When you live in rural West Texas, you do it with the understanding that you can’t always have access to everything you might want or need, especially when it comes to healthcare.
If you get sick, sometimes you just have to drive for an hour or more to get the doctor.
But for people with kidney failure – people on dialysis – the reality of living in our far flung corner of the state means getting onto a bus three days a week for a 14-hour trip, every week.
It’s before dawn in Presidio, Texas, and a small TRAX bus picks up dialysis patients from their homes. TRAX is the only public transportation for Medicaid patients for hundreds of miles.
The bus leaves Presidio, then picks up more clients in Marfa and Alpine. Then we are off to DeVita in Fort Stockton, the nearest dialysis center.
It’s a three-hour drive over 200 miles.
Annabel Campos’s mother is in dialysis and in a wheelchair. When asked how her life has changed since making these trips, she said, “I don’t have much free time anymore. Most of my time is spent over here.”
Campos is 30 years old and her mother’s full-time caretaker.
“It gets me frustrated for her,” Campos said, “because she has to do this for so long, and then she has to get up so early in the morning She just gets real tired. Dialysis takes out so much of you.”
People go on dialysis when they lose about 90 percent of their kidney function. Dialysis is a machine that filters toxins and fluids from the blood, waste that would be excreted as urine. The whole process takes about four hours.
When asked why she and her mom have not moved closer to the center, Campos explained, “My family’s job’s over there in Alpine. My two brothers live with us, and they’re the ones who help me with my mom. And I don’t know how we could move over here, all of us move over here.”
Campos said she doesn’t know how long she can afford these trips. Her mother’s rides are covered by insurance, but Campos has to pay $22.50 per trip.
That’s almost $70.00 a week, and being a full-time caretaker, Campos doesn’t have a job.
“It didn’t bother me to give up everything to take care of her,” Campos said. “I’ll just go ahead and keep coming to these things with her, and just keep going and keep going.”
The clients get out of dialysis at 3:30 PM. It’s been five hours since we arrived. We go to a Mexican restaurant for lunch, but most people stay on the bus, saying they cannot afford to eat out.
“It’s harder after the dialysis because they drain all our bloods out,” Ana Maria Ramos, one of the dialysis patients, explained. “And we can sometimes hardly walk.”
Ramos’ kidney’s failed after she got in a car accident and went in a coma. That was 10 years ago. She’s made this trip three days a week ever since, and she struggles knowing she is dependent on a machine for survival.
“It’s depressing. And it’s very, very hard. But that’s the only way that we can live,” said Ramos.
Ramos said she’s looking for an apartment closer to the center, but she cannot find one she can afford on her monthly disability check.
There are no plans to open a dialysis center in Presidio, Marfa, or Alpine. There is not the tax base to support a non-profit clinic, and the population base isn’t there to support one, even as a for-profit.
At 8:15 PM, we return to Presidio – 14 hours after we left that morning.
“It’s terrible,” Ramos said. “Come on Monday, you’re drained out. By Tuesday you’re just barely starting to get your rest and everything when Wednesday comes again, and it’s a routine. It’s something pretty hard.”
For dialysis patients, the road to medical care is a rough system. It’s constant, and it’s also precarious.
TRAX relies on annual grants to operate, and funding changes from year to year and is never guaranteed. Plus, TRAX is struggling to hire and retain drivers, but for now, it’s the only system that allows people to live in their communities and receive treatment three times a week, every week, for years.
– Anna Rose MacArthur