Former British Gurkha soldier KS Limbu is fighting the hardest battle of his life at age 70. With both kidneys damaged, this war veteran has spent nearly all his savings to stay alive. Lying down on the narrow hospital bed at the National Kidney Centre (NKC),
Limbu's life depends on a dialysis machine. When the kidney is damaged, toxins build up in the blood and the only way to prevent further kidney failure is dialysis. Two needles are injected into blood vessels of the wrist and are attached to a dialysis machine. The machine purifies the blood from the patient before pumping it back into the body.

Since kidney transplants are unavailable in Nepal, the only way to stay alive is through excruciating four-hour dialysis sessions twice a week. Transplants in India

cost up to Rs 500,000 but even then patients need follow up care at kidney care centres and have to take medications all their lives. The other option, dialysis, doesn't come cheap either. At Rs 30,000 every month, it is out of reach for most patients. "My children support me, but soon I'll have to take a loan because we are all running out of cash," says Limbu weakly. But even so, Limbu is lucky. He pays considerably less for his live-saving procedure at NKC than at other private health clinics.

While the centre is making serious efforts to subsidise the treatment, it does not give it for free. "Once we start doing that, we will have to close," says Rishi Kafle, chief nephrologist at NKC, which is run by the non-profit Health Care Foundation-Nepal (HECAF) in Naxal. Till a few years ago, most Nepali kidney patients either went to India or waited for months at Bir Hospital. Running a private dialysis facility was unthinkable. Dialysis machines cost Rs 1.5 million each and need expert maintenance. The NKC only manages because it teamed up with a German social worker, Beate Vogt.

When she was in the United States, Vogt met a Nepali kidney patient who told her there was no dialysis centre in Nepal. Vogt's mission became to roam from one German hospital to another, begging them to donate old dialysis machines. She hired technicians to repair them and ship them to Nepal. The NKC was established in 1997 with Vogt as its honorary advisor. Today, the NKC is the nation's best-equipped kidney care centre, and carried out 700 dialysis sessions in the first year. Now, with 15 dialysis machines, it caries out over 650 sessions every month.

Pawan Ghimire has been coming to the NKC with his 66-year-old mother who has suffered from kidney failure for the past six years. He used to take her to India but having her treated here has become more economical. Still, it's difficult for him to foot the bill every month, even on a good salary. "It's expensive for us but the doctors here are reasonable," he says. "When I don't have money, they consider my position." Although NKC refuses free dialysis, it does offer free sessions to regular patients who run out money and are compelled to stop. "It is difficult for us to watch someone quit, and the patient suffers," says Kafle.

Things are not easy with high operational costs: daily tanks of pure water, rent and huge electricity bills, medical supplies and salaries for the 60 hospital staff. "Fortunately, Beate helps us with the technicians and sends us machines and spare parts," says Kafle. "We also owe much to the Nepali patients because they trusted us and without them, we would not be able to run so smoothly." Every year, 2,000 new kidney patients are added in Nepal. Several private nursing homes have either stopped dialysis treatment or reduced the number of sessions because of high overheads. Even in India, the renowned Sai Baba Hospital-where most Nepalis used to go for kidney treatment-has closed. New Delhi's Apollo Hospital, one of South Asia's largest medical facilities, has only 18 machines.

This makes the service NKC provides much more critical. It plans to branch out to Pokhara and Nepalganj to cover the west and far-western regions where there is no dialysis service. The centre has also set up an isolated unit in Naxal for HIV and Hepatitis patients with kidney problems. Since they are perceived to put other patients at risk, most hospitals are reluctant to accept them. A 25-year-old army officer under treatment at the army hospital was transferred to this centre after he was infected with Hepatitis C while being treated for kidney failure. "This unit has made it safe for these kinds of patients because we have separate machines for them," says the centre's doctor, Salil Poudyal.