Critical care

For the last three months, Tul Bahadur Baram, 18, from Taku, Gorkha, has been living with his older sister Anni Baram, 21, near Dallu Pul, Kathmandu. They live in a small rented room that sees barely any light. 

The siblings came to Kathmandu almost a year ago after both of Tul Bahadur’s kidneys started to fail. Ever since, Tul Bahadur, a Grade 8 student, has not been attending school. The siblings had to leave their village because dialysis treatment is available in only the major cities in Nepal.

The first signs that there was something wrong with his kidneys emerged when Tul Bahadur was 17. His right ear had started to itch. People with dysfunctional kidneys often report experiencing itchiness. His mother initially thought some insect must have lodged itself inside the ear. For a few days, she poured some oil into his ear, to force the insect out, but there was nothing. 

Later, Tul Bahadur started showing other symptoms. For example, the right half of his face started to swell, and the family knew he needed to get diagnosed. One day, it got so bad, he fainted while drinking tea. That’s when the family decided to rush him to Kathmandu. 

In Kathmandu, he was admitted to Teaching Hospital, Maharajgunj, where he learned that his kidney was failing, owing to sugar and blood-pressure problems he had developed.

The siblings decided to stay back in Kathmandu because Tul Bahadur would need regular dialysis. For patients who cannot afford the service, the government has a system whereby certain hospitals provide free dialysis services. Tul Bahadur’s designated hospital was Buland Siddhi Hospital, in Gongabu. But once the lockdown was clamped, the hospital was not able to provide free dialysis treatment for him. According to the hospital, they have had problems with routing the Ministry of Health’s funds for their dialysis unit. Tul Bahadur was thus referred to a hospital in Bhaktapur, instead.

For the siblings, Bhaktapur is impossible to get to, especially in this time of the lockdown. So Tul Bahadur has continued to get his dialysis done, on credit, at Buland Siddhi Hospital. He has been told the credit will eventually get waived. But when we met him to do the story, we observed how Tul Bahadur had to make his case for availing of the free service.  

For getting by in Kathmandu, the siblings depend on the earnings made by Tul Bahadur’s sister. She works at a Patanjali shop in Khusibu, Naya Bazaar, and earns Rs. 12,000 per month. Rs.3,500 of that goes towards their rent.

Whenever he finds the pressures of his life in the capital getting to him, Tul Bahadur reminisces about his school days, about how he and his friend would go fishing in the Daraudi River. He used to dream of someday becoming a lahure. For now, his family just hopes that he can continue to get his dialysis treatment.

Tul Bahadur often misses his schoolmates back home. Here, he’s mostly housebound, but in Gorkha he used to play volleyball and fish with his friends.

 Tul Bahadur’s swollen stomach. After a person’s kidneys fail, the body swells whenever waste fluids build up.

 Tul Bahadur gets ready to go to Buland Siddhi Hospital. Before the lockdown, the siblings would get there in an ambulance, for which they paid between Rs 500 to 1,000.

Tul Bahadur takes a combination of medicines for his kidney ailment. He will probably need to continue taking medications and undergoing dialysis for life--until he gets a kidney transplant.

Tul Bahadur descends from his room to start the walk to the hospital. It’s going to be a long walk.

 Tul Bahadur and his sister begin walking from Naya Bazaar to Gongabu Chowk, where Buland Siddhi Hospital is located.

Along the way, the siblings walk under the overhead bridge near the New Buspark. For a dialysis patient, it can be exceedingly difficult to walk the distance the duo traverse.

Tul Bahadur’s favourite drink is Sprite. To maintain his body’s fluid balance, he must watch his liquid intake. But he is allowed to drink some Sprite before his dialysis.

 Tul Bahadur shows the scars from his AV fistula surgery. Doctors make an AV fistula connection at the start of the dialysis process.

Tul Bahadur grimaces as a nurse inserts a needle in his vein to start the dialysis. The overall dialysis procedure lasts around four hours.

During dialysis, Tul Bahadur’s blood is pumped through a dialyser, which takes his blood, cleans it, and returns the cleaned blood back to his blood vessels.

 Tul Bahadur eats during his dialysis. His mouth gets dry during the treatment, but he has to refrain from consuming fluids.

Tul Bahadur and his sister hold hands on their way home after getting done with his treatment.

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