Nonhlanhla Kotwane, 27, was born with just one kidney, which stopped working when she was only 7 years old. Over the last 20 years, she has had three kidney transplants each of which successively failed.

Kotwane now wakes up at 4:30 am three times a week to reach Charlotte Maxeke Academic Hospital by 7am where she undergoes dialysis for four hours each time.

“Dialysis will be the only way to remove toxic waste from my body that can’t be removed by my kidney. If I don’t dialyse, I would die, you know,” said Kotwane from her hospital bed.

She is not alone, more than 6000 people in South Africa are on dialysis treatment during which a patient’s blood is extracted, purified by a dialysis machine and returned to the patient.

For patients with renal failure, the machine is the only thing keeping them alive.

“The blood is removed from the body, it’s cleared by a filter, which the machine regulates…and then the clean blood is returned back to the persons body,” explained Professor Sarala Naicker, President of the South African Renal Society.

According to Naicker, South Africa is currently only treating approximately a third of the patients who are in need of hemodialysis, a type of dialysis that can only be done at health facilities.

Naicker estimated that about 18,000 South Africans could be in need of dialysis.

While the burden of kidney disease has increased, the number of dialysis machines in South Africa has not.

“A fair number of patients, by the time we can make a slot for them, they’re no longer alive and that’s a very sad situation.”

Some of the patients in Kotwane’s ward travel from as far afield as Benoni and Witbank, making use of unreliable public transport like trains and buses to reach the hospital.

With long journeys to and from hospital and the hours spent attached to the dialysis machine, treatment can become an all-day affair. This makes holding down a regular job near impossible.

“If we had enough machines situated in the nearest hospital it wouldn’t be such a problem,” Kotwane told Health-e News. “Hospitals need machines and more trained staff because with more machines you need more staff.”

Dialysis machines can be purchased for about R200000, but the actual treatment is very costly. It costs the state about R120 000 per year for each patient receiving hemodialysis treatment.

Public hospitals throughout the country are frequently turning desperately ill patients away, Naicker added.

“In the last two years, our waiting list crisis has become acute,” she explained. “A fair number of patients, by the time we can make a slot for them, they’re no longer alive and that’s a very sad situation.” said Naicker.

Public hospitals will also only take in patients for dialysis who are eligible for a kidney transplant, but there is a lack of donors.

“It’s actually been a very difficult situation for the doctors and nurses on the ground because there are lots of patients who do fulfill the criteria for straight treatment but are unable to have it,” Naicker told Health-e News.

Naicker and other kidney doctors have suggested that smaller satellite treatment centres be established to make dialysis more accessible.

“In the short term, we do need to have increase in our dialysis facilities so that we are able to offer more treatment to people already in kidney failure,” she said. “We need many more units in many more places.”

Meanwhile, Kotwane remains one of the lucky few.

“I just say one thing that I’m alive, that’s all,” she said. “That’s all that matters…all these years dialysis has been keeping me alive.”

An edited version of this article was first published in the 12 March editions of The Star, the Daily News and Pretoria News newspapers