According to both the foundations, there was a growing need to introduce the mobile ambulance van for the vulnerable section of the society. "Most hospitals do acute or temporary dialysis on HIV postive  patients with renal failure. Since there is blood exposure during chronic dialysis, many times healthcare professionals are reluctant to perform it fearing it might affect them and other patients too. Also, hospitals cannot open a separate dialysis unit for HIV positive patients as it may reveal the identity of patients," said Dr Umesh Khanna, consultant nephrologist at Asian Heart Institute and Chairman of Mumbai Kidney Foundation. Another reason for the introduction of the van, accord- ing to the chairman of Jain foundation, Nirup Kothari, is the cost of a dialyzer. Costing Rs 700 per tube, a dialyzer can be used for 7-8 times on a normal patient with renal failure, whereas in case of a HIV positive patient, it has to be disposed off after every use. "We will subsidise the cost to Rs 200 per dialyzer for HIV patients," Kothari said.

The foundation has installed 45 dialysis machines across the city and is running another dialysis ambulance since last one year.

As of now, according to Dr Khanna, HIV positive patients requiring dialysis are on chronic ambulatory peritoneal dialysis, which has its own limitations. "Majority of these patients do a peritoneal dialysis on their own or with the help of their relatives (stomach dialysis, also called water dialysis). This does not involve exposure to blood and is considered to be a safe option, but cannot be done on every patient for various technical reasons. There are chances of infection if a patient switches to hemodialysis from peritoneal dialysis," said Dr Khanna.

The foundation has also taken care to protect the identity of the patients seeking treatment in the mobile dialysis unit. "Keeping in mind the stigma attached to the disease, confidentiality of HIV patients will be maintained. The van will look like any other general ambulance for dialysis and no mention of HIV patients will be made on it," said Dr Khanna.

A couple of HIV affected persons are also undergoing training under Dr Khanna to perform dialysis on HIV positive patients. "This will help these technicians to earn their livelihood without the fear of contracting the disease or infection from patients," said Dr Kothari.

There will be a 24-hour helpline (9821767777) and the ambulance will be equipped with all latest equipment like computerized dialysis chair, dialysis machine, UPS system, water tanker, monitor defibrillator in case of emergency and two technicians.

Even though Dr Khanna is not sure about the number of beneficiaries from the ambulance since there is no proper record maintained of such patients, he is hopeful that once the ambulance is in place and as patients learn about this facility, the number would increase.

Dr Alaka Deshpande, HIV specialist at JJ Hospital, said, "Occasionally, we get HIV patients with acute renal failure. We have received 25 such patients in last three to four years. However, the exact number of HIV patients with renal failure is not recorded. Also hospitals do not take up these patients for dialysis due to fear of infection. There are two hospitals - one in Bangalore and the other PGI, Chandigarh and a couple of private trustrun dialysis centres in Mumbai who admit patients for dialysis. Introduction of such a mobile van is a welcome move." jinal.shah@expressindia.com

URL: http://epaper.indianexpress.com/Default.aspx?selpg=1391&selDt=03/26/2008&BMode=100