Kidney Disease Epidemic in Undocumented Communities Forces U.S. Hospital Closures { 24 images } Created 27 Mar 2018

Dr Brian Wickwire squeezes the wound on his patient’s finger, catching a tiny bead of scarlet blood with a pipette, and feeding it into an examination machine. In an area of the U.S. where access to medical treatment is particularly scarce, Wickwire is testing for diabetes, trying to catch the disease while it’s symptoms are manageable, before kidney failure and a need for dialysis. He tests 22 patients through the day, only 4 have normal blood sugar levels.

Engulfing Wickwire’s clinic, the Mercadome Flea Market is buzzing with visitors, clowns entertain crowds of children, a Dance Hall band plays to swaying couples under strobing lights, and vendors hawk goods to ambling passersby. It’s the largest market in the Rio Grande Valley, just 12 miles from the Mexican border in Hidalgo County, Texas, where a diabetes epidemic is worsening among the undocumented and uninsured population.

Texas has the largest number and the highest proportion of uninsured residents in the U.S., 1.75 times the national average. Hidalgo County is double that again, 32% are uninsured, with many of its residents failing Obamacare eligibility.

Without treatment diabetes creeps up slowly. Over time high sugar in the bloodstream damages the capillaries inside kidneys, causing them to scar, eventually stopping kidney function. Without regular dialysis toxins like urea leak into the bloodstream, and excess fluid is not removed. Blood pressure rises, oxygen levels fall, lungs fill with water, and high potassium levels begin to interrupt heart rhythm causing cardiac arrest.

“That's how you execute people, you knock them out, then you inject them with potassium until the heart stops. That's what's happening every week,” says Wickwire.

Uninsured and undocumented patients rely solely on the Emergency Medical Treatment and Labor Act (EMTALA). Written in 1986, EMTALA requires medical aid to be given to anyone arriving at a hospital emergency room, regardless of status and ability to pay, without guaranteeing the frequency of treatment – a problem for dialysis patients. In areas caught in the grip of a diabetes epidemic, the growing burden of uncompensated care on hospitals is causing many to close. And Trump’s attempts at healthcare reform all stand to weaken the Affordable Care Act, decreasing insured eligibility further.

“In America, organ transplantation is certainly not for everyone,” says Dr Patrick Wood, Transplant Coordinator, Life Gift, “the guy fixing my car for $80 a day definitely isn’t going to get treatment.”

An insured patient would expect to receive dialysis thrice-weekly, even then the mortality rate in adults is 50% over a five-year period. Uninsured patients seeking treatment under EMTALA can only expect dialysis once every ten days, when they arrive at hospital in critical condition. Their mortality rate is 14 times greater than insured dialysis patients.
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