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2.19
The Lifeline in the Machine
Keeping the Flame Alive in the Nephrology Gapoat
The Quiet Revolution of 2007
October 2007 marked the beginning of a quiet revolution at MGIMS. It wasn’t a grand, ribbon-cutting affair with flashbulbs and speeches. Instead, it was the soft, rhythmic whirring of two brand-new hemodialysis machines tucked away in a corner of our hospital.
Back then, the unit felt like a lonely outpost. We had those two machines and a single, dedicated technician named Amit. In those early days, the silence was almost unsettling; we performed maybe one dialysis a week, sometimes only one a fortnight. There were moments when I wondered if we had overreached.
But in healthcare, supply has a way of creating its own demand. As word filtered through the villages that patients no longer had to endure the long, expensive journey to Nagpur just to clean their blood, the trickle turned into a stream. By 2011, those two machines weren’t just humming—they were exhausted, performing thirty-five procedures a month.
Human Infrastructure
Early in my tenure as Medical Superintendent, I realized a fundamental truth: a million-rupee machine is nothing more than a sophisticated paperweight without the right hands to run it. Instead of trying to lure expensive consultants from the city who might not stay, we decided to grow our own expertise.
In 2012, we chose Nandini, one of our most capable nurses, and sent her for intensive training. She returned six months later with something far more valuable than a certificate; she brought back an intuitive understanding of fluid dynamics and a deep empathy for the renal patient.
That investment in human capital was the spark. Over the next decade, the surge was staggering. We went from 324 procedures in 2009 to nearly 7,000 in 2022. Today, our fleet has grown to fifteen machines, treating 600 patients every month. These aren’t just statistics on a spreadsheet; they are lives tethered to our wards by a few meters of plastic tubing.
The Heavy Burden of Survival
However, as a physician, I find it hard to romanticize dialysis. While it is a triumph of engineering, the life it offers is grueling.
Dialysis is a demanding master. It requires a patient to surrender their life to the hospital two or three times a week, every single week, without fail. It is a routine that devours time, energy, and spirit. I watch our patients arrive—physically spent and emotionally drained. The process, while life-saving, often leaves them feeling “washed out,” as if the machine has taken something intangible along with the toxins.
For a rural family, it is also a financial catastrophe. Even when the procedure itself is free, the “hidden” costs are predatory. There is the bus fare to Sevagram, the loss of a day’s wages for the patient, and the loss of another day’s wages for the family member who must accompany them. It is a slow bleed of resources that can hollow out a household.
Bridging the Nephrology Gap
Operating a high-volume unit in a rural setting brings unique clinical hurdles, the most stubborn being “vascular access.” To run dialysis effectively, we need a fistula—a surgical bridge between an artery and a vein.
Creating and maintaining these in a village setting is immensely difficult. We face a high failure rate and, more significantly, we operate in what I call the “Nephrology Gap.” We don’t have a full-time nephrologist on site. The unit is kept afloat by the heroic efforts of our nurses and technicians, overseen by our medical consultants. We manage the uremia, we fix the imbalances, but we are acutely aware that we are offering a bridge, not a final destination.
The Transplant Void
The ultimate tragedy is that dialysis should be a waiting room, not a permanent residence. The gold standard for these patients is a kidney transplant. Yet, in all these years, not one of our dialysis patients has moved on to a transplant.
This reflects a grim national shadow. In India, nearly 90% of renal patients die because they cannot afford long-term care, and 60% stop dialysis midway simply because the money runs out. Private hospitals charge rates that can push a middle-class family into poverty within months.
The Safety Net
This is where Sevagram stands as a sanctuary. We have spent years weaving a safety net out of philanthropy and policy. We’ve been fortunate to have donors like the ICICI Foundation, who stepped in to fund new machines when our old ones were flagging.
But the real game-changer has been the Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY). Today, roughly 95% of our dialysis patients are covered by this government scheme. It isn’t perfect—the paperwork can be dense and the coverage has its limits—but it is quite literally the difference between a life lived and a life lost. It ensures that a farmer in Wardha doesn’t have to sell his ancestral land just to keep his blood clean.
We have come a long way since those two lonely machines in 2007. We are keeping hundreds of people alive, but the dream remains unfinished. I look forward to the day we move beyond just maintenance—the day we can offer a definitive cure. Until then, we keep the machines humming, and we keep the faith.