Death or dialysis? Gasp kidney patients face tough choices

Given the choice between dying or travelling 800 kilometres three times a weekfordialysis treatment, 85-year-oldYvette Lamarre would choose death.

Lamarrelives in Gasp, which like many rural areas in Quebec is poorly served by specialist medical services. There are only 12 spots in a dialysis treatment centre in Chandler, 100 kilometres down the coast, but they're all taken.

That's the only health centre that offers hemodialysis on the Gasp Peninsula, an area roughly the size of Belgium.

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ForLamarre to get treatment for her failing kidney, her next closest optionis Rimouski, nearly 400 kilometres away. The nine-hour round trip isn'tsomething she is willing to consider.

"I won't have the choice. What do you want?,"Lamarre said. "It's up to the government to take care of us."

Lamarrehas been receivingperitoneal dialysis at home for the past 10 years.

LastSeptember, her doctors told her that treatment was no longer working; she would have to switch tohemodialysis, in whichblood is pumped out of the body to an artificial kidney machine to be filtered and cleaned before being pumped back.

Each hemodialysissession can last four hoursand must be donethree times a week.

Whilehemodialysis can be doneat home, patients must first undergo a nine-week-long training session in Quebec City. For Lamarre, that'stoo far to go, for too long.

And moving to Rimouski?

"My family is all here. My daughter lives with me to help me. My husband helps me a lot," Lamarre said. "I'm comfortable at home, so I don't want to leave here."

'I don't have a choice'

Lamarre is not the firstresident of the Gasp Peninsula forced to travel vast distances for hemodialysis treatment, nor is she the first to suggest all that travellingchallenges a patient's will to live.

Facing a four-hour round trip betweenSainte-Anne-des-Montsand the hemodialysis centre in Rimouski, Cyrille Gibeaultwarned lastAugust that he wouldsimply stop seeking treatmentunless a better arrangement was found.

His son, CyrilleJuniorGibeault, who also suffers from kidney failure and requires dialysis three times a week, threatened to join his father in the protest.

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"I don't have a choice,"JuniorGibeault told Radio-Canada. "My father is going to die, and for what? For inaction."

Local health officials eventually agreed to sendGibeault, 63, to Quebec City to receivethe training necessary to perform thehemodialysis at home.

Gibeault, with the help of his local MNA, theParti Qubcois'sGatan Lelivre, tabled a petition last month in the National Assembly with more than 2,000 signatures, calling for betteraccess tohemodialysis in the Gasp region.

A similar petition, this onewith 8,500 signatures, was tabled in 2015

'Capacity is capacity'

Health MinisterGatan Barrette recognizesthat the situation in the Gaspis far from idealand indicated the government is looking at a number of solutions, including dispatching a mobile dialysis unit to the area.

In the meantime, he said,Lamarreand others willsimply have to wait their turn fordialysis treatment closer to home.

"We're trying to make arrangements," Barrette told CBC'sBreakway. "Dialysis is a service. You cannot bump someone. Capacity is capacity. You cannot take the place of someone else."

Pressure on the region's already limited dialysisresources is only likely to grow in the years to come, warnedMartin Munger, executive director of the Quebec branch of the Kidney Foundation of Canada.

Referring to Lamarre's case, he said,"With people getting older and older we will see this kind of very difficult situation more frequently."

The province's own guidelines recommend that kidney patients not have to face round-trip travel of more than three hours to undergo dialysis.

But setting up additional treatment centres is expensive. Munger estimated that treating one dialysis patient costs more than $60,000 per year.

"It takes a machine, it takes a room, but more importantly, it takes nurses anddifferent health professionals to operatea dialysis centre," he said.

The ideal solution is to expand the availability of home dialysis, he said.

But at the moment, it is believedGibeault is the only person in the Gasp region trained to administer the treatment to himself.