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Renal failure means death in Fiji, so some sufferers have been helped in Australia -- until now, Brian Woodley writes

By Brian Woodley

SYDNEY, Australia (July 23, 2001 –The Australian)---The death warrant came by registered mail. When Stan Ritova, 66, opened the envelope, his Fijian passport fell out -- and his life fell apart. When Ellen Whippy asked the Department of Immigration to change her father's visa from tourist to medical, the department's response was worse than a routine no.

Flicking through the passport, Ritova was shocked to discover his multiple-entry visa, supposedly valid until 2005, had been summarily cancelled. He turned the page and found a brand-new stamp saying he could not remain in Australia beyond August 29. The stamp was not signed by any official. There was no covering letter, no explanation, no insincere word of regret. Just the amended passport.

Four of Ritova's seven children live in Australia. But that is not why he needs to stay. Indeed, Immigration Minister Philip Ruddock might be pleased to know that this man of letters wants to return to Suva and his wife, Malika. "I miss my family," he says. "I miss the way of life, talking to people. I'm missing all the political action. Here, it's so lonely. Everyone goes to work and you're left on your own."

The problem is, within two weeks of reaching Fiji, Ritova will be dead.

In common with most South Pacific islands and Third World countries, Fiji has no facility for treating kidney failure and no intention of developing any. This seems astonishing, given that Fiji has the third highest incidence of diabetes -- a condition that, untreated, can progress to diseases of the kidneys, eyes, nerves and heart. Recent estimates suggest one in four of the population has diabetes.

"Yes, diabetes is a problem and a lot of bad ones complicate to renal failure," says Nacanieli Goneyali, director of hospital services for Fiji's Department of Health. "But what can I say? We do not have any funding at all set aside from the Government and the guidelines are clear: we do not treat renal failure. Also, with insurance, they won't cover you for renal failure."

Goneyali does not expect a change in policy after Fiji's forthcoming elections. The country's official and longstanding fatalism is governed by money -- or the lack of it. Kidney transplants are out of the question and dialysis is deemed too expensive for the national budget to bear.

This is not an intractable problem for the rich, who can exercise options such as private treatment in Australia or New Zealand. Determined individual efforts among the middle classes, such as has happened with Ritova, can also succeed in saving life. But for the poor -- that is, most Fijians -- renal failure is tantamount to a death sentence.

Australia is aware of the plight. "This is not uncommon," says the Immigration Minister's spokesman. "It happens in almost any Third World country. Fiji is far from isolated. A lot of people with renal failure want to migrate here. But we have waiting lists in Australia as well. We have a shortage of kidney donors and not a lot of dialysis machines, so people are competing for places. Which Australians do you go to and tell they have to be pushed down the list?"

He says migrant applicants are not eligible for Medicare and seldom have the money to pay for a permanent treatment regimen. "In some cases people can come out on a medical visa, but they need virtually unlimited funds."

Ruddock's spokesman does not exaggerate the pressure on resources. The Australian Kidney Foundation says the number of Australians being treated with chronic dialysis or transplantation more than doubled between 1995 and 2000, to almost 12,000. Leanne Fardone, the foundation's communications manager, says hospitals are implementing round-the-clock shifts, seven days a week, to meet demand. Some are using emergency dialysis machines for routine treatments.

Ritova, near death, was admitted to the Colonial War Memorial Hospital in Suva about the time of George Speight's armed takeover of Parliament in May last year. He was placed in a 20-bed ward with other kidney patients. It was assumed he would share their fate, being made comfortable as he waited to die. In the two weeks before he was admitted, four patients had succumbed in that manner.

Ritova's daughter Ellen, who runs a recruitment company in Sydney, was not prepared to let go. She rounded up other members of the family, had her father flown to Sydney and went scouting for doctors. One specialist told her: " Unless your father is a Kerry Packer who received a kidney transplant courtesy of his pilot, don't even bother to bring him here because I wouldn't even look at him."

Then she found Elliott Savdi, a renal specialist at St. Vincent's Hospital, just up the road from her Paddington home, where Ritova has been living for the past year. Savdi remembers a Fijian patient from the early 1980s who was in the same predicament as Ritova. The man's condition was such that he could be trained in home dialysis. Equipment and supplies were made available through charities, and he was kept alive in Suva for several years. "That was an exceptional case," says Savdi.

Home dialysis for Ritova appears an unviable option, at least for the moment. He requires a complete circulation withdrawal and recycling of blood through his system three times a week, at a cost of more than $700 a time. His family struggle to keep pace with the payments and the crisis in his immigration status has come as a horrible blow.

Savdi has no patience with officialdom. "My own modus operandi is that I treat the patient, then deal with authorities and immigration departments after -- the general bureaucratic hoops and demands for money.

"These barriers are a great pity. You can't get people into the country, but if they're here they can be treated."

As he explains in a letter to immigration authorities, "Should Mr. Ritova be forced to return to his home in Fiji, he will have a life expectancy of only one or two weeks by virtue of the fact that dialysis is not available in that country."

The doctor urges that Ritova's visa be extended on compassionate grounds, "as his current state of health is excellent with the prescribed regimen."

Savdi observes that Australia has managed to extend the availability of dialysis to chronically afflicted areas of the Northern Territory, Queensland and Torres Strait Islands, where the incidence of diabetes is rampantly high among indigenous people.

But moving beyond Australia's jurisdiction into the dirt-poor countries of the region via special aid efforts appears to be beyond us.

"We and New Zealand are wealthy countries. It behooves Australia to do a little bit in this regard," Savdi says.

Such attempts have occasionally been made, but with only temporary success. Ritova was involved in a project that raised $300,000 to pay for a specialist to visit and repair the eyesight of Fijians suffering from diabetes.

Also, in the same building as the Suva ward where Ritova was expected to die are two dialysis machines, disused and gathering dust, supplied by well- meaning fundraisers.

But the machinery, although not cheap, is the least of what Fiji and similarly afflicted countries need. More vital is the infrastructure -- properly trained doctors, nurses and technicians, working in a sterile environment with regular supplies of the costly materials used to flush wastes from the body. It is in these areas that Fiji refuses to invest, having written it off as too expensive.

Ritova is embarrassed by his condition and his country's attitude to the health of its citizens. He is a once-active man with a still-busy life -- yet the vivid streams of his life are back in a place where he instinctively belongs but cannot survive.

Fidgeting for the most part around his daughter's home, he sometimes visits the State Library of NSW to research a book on the history of the Fijian newspaper industry. This will be his second book, after a 1988 account, No Other Way, of Sitiveni Rabuka's coup.

Ritova knows something about newspapers. He joined The Fiji Times as a reporter in 1956, and later worked as a correspondent for Reuters, Agence France-Presse and Australian Associated Press. At the beginning of last year he was hired to edit the newly revived Fiji Sun, one of three morning dailies in Suva. The editorship has been held for him through his illness.

"I'm a journalist through and through. I'll never retire," he says. "I've written about the Fiji health situation in the Sun, but no one's impressed unless it involves them. It was fortunate I had connections here. Otherwise it would have been curtains for Stan Ritova. The man in the street, there's no way he can afford it, and he's going to die. "

Says Stuart Inder, former editor of Pacific Islands Monthly, doyen of Pacific journalism and an old mate of Ritova: "I can't believe that ... Immigration would be allowed to issue what in essence is Stan's death warrant. Yet I might be wrong. And the wider problem remains that people are dying in Fiji and that Fiji has to do something about it for everybody's sake. "


Renal Disease On The Rise

§ From 1995 to 2000, the number of Australians being treated with chronic dialysis or kidney transplants increased from 5,476 to 11,696.

§ Statistics for the most recent available year, 1998, show 1,562 Australians were on the transplant waiting list.

§ Each year an estimated 2,440 Australians develop acute renal failure. As many as one in three die within three months. Half a million Australians have impaired kidney function.

§ The incidence of end-stage renal disease is five times greater among Aborigines. It is linked to diabetes, to occur disproportionately among women and to start at a young age.

§ Among Australians, end-stage renal disease is increasing by 6 percent a year.


Authorities' Lack Of Interest An Obstacle

Steven Rich, Sydney businessman, philanthropist and father of former One Tel joint managing director Jodee Rich, sees indifference by Fijian authorities as a key obstacle to addressing the "atrocious health crisis over diabetes-induced kidney disease."

"I could get a group together who have the resources and the will to do this," he says of his ambitions to take dialysis treatment into Fiji. "That would be a labor of love."

But the last time he tried, three years ago, he got no response from the Fijian minister for health or the Fijian High Commission in Canberra.

"They weren't interested, apparently," says Rich, 75, who has been on dialysis for six years.

He shares the same doctor as Stan Ritova and describes Ritova as one of the most popular patients among staff at St. Vincent's Hospital in Sydney.

"The number of people dying out there in areas where diabetes is endemic is just amazing," says Rich.

"I had a near-death experience myself and wanted to help. I wasn't doing anything on Monday, Wednesday and Friday nights anyway" -- his thrice-weekly dialysis appointments.

He observes that Nouméa, in French New Caledonia, is a notable exception in the Pacific, with well-resourced dialysis facilities.

He also calls for a change in Australian attitudes towards organ transplants.

"In Australia, the people own their own organs. In Norway, the state owns the organs.

"I know that sounds Nazi-like. But, in effect, it works because there's no waiting list in Norway."

Brian Woodley

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