The Fresenius center answered claims of patients of the dialysis centers in Kyrgyzstan

2020

The Fresenius center answered claims of protesters

On November 4, 2020 before the building of the Ministry of Health in Bishkek there took place the meeting in which some patients undergoing dialysis procedures in Fresenius Medical Care clinics in Kyrgyzstan participated.

On November 7, 2020 it became known that with respect thereto the press service of Fresenius Medical Care in Kyrgyzstan is authorized to make the following statement:

The situation, in our opinion, is caused by misunderstanding which can be overcome in direct dialog with representatives of the company. The company always organized such direct discussion earlier and will be glad to organize and in the future. We conduct regular survey of patients, and responses about our work, as a rule, good. Complaints of the patients who came to a meeting were known, on them the answer both through official letters, and in conversations with certain patients always arrived. Recently there took place the meeting with representatives of the patient organizations at which the staff of the company it is detailed, for several hours, answered questions. Fresenius Medical Care clinics in Kyrgyzstan work in full accordance with terms of the contract about public-private partnership which provides rendering to patients the necessary qualified treatment. Moreover, we render the free services which are not entering the agreement: carried out vaccination against flu and hepatitis, we carry several months of patients to the place of passing of dialysis procedures and back in connection with a pandemic of a coronavirus and restrictions in work of public transport. The statement stated by several patients that patients are deprived of an opportunity to pass into other dialysis center, is deprived of the bases. All patients have the right to pass into other dialysis center, having filed a petition to the Ministry of Health, we do not interfere with it. Let's emphasize that we carry out for one and all patients treatment at the level of the international standards and are ready to answer positively all requests, except those which as in a case with a request to cancel the appointed alternative medicine, can cause damage to health of patients. The appointed alternative medicine epoetin the zet which application raised questions at several patients is European (it is manufactured according to the German license in Spain), it is used in many countries. The efficiency of medicine is proved by clinical trials, it is positive not only the company, but also doctors in Kyrgyzstan and in the world in general. All medicines are appointed by doctors not randomly, and is strictly individual, in the presence of indications to it, on the basis of analyses. We express a regret that some of our patients receiving procedures in the dialysis centers Fresenius Medical Care considered information provided by us earlier insufficiently convincing. We assure our dear patients that, as before, representatives of our company are always glad to answer any arising questions. Let's note also that other patients receiving procedures in our clinics in Kyrgyzstan (and it is nearly 300 people), apparently from the conducted anonymous surveys, are happy with our work[1].

The Minister of Health got acquainted with conditions of provision of services of dialysis to patients

On November 6, 2020 it became known that the Minister of Health Alymkadyr Beyshenaliyev visited clinic of Frezenius company to Bishkek which renders hemodialysis services to patients with a chronic renal failure of the fifth degree.

The minister got acquainted with conditions of provision of services of dialysis to patients, the discussion with patients was led.

Patients, during conversation, sounded the wishes on improvement of activity of clinic.

During working meeting with representatives of clinic of Frezenius company, the minister made the recommendations submitted on quality improvement of medical care to hemodialysis patients.

At a meeting the main requirements of patients connected with increase in mobility of patients in the choice of the hemodialysis centers, to taking of the informed consent of patients on purpose of medicines of an eritropoetinovy row (Rekormon, Eposan) were once again read.

Representatives of clinic noted that they will bring the stated minister's wishes to the central company management of "Fresenius Medical Care Deutschland GmbH" (Germany, Hamburg) for the fastest decision-making for benefit of patients.

The Ministry of Health of KR understands requirements of patients and in return makes and will make all efforts for the solution of urgent problems, in strict accordance with the current legislation.

The source noted that all decisions between partners are made according to the current agreement on public-private partnership between the Ministry of Health of the Kyrgyz Republic and Fresenius Medical Care Deutschland GmbH company on project implementation of public-private partnership "Organization of services of a hemodialysis in the cities of Bishkek, Osh and Jalal-Abad"^[2].

Meeting of patients with a chronic renal failure

On November 4, 2020 at the building of the Ministry of Health of Kyrgyzstan there took place the meeting of patients with a chronic renal failure who receive a hemodialysis. Protesters said that the hemodialysis center "Frezenius" violates their rights when choosing medicines.

Patients of the center of dialysis Fresenius in Kyrgyzstan said that "hold of them hostage". Photo source: kloop.kg

The original medicine "Rekormon" lifting hemoglobin is replaced on biosimilyar with Eposan — protesters said.

Also the audience acted against they were forced to be got a hemodialysis only in one center. According to them, patients of Frezenius remained "in hostages" — to them do not permit to select the hemodialysis center and to move across Kyrgyzstan as it is provided by the legislation.

The Minister of Health Alymkadyr Beyshenaliyev left to protesters and asked to give time till Saturday for studying of this question. According to the minister, he will meet leaders of a meeting and will discuss with them this problem at the end of the week.

Besides, the patients receiving a hemodialysis wrote the letter to the acting president and prime minister Sadyr Zhaparov with a request to pay attention to partnership of the Ministry of Health and Frezenius. According to them, there not only violate the rights of patients, but also render services of a hemodialysis in inflated price.

The state overpays 2,112.50 som for each patient of Frezenius. In a year the state overpays 100,436,700 million som. Could receive free dialysis for this money of 127 patients with CRF (chronic renal failure) of the 5th stage standing in a queue on budget dialysis — note in OO "Consolidation of Hemodialysis Patients".

Fresenius Medical Care — one of the world companies which is engaged in products and services connected with treatment of a chronic renal failure. The Kyrgyz Ministry of Health signed the agreement with Fresenius Medical Care on the organization of services of a hemodialysis within projects of public-private partnership in 2017. Since then four centers for patients with a renal failure, two of which are located in Bishkek, opened and function.

In 2018 the patients receiving a hemodialysis from the state also protested against replacement with the Ministry of Health of the checked Swiss medicine "Rekormon" by the medicine "Repoitin" from the Indian producer. After protests the Ministry of Health provided with their Rekormon, and then transferred patients of Bishkek, Osh and Jalal-Abad of Frezeniusu.

The company worldwide was accused more than once of overestimate of the prices in comparison with other suppliers of hemodialysis services. And the Ministry of Justice of the USA in 2019 accused Fresenius Medical Care of bribery to officials of health sector and to representatives of authorities of 13 countries, and obliged to pay a penalty in the amount of $231 million^[3].

2019

Nurkhan Zhumabayeva about need of prevention of diabetes for decrease in a flow of hemodialysis patients

The chairman of Public council of the Ministry of Health of the republic Kyrgyzstan Nurkhan Zhumabayeva on July 2 20109 years told about how prevention of diabetes will allow to avoid a new flow of hemodialysis patients.

The most widespread type of treatment of HPN is the hemodialysis. According to information for July, 2019 in the republic Kyrgyzstan of service of a hemodialysis on a budget basis 554 persons, a preferential hemodialysis — 764 persons receive.

In total within the agreement on the public-private partnership (PPP) between Fresenius Medical Care and the Ministry of Health of Kyrgyzstan 4 dialysis centers were open: in Jalal-Abad (on October 8, 2018), in Osh (on April 24, 2019) and Bishkek (on February 1 and on May 31, 2019).

Thus, the problem of rendering hemodialysis services is almost solved, but there are relevant other aspects: diagnostics and treatment of a chronic renal failure. In Kyrgyzstan on procedures of a hemodialysis 690 million som, and are selected for treatment of diabetes — 65 million som.

According to Nurkhan Zhumabayeva, it is possible to avoid big costs for a hemodialysis if means to select for prevention of the diseases leading to such effects than to fight already against effects from a disease. As you know, diabetes is one of the main reasons which leads to diseases of kidneys. Need of prevention of diabetes is very relevant, the chairman of OS of the Ministry of Health emphasized.

Nurkhan Zhumabayev suggests to take the following measures:

• Train nephrologists in the international commonly accepted standards of diagnostics. Revealing the prime cause, it is possible not only to save health of the patient in time, but also to considerably cut down expenses, owing to treatment of a disease.
• Carry out constant, objective surveillance and monitoring of rendering hemodialysis services in international standards;
• Make the long-term plan of actions of MZ for nephrological service;
• Consider a question of transplantation for patients.

According to the chairman of OS of the Ministry of Health, it is important to have modern clinical bases for training of nephrologists and transplantologists. At the same time all clinics should provide quality of the rendered services in uniform requirements — work experience of the world Frezenius brand can become a standard of rendering services.^[4]

Opening of the dialysis center in Bishkek

On May 31, 2019 it became known that in Bishkek one more dialysis center of Fresenius Medical Care Kyrgyzstan company opened. It is already the second of the clinics opened in the capital of Kyrgyzstan, and the last from 4 dialysis centers in the Kyrgyz Republic which opening was provided within the agreement on the public-private partnership (PPP) between Fresenius Medical Care and the Ministry of Health of the Kyrgyz Republic. Capacities of these clinics allow to carry out dialysis procedures for all patients with diseases of kidneys whom the company services according to the agreement on PPP.

Thanks to the carried-out work during which many of patients who were serviced in the public medical institutions earlier were transferred to Fresenius Medical Care clinics it was succeeded to expand considerably medical care in Kyrgyzstan for the patients having the chronic renal failure (CRF).

The dialysis center in Bishkek was open for the purpose of creation of additional capacities for service of patients in the capital of Kyrgyzstan: it is intended for a number of patients who were attributed to the main dialysis center which opened in Bishkek in February earlier. The dialysis clinic is located at the address Chokan Valikhanov St. 1/3 and equipped with dialysis devices of series 5008S CorDiax: it is the modern, widely applied in the world market model which effectively performs the lost function of kidneys on removal of toxic substances from an organism when holding dialysis procedures.

In the dialysis center qualified employees, including doctors, nurses and technical workers work. All of them passed programs of additional training and advanced training thanks to what respect for the high quality standards operating in Fresenius Medical Care company is provided.

Opening of the dialysis centers in Bishkek, Osh and Jalal-Abad allowed to improve considerably service of many patients who have a chronic renal failure: they got access to the free medical support conforming to the advanced international standards. Besides, as a result of opening of clinics in Kyrgyzstan about 100 jobs appeared. I thank our partners who gave active support when implementing the project, including, first of all, the Ministry of Health of the Kyrgyz Republic and the Government of Kyrgyzstan, told Yury Kremer, the senior manager of regional directorate of Fresenius Medical Care across Eastern Europe and Central Asia

Within the project of PPP on the organization of dialysis services in the Kyrgyz Republic arrangements between the investor and the state were in full executed. The open dialysis centers are equipped with modern appliances and the advanced international practicians in the field of kidney dialysis allow to implement in Kyrgyzstan, and the patients having a chronic renal failure receive the most modern medical support in these clinics. It is sure that Fresenius Medical Care and will make in the future an important contribution to development of health care in the country, commented Kosmosbek Cholponbayev, the Minister of Health of the Kyrgyz Republic

We are very glad that helped to implement this initiative. Successful experience of implementation of PPP project says that this tool in Kyrgyzstan effectively works, so, there are excellent premises for start of other projects of PPP. Kyrgyzstan with his big needs for investments and limitation of budgetary funds needs that such initiatives became more and more. We will continue to give support to the republic in implementation of PPP projects in socially important spheres, noted Martin Negele, the head of the International Finance Corporation (IFC) in Kyrgyzstan

Dialysis clinics Fresenius Medical Care in the Kyrgyz Republic opened according to the agreement on the organization of dialysis services in Kyrgyzstan within the project of public-private partnership. This agreement was signed in August, 2017 between Fresenius Medical Care and the Ministry of Health of the Kyrgyz Republic. It is the project which was implemented within the mechanism of PPP in Kyrgyzstan. The project was prepared at a financial support of KfW and the consulting help from the International Finance Corporation (IFC) entering into the World Bank Group and also the governments of Germany, Austria, Hungary and Switzerland. Total investment within this project was more than 10 million dollars^[5].

2018: Opening of the dialysis center to Jalal-Abad

On October 17, 2018 in the city of Jalal-Abad (Manas St. 21A) opening of the first dialysis center of Fresenius Medical Care Kyrgyzstan company, subsidiary of the international company Fresenius Medical Care took place. All 24 patients living in Jalal-Abad will receive free treatment in clinic. The clinic is equipped with 15 devices "artificial kidney".^[6]

The dialysis center Fresenius Medical Care in Jalal-Abad

As reported, it is the first of 4 dialysis centers which will begin the work in Kyrgyzstan according to the agreement on the organization of providing dialysis services in the republic within the project of the public-private partnership (PPP) between Fresenius Medical Care and the Ministry of Health of Kyrgyzstan. This agreement was signed by the parties in August, 2017.

Opening of the dialysis centers became the first project implemented within the mechanism of PPP in Kyrgyzstan: it was prepared at a financial support of KfW and the consulting help from the International Finance Corporation (IFC) entering into the World Bank Group.

It is expected that activity of Fresenius Medical Care clinics in three cities (two in Bishkek and on one in Osh and Jalal-Abad) will allow to increase considerably service quality, rendered to the citizens of Kyrgyzstan having the chronic renal failure (CRF) to guarantee them receiving available, timely and free medical care. It is supposed that within the PPP of the project performed on the mechanism in clinics of the company more than 280 patients will be able to receive treatment.

Besides, emergence in Kyrgyzstan, according to preliminary estimates, about 100 jobs will also become result of opening of the dialysis centers.^[7]

For reference use: replacement kidney therapy is, in addition to transplantation, the unique method of treatment and survival of patients with the chronic renal failure (CRF). The most widespread type of treatment of HPN is the hemodialysis. This method allows to purify blood from toxins and to regulate water and electrolytic and acid-base balance in an organism of patients thanks to use of the device "artificial kidney". Dialysis helps to provide to patients with a chronic renal failure rather high level of life.

Notes