Ivan Velasco, working as a doctor in a dialysis center in Ecuador founded by his late father, shares his experience supporting patients whose lives depend on continuous treatment. Through the COVID-19 pandemic and periods of national unrest, he and his team faced major disruptions yet continued providing care without interruption. Today, he highlights the fragility of healthcare systems and the urgent need for sustainable support to ensure life-saving dialysis care.
My father was a nephrologist. Around 14 years ago, he started his own dialysis center alongside my mom. Five years ago, he died, and I was starting my last year of medical school. Even with that, with mymom, we continue to provide the service, as he always said, “Dialysis never stops”. Last year, I worked as a doctor in the same dialysis unit in Ecuador, helping patients whose lives depend on a machine that replaces the function their kidneys can no longer perform. Every day I walk into the unit knowing that what happens here is more than medicine; it is survival.
When the COVID-19 pandemic hit in 2020, it was like an invisible storm sweeping through the country. Hospitals were overwhelmed, health systems collapsed, and fear became a daily companion. But dialysis could not stop. Patients with kidney failure need their treatment three times a week, without exception. There is no “lockdown” for a failing kidney.
We improvised, adapted, and protected our patients and our staff with minimal supplies and endless courage. The fear of infection was real; many of our colleagues got sick, including my hero (my dad), and some never returned. Yet, day after day, we continued. Stopping dialysis would have meant losing lives immediately.
As if the pandemic were not enough, Ecuador also faced massive waves of national protests, first in 2020 and later in 2022, that paralyzed transportation, disrupted supply chains, and made it nearly impossible for patients and healthcare workers to reach treatment centers.
Some patients traveled hours on foot or waited for military escorts to pass through roadblocks. Nurses and technicians slept in the clinic for days, unable to return home. In those moments, we understoodthat dialysis centers are not just medical facilities; they are lifelines for hundreds of families.
| Dialysis treatment in Ecuador is recognized as part of the “catastrophic illness” coverage provided by the public health system since 2008. | That means the government must pay private clinics for each dialysis session. But for years, those payments have been delayed, and the debt has grown to levels that threaten the entire system. |
According to the Ecuadorian Association of Dialysis Centers, by April 2025, the government’s outstanding debt to dialysis providers reached USD 200 million, and with historical arrears, it may exceed USD 350 million nationwide.
Even though the Ministry of Public Health (MSP) and the Ecuadorian Social Security Institute (IESS) made partial payments, approximately USD 110 million in 2024 and another USD 65.5 million in early2025, they remain far below what is needed to sustain regular operations.
When the funds do not arrive, everything begins to crumble: Essential supplies run out. Bloodlines, dialyzers, bicarbonate, and medications become scarce. Some patients are forced to buy their ownmaterials to receive treatment.
Dialysis sessions are shortened or reduced. In extreme cases, units have had to cut treatment time or cancel one of the three weekly sessions, endangering patients’ lives. Deaths rise. Patient organizationshave reported dozens, possibly hundreds, of deaths linked to a lack of access to complete dialysis treatment.
Healthcare workers suffer burnout and job insecurity. Doctors, nurses, and technicians continue working despite months of unpaid wages and mounting pressure. Each missing payment does not just hurt a budget; it puts lives at risk.
In several provinces, including Manabí, clinics have closed their doors after more than 20 months without government reimbursement. When a dialysis center shuts down, patients are left stranded, oftenwithout another nearby facility. For many, relocation means long travel times, worsening health, and unbearable financial stress. This is not just a financial collapse; it is a humanitarian one.
After 14 years in dialysis, I have learned that resilience has its limits. You cannot run a dialysis unit on courage alone. You need stability, supplies, and a government that honors its responsibility.
Our story, surviving a pandemic, enduring protests, and now confronting the weight of unpaid debt, is not just about medicine. It is about humanity. It is about every patient’s right to live, and every system’sduty to ensure that right is protected.
Until that happens, we will continue to stand by our patients, one dialysis at a time, because their lives cannot wait for bureaucracy to catch up. I promised my dad that dialysis will never stop, I am doing my best, but after all of these calamities, debt is the one making me unable to accomplish that promise.
Disclaimer: The blog series is intended for informational purposes only and is not meant to endorse or promote any specific drug, product, or brand. Each individual’s experience is unique and should not be construed as medical advice or a guarantee of similar results for others. Always consult a qualified healthcare professional before making any decisions regarding your health and well-being.
