home. However, For the past eight months, they have spent the week in an inpatient ward at the hospital or at another MINSAP facility, far from their families, poorly fed and exposed to the many illnesses that circulate in healthcare facilities.
“It has been a decision that has had a profound and very negative effect on our group. For many people, it has created the feeling that they are living through an endless hospital stay,” he said.
Few patients can afford to travel on their own to Bayamo or Manzanillo, the cities where hospitals still have functioning hemodialysis wards. Nor are many able to bring enough food with them to ensure a balanced diet throughout the week. “They’ll be getting the results soon from a battery of tests they ran, and I’m sure problems with hemoglobin and similar indicators will predominate,” said the principal interviewee for this article.
There is no shortage of reasons for his bleak prediction. At a time when everyday existence has become an odyssey in Cuba, it is difficult to understand how patients with kidney disease find the strength to survive. The point is, it shouldn’t have to be this way.