{"id":377598,"date":"2022-10-13T06:02:23","date_gmt":"2022-10-12T20:02:23","guid":{"rendered":"https:\/\/www.saipantribune.com\/?p=377598"},"modified":"2022-10-13T06:02:23","modified_gmt":"2022-10-12T20:02:23","slug":"many-cnmi-patients-have-to-move-to-get-life-saving-access-to-dialysis","status":"publish","type":"post","link":"https:\/\/www.saipantribune.com\/index.php\/many-cnmi-patients-have-to-move-to-get-life-saving-access-to-dialysis\/","title":{"rendered":"Many CNMI patients have to move to get life-saving access to dialysis"},"content":{"rendered":"
\"\"<\/a>
Abraham Taimanao hammers two sheets of tin to make a roof for the chicken coop he is building.\u00a0(CARLO DOMINGO\/CIVIL BEAT\/2022)<\/figcaption><\/figure>\n

Editor\u2019s Note: This story was originally published by Civil Beat. Read the original article here: https:\/\/www.civilbeat.org\/2022\/09\/many-pacific-islander-patients-have-to-move-to-get-life-saving-access-to-dialysis\/ Reprinted with permission. Most of the article\u2019s original style is retained.<\/em><\/p>\n

AS LITO, Saipan\u2014<\/strong>Abraham Taimanao leans over two pieces of tin and lifts his hammer to flatten them together.<\/p>\n

The tin is intended for the roof of a new chicken coop that Taimanao has been building, near rows of hot pepper plants and other plants he\u2019s been cultivating.<\/p>\n

This isn\u2019t Taimanao\u2019s land. He\u2019s not exactly sure who owns it. But the 60-year-old comes here every day because it reminds him of his real home\u2014his farm on the island of Rota, nearly a half-hour flight away.<\/p>\n

\u201cI come out here just to give me a peace of mind, not thinking about dialysis, not thinking about anything else, but to enjoy life like what I usually do [on] Rota,\u201d says Taimanao.<\/p>\n

Across the street is the concrete building that Taimanao and other dialysis patients have called home ever since they were told that they needed to get dialysis three times a week to survive.<\/p>\n

In the Commonwealth of the Northern Mariana Islands, the only dialysis centers are on the capital island of Saipan. Neighbor island residents from Tinian and Rota, most of them Indigenous Chamorros, move to Saipan to access the life-saving care.<\/p>\n

Tinian is home to around 3,000 residents, while Rota\u2019s population is about 1,800. Nearly two dozen of them are living on Saipan solely to get dialysis.<\/p>\n

Diabetes, the leading cause of kidney failure, is a huge problem in the U.S. territory, especially among its Pacific Islander communities.\u00a0One 2016 survey, the latest such survey available, estimated while the diabetes rate was 12.5% among all Commonwealth adults, the figure was as high as one in five Chamorro adults and about a third of all adults over the age of 65.<\/p>\n

The prevalence of diabetes in the Northern Marianas is driving up the demand for dialysis. In 2018, Saipan\u2019s only hospital,\u00a0the Commonwealth Healthcare Corp., had just over 100 dialysis patients, but now the number fluctuates between 170 and 180, says Nikki Villagomez, who leads the hospital\u2019s dialysis clinic.<\/p>\n

\u201cThe increase of patients was steady for a long time. For some reason it kind of skyrocketed out of nowhere,\u201d Villagomez says. \u201cI just see it increasing even more in the future.\u201d<\/p>\n

Diabetes is a problem throughout the Pacific and forces people from many islands across the Micronesian region to move to Hawaii and elsewhere in the U.S. to access the necessary care.<\/p>\n

In the Northern Marianas, the demand for dialysis on the neighbor islands hasn\u2019t yet been met by supply. Past efforts to open a center on Rota ran up against difficulties recruiting staff.<\/p>\n

\"\"<\/a>
Jesus Cruz pays $91 every weekend to fly home to Tinian because he can’t stand being far away. Other patients aren’t able to afford that. (CARLO DOMINGO\/CIVIL BEAT\/2022)<\/figcaption><\/figure>\n

Congress has appropriated more than $500,000 of rural development funding to help patients conduct in-home dialysis, a\u00a0growing national trend. But many patients from Tinian and Rota who live on Saipan say they fear infections if they\u2019re performing dialysis by themselves, and what they crave is safe access to a doctor and hemodialysis chairs back home.<\/p>\n

In the meantime, many Tinian and Rota residents move to Saipan for care, leaving behind their homes, friends and family members, and the peace and familiarity of those smaller islands.<\/p>\n

Dialysis on Saipan keeps patients like Taimanao alive, but at the cost of spending time with loved ones back home. They miss out on birthdays, holidays and traditional ceremonies like the nine-day Chamorro rosaries held to honor deceased relatives and village saints. The longest any dialysis patient can be away from the machines is four days.<\/p>\n

Many are following the same path their parents took. Taimanao visited his mother on dialysis on Saipan for 20 years before she was buried back on Rota. He hopes his children and grandchildren don\u2019t end up like him.<\/p>\n

\u2018You have to go\u2019<\/strong><\/p>\n

On Rota, Taimanao hunted coconut crabs and deer, went fishing and caught sea crabs to feed his family. When he found out that he would be forced to move to Saipan, he asked his wife, \u201cWhere are we going to get the resources to meet our kids\u2019 needs?\u201d Saipan has different rules for fishing than Rota, and Taimanao wasn\u2019t sure where he\u2019d be allowed to hunt coconut crabs.<\/p>\n

\u201cWe have to go because it\u2019s for your health,\u201d his wife replied. That wasn\u2019t an answer to his question, but she reminded him that staying would mean dying, which would mean saying goodbye to his kids.<\/p>\n

\u201cI still want to see my kids,\u201d he told her.<\/p>\n

\u201cYou have to go,\u201d she concluded.<\/p>\n

Similar conversations have played out in many other patients\u2019 homes. Jesus Cruz remembers how his father moved back to Tinian after five years and decided to move back home, even if it meant dying.<\/p>\n

His father didn\u2019t want to financially burden his family by requiring them to pay for flights to Saipan, a hotel and rental car if he were hospitalized in the intensive care unit.<\/p>\n

\u201cIt cost money. So my dad said never mind,\u201d Cruz, now 60, said. The family gathered on Tinian by his dad\u2019s bedside when he died in 1998.<\/p>\n

\"\"<\/a>
Rose Sylvia San Nicolas describes how Tinian is different from Saipan as she holds her dog outside her apartment where she has been living on Saipan for over a year. She grows Chamorro medicinal plants such as\u00a0korason gala on her lanai. (CARLO DOMINGO\/CIVIL BEAT\/2022)<\/figcaption><\/figure>\n

Several years later when Cruz was told he needed to get dialysis, he spent four years trying to avoid it because he didn\u2019t want to leave his house and life on Tinian.\u00a0His kids and grandkids pressured him to go get the treatment.<\/p>\n

\u201cI\u2019m doing this for them,\u201d says Cruz, sitting at a picnic table in the courtyard of the apartment complex dedicated to patients like himself. \u201cNot for me.\u201d<\/p>\n

The municipal governments of Tinian and Rota provide studio apartments for patients including Taimanao and Cruz to live in rent-free. They cover the cost of utilities and transportation to and from appointments. Patients get $100 monthly stipends, which helps because their dialysis schedules and health problems make it difficult to work. Currently 13 patients from Tinian and nine from Rota are receiving such services.<\/p>\n

The patients are grateful for the help, but it\u2019s not the same as home. On Tinian, Cruz raised 80 pigs on his farm where he also grew bananas, tangerines, and lemon trees and had countless chickens. Since he left, the farm turned back into a jungle.<\/p>\n

On Saipan, his days are filled with dialysis and chronic pain. He pays $91 for a roundtrip ticket back to Tinian every weekend because he can\u2019t stand being away. He estimates he has spent about $26,000 on plane tickets alone over the past six and a half years. His wife stayed on Tinian and when the pandemic shut down interisland travel, he couldn\u2019t see her for four months.<\/p>\n

\u201cI want to feel like I\u2019m home,\u201d he said. \u201cThis is not a home for me. I don\u2019t call this home.\u201d<\/p>\n

Failed attempts to open a dialysis center<\/strong><\/p>\n

Sen. Paul Manglona, who represents Rota in the Commonwealth Legislature, has been trying to establish a dialysis center for his constituents for more than a decade. In the mid-2000s, lawmakers appropriated $1.5 million to renovate a wing of the Rota Health Center.<\/p>\n

The building was complete with a reverse osmosis machine to treat the water and room for at least four dialysis chairs. But Manglona said the space never got up and running because of lack of staff.<\/p>\n

It\u2019s still empty and unused. A 2012 analysis found the space would need a lot more renovations before it could be operational.<\/p>\n

Manglona wishes that the local hospital could partner with a company to start up a new center.<\/p>\n

U.S. Renal Care, a national dialysis company,\u00a0previously ran five dialysis centers on Guam before selling them all in January 2020 to\u00a0Fresenius, which operates Liberty dialysis centers and is one of the largest dialysis companies in the U.S.<\/p>\n

Pliny Arenas, who leads the Hawaii region for U.S. Renal Care, said that before the sale, the company looked into potentially opening a dialysis center on Rota.\u00a0But it didn\u2019t proceed because of the challenging logistics of getting supplies from the mainland to Rota.<\/p>\n

Scott Sayres, spokesman for Fresenius, said the possibility of opening up dialysis centers in the CNMI is under evaluation.<\/p>\n

\u201cWe constantly evaluate opportunities to expand our services for patients,\u201d he said. \u201cMany factors go into those evaluations, including what\u2019s best for patients, staffing needs and business requirements.\u201d<\/p>\n

Staffing needs aren\u2019t a small issue. Esther Mu\u00f1a, executive director of the commonwealth\u2019s hospital, estimates the public dialysis center on Saipan is operating at 80% staffing because of the need for more nurses.<\/p>\n

The center has just one nephrologist that it must share with two private dialysis clinics on island. Mu\u00f1a said the cost of hiring another nephrologist could run higher than $300,000 a year. That doesn\u2019t include wraparound services like dietitians and social workers.<\/p>\n

She said the facility may become ready, but it\u2019s difficult to pay staff enough to retain them.<\/p>\n

\u201cYou can provide those services, but then you\u2019re not going to have the stability to continuously provide those services,\u201d she said.<\/p>\n

Manglona is frustrated telemedicine can\u2019t provide more options, and is convinced patients who moved to the states for dialysis would return home to Rota if it had a local clinic.<\/p>\n

\u201cWhy can\u2019t we have the nephrologist here go to Rota every week, every two weeks?\u201d he asks during an interview at a restaurant on Saipan. \u201cWe\u2019ll never make it possible if there\u2019s no political will to support it.\u201d<\/p>\n

The issue has become more personal to the senator in the last couple of years since his wife was ordered to get on dialysis.<\/p>\n

He tried to bring her to Washington state to live with their daughter there to get a kidney transplant, but the closest available dialysis seat was an hour\u2019s drive away, so they moved back to the CNMI.<\/p>\n

A home away from home<\/strong><\/p>\n

Some patients who moved to Saipan have found ways to adjust.<\/p>\n

\u201cSee, I\u2019ve got my onions here, and my hot pepper and this flower the old lady gave me this one, si Auntie Rose,\u201d Harold Manglona says as he points to different pots of plants lined up in the courtyard.<\/p>\n

The Rota native is standing outside of his studio apartment on Saipan in the complex where he lives with Cruz and Taimanao.<\/p>\n

Harold Manglona, 55, a cousin of the senator, has been on Saipan for dialysis for five years.<\/p>\n

He initially planned to refuse the treatment, but his siblings persuaded him to do dialysis for his children and grandchildren.<\/p>\n

Both his parents were diabetic. Manglona was 49 when he realized he was diabetic too.<\/p>\n

He can usually only afford to go to Rota once per year. Tickets are $241 roundtrip per person for locals, or close to $500 if he and his wife travel together.<\/p>\n

The 55-year-old retired firefighter decorates the table next to his front door with pictures drawn by his 11-year-old granddaughter. He visits his wife\u2019s relatives on Saipan and goes for walks along the marina or in the big stores that he wouldn\u2019t find on Rota. He dances in the courtyard sometimes to make his fellow patients laugh and temporarily forget their minahalang, the Chamorro word for the feeling of missing something.<\/p>\n

\u201cI keep myself busy to forget what I left out [on] Rota. I\u2019m getting used to Saipan life,\u201d Manglona says as he sits outside his studio apartment. \u201cI got a lot of friends here now.\u201d<\/p>\n

Like Taimanao and Cruz, Manglona left behind his farm when he moved. His son sold Manglona\u2019s cows to afford tickets for his family to visit Manglona on Saipan for Christmas.<\/p>\n

No local transplant center<\/strong><\/p>\n

For many people with kidney failure, dialysis isn\u2019t the only answer\u2014kidney transplants are another option. They\u2019re harder to get, but every year in the U.S. thousands of patients do.<\/p>\n

That doesn\u2019t feel like an option to many patients from Rota and Tinian, who are unfamiliar with the requirements of getting a transplant and concerned about the costs to do so.<\/p>\n

\u201cAm I too old for that?\u201d wonders Rose Sylvia San Nicolas, who moved to Saipan from Tinian. She\u2019s 47. \u201cI don\u2019t know. I have to move to the states, that\u2019s another move.\u201d<\/p>\n

The Transplant Center at The Queen\u2019s Medical Center in Hawaii will sometimes perform transplants on patients even in their 70s, if they\u2019re otherwise healthy. It\u2019s the only transplant center in the Pacific Rim.<\/p>\n

Since 2012, the center has performed transplants for 11 patients from Guam, Saipan, and American Samoa. Over that time period 20 patients from the Federated States of Micronesia and 11 from the Marshall Islands also got transplants.<\/p>\n

The center does not have data on whether any patients from Rota or Tinian have ever received kidney transplants.<\/p>\n

Alan Cheung, medical director at Queen\u2019s Transplant Center, said most patients are waiting for a kidney from a deceased donor and the center tells patients to move to Hawaii about six months ahead of when they expect to get a kidney. Most end up staying.<\/p>\n

\u201cWith the flights available, it is logistically impossible, for instance, for patients from Saipan to fly to Oahu in time for transplant surgery from the time they get the deceased organ offer,\u201d he said. \u201cFor this reason, we require patients to relocate to Hawaii when they get towards the top of the waiting list.\u201d<\/p>\n

Patients will also need to stay in Hawaii for a year after the transplant for post-transplant care, Cheung added.<\/p>\n

Cruz says he\u2019s not willing to move to Hawaii for the slim chance that he could get a new kidney. It was hard enough to move to Saipan. His son even offered to donate his kidney, but Cruz said no because he is afraid his son\u2019s other kidney might fail and that his son could end up on dialysis like his father, uncle and grandfather.<\/p>\n

Even if insurance covered most of the transplant itself, moving to Hawaii would be expensive and require covering the high cost of rent and food in the state. Manglona has thought about trying to get a transplant but says he\u2019d rather save his money to give to his kids and grandkids.<\/p>\n

The Commonwealth\u2019s medical referral program\u2014which helps many patients access health care in the states\u2014doesn\u2019t support patients moving for transplants because getting one requires such a long wait, said Villagomez, the Saipan dialysis center director.<\/p>\n

Another option: At-home dialysis<\/strong><\/p>\n

Mu\u00f1a thinks the answer for patients living on Tinian and Rota lies in at-home dialysis.<\/p>\n

Peritoneal dialysis is a form of at-home dialysis that patients can do themselves by sticking a tube in their abdomen that filters blood. At home hemodialysis,\u00a0which is an option in Hawaii, is not an option on Rota or Tinian, Villagomez said.<\/p>\n

Delegate Gregorio Kilili Sablan asked for\u00a0$391,500 for peritoneal dialysis\u00a0on Rota in the 2022 budget\u00a0and another $389,250 for Tinian this year.<\/p>\n

He said he put in the request at the urging of Mu\u00f1a, the hospital executive director. The hospital has about a dozen peritoneal dialysis patients, up from previous years, but is hoping to expand the program.<\/p>\n

But first the hospital will have to overcome patients\u2019 fears. Many of those staying on Saipan know people who got sick with infections after trying out peritoneal dialysis and those stories have discouraged them from trying themselves. Part of their concern is the lack of a real hospital on Tinian or Rota\u2014an infection could require getting an emergency evacuation to the hospital on Saipan.<\/p>\n

Plus, not everyone is qualified for peritoneal dialysis. Doctors have to certify that patients are not only physically capable of it but have enough space in their homes to do so.<\/p>\n

Ambrocio Ayuyu, 62, quit his job and moved to Saipan three years ago to take care of his wife Rose, 66, who needed dialysis. His wife is not only sick with kidney failure but also uses a wheelchair after having a foot amputated.<\/p>\n

Ayuyu says he and Rose considered peritoneal dialysis, but they can\u2019t afford to pay for air conditioning at their house on Tinian, where they rely on fans to counteract the tropical heat. Ayuyu says he was told air conditioning is necessary to keep the dialysis supplies at a certain temperature.<\/p>\n

He\u2019s only been able to afford to go back to Tinian once since moving to Saipan three years ago.<\/p>\n

Leaving Tinian meant leaving most of his children and grandchildren, and hundreds of chickens and ducks on his farm.\u00a0Instead of working on his farm, his daily routine on Saipan now involves doing laundry and cleaning the apartment while his wife gets her treatment.<\/p>\n

\u201cMost of the day, nothing to do, so we just stay home and sleep,\u201d he said. Since he moved to Saipan, he\u2019s gained 20 pounds and his cholesterol levels have worsened.<\/p>\n

San Nicolas, the Tinian patient, hadn\u2019t been planning to move at all when she was medically evacuated from Tinian to Saipan on Jan. 6, 2021. There was no opportunity for a second opinion or any time to think about it.<\/p>\n

She was so depressed in the first months of the move that she lost 70 pounds. She tried to do home dialysis but was told that she\u2019d have to give up her dog, a beloved Maltese named Sugar Boy that she calls her son, in order to do it.<\/p>\n

But after a year and seven months of having to live away from her siblings and only child, she has decided to ask her husband to build a dog house for Sugar Boy outside their home on Tinian so that she can qualify for peritoneal dialysis.<\/p>\n

Her days on Saipan are filled with work and treatment and none of the joys of family gatherings that she had on Tinian. On Monday, Wednesday and Friday, she works at a human resources job at the hospital from 6:30am to 3:30pm before going to dialysis, where she sometimes stays as late as 8:30pm. Tuesdays and Thursdays she can start work later but is often tired from the previous days.<\/p>\n

Growing plants and spending time with her dog and husband helps with the homesickness, but it\u2019s not enough. She misses Tinian\u2019s clear waters\u2014swimming on Saipan\u2019s shallow lagoons isn\u2019t the same. But mostly she wants to be near her daughter and her siblings.<\/p>\n

\u201cMy priority is I want to be reunited with my family,\u201d she said. \u201cIf you\u2019re with your family, even if you\u2019re down, you\u2019re always up.\u201d<\/p>\n

Praying to go home<\/strong><\/p>\n

Even though Harold Manglona is doing his best to adjust to Saipan, he wishes he could get the treatment he needs on Rota.<\/p>\n

\u201cWe\u2019re losing out by staying here on Saipan,\u201d Manglona said. \u201cWe should be somewhere where we can do something for our family and for ourselves.\u201d<\/p>\n

Once he joked to his neighbor Cruz, \u201cThe only time we\u2019re going to stay [on] Tinian or Rota is in the coffin.\u201d<\/p>\n

It\u2019s not really a joke. Manglona has already seen six other patients from Tinian and Rota die\u2014he points to the apartments they lived in: one, three, eight. He already has his burial plot picked out on Rota. It\u2019s where he wants to be buried even if he can\u2019t live there anymore.<\/p>\n

Taimanao also jokes darkly about finally going home as cargo after he dies. He misses hunting coconut crabs on Rota, and is wary of trying it on Saipan where he doesn\u2019t know who owns which land.<\/p>\n

Cruz wishes the government and a private company could work together and find an alternative to help patients like himself\u2014and not just himself, but the patients who come after him.<\/p>\n

\u201cAre they going to go through what we\u2019ve been through?\u201d he wonders.<\/p>\n

This story was produced with support from the\u00a0USC Annenberg Center for Health Journalism\u2019s 2022 Impact Fund for Reporting on Health Equity and Health Systems, and Civil Beat supporter Dr. Mary Therese Perez Hattori.<\/p>\n","protected":false},"excerpt":{"rendered":"

Editor\u2019s Note: This story was originally published by Civil Beat. Read the original article here:…<\/p>\n","protected":false},"author":11,"featured_media":377607,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[94],"tags":[],"class_list":["post-377598","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-headlines"],"_links":{"self":[{"href":"https:\/\/www.saipantribune.com\/index.php\/wp-json\/wp\/v2\/posts\/377598","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.saipantribune.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.saipantribune.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.saipantribune.com\/index.php\/wp-json\/wp\/v2\/users\/11"}],"replies":[{"embeddable":true,"href":"https:\/\/www.saipantribune.com\/index.php\/wp-json\/wp\/v2\/comments?post=377598"}],"version-history":[{"count":0,"href":"https:\/\/www.saipantribune.com\/index.php\/wp-json\/wp\/v2\/posts\/377598\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.saipantribune.com\/index.php\/wp-json\/wp\/v2\/media\/377607"}],"wp:attachment":[{"href":"https:\/\/www.saipantribune.com\/index.php\/wp-json\/wp\/v2\/media?parent=377598"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.saipantribune.com\/index.php\/wp-json\/wp\/v2\/categories?post=377598"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.saipantribune.com\/index.php\/wp-json\/wp\/v2\/tags?post=377598"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}