Patients undergoing treatment at the Koppal Institute of Medical Sciences alleged that the dialysis at the hospital gave them Hepatitis C.
Representational image for dialysis. (iStockPhoto)
Twenty-five renal patients went for dialysis at a district hospital in Karnataka’s Koppal district and returned with an unwanted “gift” — the Hepatitis C virus (HCV).
The incident was “shocking and unfortunate”, a senior nephrologist based in a district neighbouring Koppal told South First.
He found it shocking since the government had been turning a Nelson’s eye to the grave issue that has been dogging several dialysis centres in the state.
“Getting infected with HCV is not a minor issue. It can lead to severe liver diseases, including cancer, which can turn fatal,” he said.
The relatives of the patients blamed the unhygienic practices and unsterilised equipment at the Koppal Institute of Medical Sciences Hospital for their predicament.
There were several protests against the abysmal quality of state-run dialysis centres. However, the government is yet to make any concrete steps to put them in order.
The Koppala incident is not an aberration. Here’s why: Undergo dialysis at your own risk in Karnataka’s state-run units.
The World Health Organisation (WHO) says HCV+ refers to a person who has tested positive for the hepatitis C virus.
Hepatitis C is a viral infection affecting the liver and could lead to serious health complications.
The virus can cause both acute and chronic hepatitis, its severity ranging from mild to serious. Lifelong illnesses caused by it include liver cirrhosis and cancer.
People can become infected with HCV through contaminated blood, typically while sharing needles or equipment used for injecting drugs or fluids, and the transfusion of unscreened blood.
Treatment for HCV involves antiviral medication and regular monitoring of the liver.
However, nephrologists explained that antiviral medications could cure more than 95 percent of persons with HCV.
Yet, there is a catch: Access to diagnosis and treatment is not easy, and the process is expensive.
Anil Gouda, son of Suresh Gouda, one of the 25 patients, who was HCV-free until a few months ago, narrated his father’s ordeal.
“Five months ago, one person with HCV was undergoing dialysis at the centre. Later, we were asked to do a serology test,” he told South First.
“Besides my father, about six others on dialysis were also asked to undergo the test,” the younger man said.
Antibody serology tests check for the presence — or level — of specific antibodies in the blood. Antibodies are proteins produced by the body’s immune system to fight viruses or bacteria.
The families of the patients paid for the test. All of them tested HCV+.
“We are not even given any money to conduct the tests. They also didn’t collect the blood. We have to pay for the test,” Anil said.
He alleged that once the patients tested HCV+, they were denied dialysis as well.
“We were told that beds were full and no slots were available. The entire unit remained closed for the past two months.
After people complained, it reopened, but is functioning with just one dialysis machine,” Anil claimed.
Noorjahan, 49, is one among the unsuspecting dialysis patients who contracted HCV. The tests have been returning a negative for the past five months. She recently turned positive.
Yellappa from a village neighbouring Koppal, too, is not an exception. He also tested positive for HCV.
The district hospital’s dialysis unit currently has at least 25 HCV+ patients. They alleged that the technician — in blatant violation of guidelines — has been using the same dialysis machine for both HCV patients and others.
“This practice could lead to a spike in HCV+ cases,” Anil opined.
Despite a spurt in dialysis patients, the state’s healthcare system has failed in providing adequate facilities and resources.
Villagers in Koppal have made several representations. They requested better accessibility, good dialysis machines, and also nephrologists. All fell on deaf ears.
“Despite making repeated complaints, we are forced to wait for long periods,” dialysis patient Tulchavva D told South First.
He also flagged inadequate facilities, outdated equipment, and lack of hygiene at the hospital.
“Not just these issues, we have to bring medicines for dialysis. Also, now we have been told that only one cycle of dialysis would be provided. We are supposed to be getting three per week,” he added.
Besides the lack of resources and outdated equipment, there are management issues as well. Patients said they were denied dialysis due to the non-availability of timeslots. The priority now is for critically-ill patients.
Speaking to South First, a nephrologist from Hubballi said he has been getting several patients from neighbouring districts, including Koppal.
“A similar incident had occurred at a dialysis unit in Bylahongala too. A few patients tested positive for HCV and there were four deaths also,” he said.
The doctor said such deaths are often swept under the carpet. “They go unreported since the relatives of patients are convinced that deaths are common among renal patients. It is not so,” he added.
Suresh said he and the family of another patient, Rajendra, wrote letters to the district collector and contacted political leaders to find a solution to the issue.
However, their pleas fell on deaf ears, and the centre continued to operate under unhygienic conditions, he claimed.
“We were accused of taking the patients to other centres for dialysis and they contracted HCV there. There is not even a doctor available at the dialysis uni. Who do we interact with,” Suresh asked.
Koppal District Health Officer Alakananda Malagi refuted the charges. She claimed to have enquired with the hospital, though medical college hospitals are not under her jurisdiction.
“I am told that there were no such complaints,” she told South First. “The allegations are false,” she added.
The patient, Rajendra, made a suggestion. “Why don’t the health department ask the medical superintendent to provide a list of all HCV+ patients undergoing dialysis at this unit and also when they had tested positive. This will clarify if we are lying or not,” he told South First.
The director of Koppal Institute of Medical Sciences Hospital was not available for comments.
Koppal District Commissioner M Sundaresh Babu assured South First that he would check with the authorities concerned.
WHO identified unsafe injection/infusion practices as a major route for hepatitis C virus transmission.
“Haemodialysis patients often get infected because the infusion tube is used multiple times instead of just once,” the world body said.
Haemodialysis is a treatment to filter waste and water from blood, a function that healthy kidneys do.
According to the rules, all apparatuses used for collecting blood and providing injections should be disposed of immediately after use. Also, all patients applying for dialysis should undergo tests for hepatitis B, C, HIV, and syphilis.
HCV causes inflammation of the liver that could lead to cirrhosis (scarring of the liver), liver failure, or liver cancer over several years.
Nephrologists said the dialysis units must make the patients understand why they should not change centres.
If they have no other option — like if shifting to some other city — the centres should ensure that single-use apparatuses such as infusion sets and syringes are not utilised for multiple patients.
It has been mandated that new patients should undergo tests for hepatitis and HIV. Also, if any patient’s LFT (Liver Function Test) results show high enzymes then s/he must be considered as a suspected HCV carrier and an HCV DNA test should be done.
A senior nephrologist said HCV is curable. However, the treatment is expensive and costs about ₹40,000-50,000. It would singe a poor villager.
The treatment is for three months and regular medication is necessary. He also stressed that every dialysis centre should have a nephrologist.
Citing the example of a similar case in Chennai where the state government compensated the patients’ families, Rajendra demanded the state government compensate the patients.
He said those who tested positive are poor and unable to take treatment for HCV.
Patients in Tamil Nadu’s Stanley Medical College and Hospital in Chennai reportedly contracted HCV after undergoing dialysis.
The patients moved a public interest litigation in the High Court of Madras in June 2015. Nine months later, the Tamil Nadu government told the court that it would pay ₹3 lakh each as interim compensation to the infected patients.
Rajendra said several people in his district are unaware of HCV or how it could hamper kidney transplants.
“I turned HCV+ a few years ago and only then did I realise that I can’t go for a kidney transplant. Our villagers do not know anything about this condition,” he said before pointing out a major issue.
However, nephrologists differed. They said a kidney patient with HCV can undergo transplant. “Patients with HCV can undergo kidney transplant,” nephrologist Dr S Sunder of Aster Group of Hospitals told South First.
“In fact, patients in the US do not take treatment as they can jump the queue and get transplanted with kidneys harvested from deceased HCV-affected patients,” he said, adding that Dr Brian Periera from Bengaluru, now settled in the US, proved that HCV patients do well after transplant.
Meanwhile, Rajendra said many patients he know do not take medicines for HCV. “The medicines are expensive and beyond their reach. They ultimately die unreported,” Rajendra said.
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