Dialysis machine donated

The Maui News
Wednesday, May 26, 2004

By MELISSA TANJI, Staff Writer

HANA - An anonymous donor has stepped up with an offer to buy a dialysis machine for the Hana community, to allow patients with failing kidneys to remain at home rather than face a lengthy drive to Wailuku.

Lehua Cosma, who started a grass-roots movement to bring dialysis to Hana after getting more than 250 signatures on a petition, said she was overwhelmed by the gesture.

"I was like, you know what, slowly I see blessings coming," she said.

But the executive director of the Hana Community Health Center said hopeful residents need to understand there are other major costs to providing dialysis services.

"That's a wonderful first step to providing a service," said center director Cheryl Vasconcellos. "But if it were as easy as just having a dialysis machine, there'd be no problem."

There will be major needs for staffing and facilities that will be more difficult to set up and for which the health center has no funds, she said. She said she has provided information on the costs to Hana residents seeking a dialysis facility for their community, "but nobody has come up to say how they would fund it."

"I do understand how frustrated people who live here can be over lack of services that allow them to live in the community. I live here too, and I care about the level of medical services that are needed," she said.

Cosma said a community group she has organized, Hui Laulima, won't necessarily seek to have a dialysis facility as part of the health center, although not doing so may result in some complications.

Cosma has been an active advocate for a dialysis facility in Hana because her mother, Cecelia "Cece" Park, suffers from a kidney disease that requires her to undergo dialysis three times a week to clear her blood of the toxins that her kidneys no longer can remove.

Cece Park and her husband, Andrew Park, need to wake up in the wee hours of the morning to make their journey to Wailuku for treatment that begins at 5:15 a.m. at the St. Francis Maui Dialysis Satellite Facility.

There has been an outcry for dialysis service in East Maui for a decade or more. The outcry has led to criticism of other planned Hana Community Health Center programs that some see as less urgent.

Cosma said she recognizes the donation for a dialysis machine, estimated to cost $24,000, is just one of many steps the community will need to take in providing dialysis treatment in Hana.

They still need to work with the state Department of Health, get estimates for the machine and staffing, develop a place to house the machine and work out a budget to continue the service. Setting up a private health-care facility may mean Hui Laulima would need a certificate of need from the State Health Planning and Development Agency.

But the offer to buy a machine to get the planning started is a positive first step, she said.

"Every positive movement, it gives our people hope," she said. "That's what matters."

Cosma said the gesture arose after Hui Laulima sponsored a public meeting attended by about 60 people in Hana last week.

There were presentations on dialysis from nurses and Dr. Steven Moser, a Wailuku kidney specialist whose patients at the Wailuku dialysis facility include several Hana residents.

Moser's presentation moved the donor from Hana to contact Cosma and offer to purchase the machine.

Elected officials from Hana said the donation is wonderful, but they also said there is a lot more that needs to get done.

"It's just one component of it. There are a whole bunch of things," said state Sen. J. Kalani English, who lives in Hana. "I've always encouraged Hana to think outside the box."

English said he will seek to obtain state support for a site and to build a facility. But, he said, "What we need now is donations for an endowment" to support the continuing operation of a dialysis facility.

Hana residents can get a better idea of what is required by reviewing the effort to provide a dialysis facility at Kalaupapa to provide for patients in the isolated settlement suffering from kidney failure, he said.

County Council Member Robert Carroll said he too will see what the county can do to assist in providing the service, saying the community may need more than one dialysis machine to provide for the number of patients in the remote rural community.

The machine is just the beginning for meeting the needs of patients, Vasconcellos said. There needs to be a facility to house the machine, and infrastructure that includes a water treatment plant to purify water for the dialysis process, refrigeration and other kinds of equipment, she said.

She estimated it will cost around $100,000 just to provide the needed facilities, "not counting the water system that is required. And once you do that, you need to staff it."

Along with a trained nurse to assist patients during the dialysis treatment, there needs to be a nephrologist, such as Moser, on call if not on site, to respond to any emergencies that may arise.

"The patients who require dialysis are not the most stable, and if one crashes while undergoing dialysis in Hana, they are not likely to survive a plane trip to Maui Memorial Medical Center," she said.

For the Hana health center, a key concern will be the cost of insurance, Vasconcellos added.

"This is a highly specialized service. It's not primary care that is within the scope of what we provide," she said. "Our malpractice insurance will not cover it. There are no community health centers in the country that are doing that kind of treatment. If we did it, we would have to insure outside our existing policy. It is very complex."

Cosma said she understands the difficulty of providing the service. But she said if her dream comes to fruition, it'll help the entire community.

"It's not for my mom or these few. We're looking further down the road for the near future," she said. "It's going to benefit the Hana people."

She said she got her first donation of $100 at the meeting and learned there are medical personnel in Hana who could help.

Cosma said the Hana Community Health Center "would be the most logical place for it." But, she said, "The community felt at the meeting it is best to go out on our own to do it."

SHPDA Administrator David Sakamoto said he would need the details on any proposal for a dialysis facility in Hana to determine whether a certificate of need were required. But he would work with the community to meet its needs.

"We do want to see people receive the services they need. We would do our best to work with the people to see what is needed," he said.

Copyright © 2003 — The Maui News

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