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State-of-the-Art Dialysis Unit Serves Diabetes Patients on the Pine Ridge Reservation

It’s called Mni Wiconi, the water of life, and it is the name of a rural water system that transects the Pine Ridge Reservation in South Dakota.

It’s particularly appropriate for the Sharps Unit of the Dialysis Management Group (DMG) on the reservation, where via a filtration system it helps to sustain the lives of diabetes patients as it flows through dialysis machines.

Older clients chat in Lakota and there are other culturally familiar features as well—an Oglala Lakota spiritual leader presided over the groundbreaking ceremony last December and DMG staff formed the Lakota Dialysis Chapter, the only reservation chapter of the National Association of Nephrology Technicians, said Allen Rada, chief executive officer of the DMG.

“I’m glad it’s here for people on the reservation, including my own people,” noted Norma Tibbits, nurse manager of the Sharps Unit, who, like most of the Unit’s 10 employees, is an Oglala Lakota tribal member.

But the clinic’s technology is all mainstream and it is the first dialysis unit in South Dakota to meet the guidelines of the federal Center for Medicare and Medicaid Services, Rada said by telephone.

The 6,000-square-feet building is built to withstand extremes of Dakota weather and is “all state-of-the-art,” he said, pointing out that it has wells for geothermal heating and a generator power source: “We could use it as a community center five days, if necessary.”

“The exterior finishes of the building were selected to withstand frequent sustained winds exceeding 90 miles per hour,” according to MedCon USA, which did project engineering in collaboration with subcontractors under the Tribal Employment Rights Office.

Given the extreme blizzards of last winter and a possibility of heavy snowfall this year, use of the facility as an emergency shelter is a possibility, Tibbits agreed in a phone interview.

In its primary purpose as a hemodialysis clinic, it saves patients the 70-plus-miles round trip to a dialysis unit in Pine Ridge they had to make when the former dialysis unit in nearby Porcupine was closed for about three years because of structural problems.

The current clinic serves rural communities that include Porcupine, Wambli, Kyle, Allen, Martin, Wounded Knee, Manderson, and others in the sparsely populated Northern Plains area.

Rada describes Sharps Corner, about five miles north of 400-resident Porcupine, as having a ruined church, convenience stop, and “our beautiful facility.”

The Unit’s 23 patients may arrive as early as 6 a.m. for weigh-in during the three days weekly the clinic is open and they remain on dialysis three to four hours as the dialysis machine rids the body of excess urea, a waste that builds up when kidneys no longer excrete it through normal functioning, Tibbits said.

The patients come in shifts, the last of which ends at 6 or 6:30 p.m. and while they are in treatment often read, sometimes sleep, or watch television from sets available at each dialysis chair, she said.

The Sharps clinic is a 12-chair unit, though two of the chairs are in isolation units which would be used in case contagious hepatitis B patients were admitted, which hasn’t happened to date.

Many patients are older—the oldest is 74--and their need for dialysis is generally linked to “diabetes, and not taking care of themselves,” she said.

But two of the patients are ages 24 and 28, the former with kidney failure possibly related to medication taken for an unrelated reason, and the latter with kidney function impaired from an unknown cause—not the high blood pressure or diabetes that often trigger problems, she said.

Kidney disease is all too familiar in Indian country, where Indian adults are 2.6 times more likely to have diabetes than non-Hispanic whites of similar age, according to the Centers for Disease Control and Prevention (CDC).

The CDC notes that between 1990 and 1998 the overall diabetes prevalence rate increased by 46 percent, but the largest growth was in Native adolescents 15 to 19 years of age, specifically 60 percent in girls and 81 percent among boys.

The agency also notes that the “dramatic increases among young American Indians and Alaska Natives raises concerns about the impact of diabetes on future generations of Native Americans.”