Kidney dialysis is a painful and costly procedure for the patient, but there is an added factor to the problem of providing this vital life-saving procedure: millions of packages of waste fluid to be disposed of every year.
There is, however, a way to recycle them and reduce the amount of waste being incinerated, thanks to the Friends of Kidney-Failure Patients Club.
"To my mind, they are a gold mine," said Thanadol Dokkaew, head of the club, which in 2014 started turning the discarded packages into a wide range of consumer products, such as bags, aprons, raincoats and air pillows.
According to Public Health Ministry records last year, about eight million people were suffering from kidney problems. Of them, 200,000 are in the final stage of the disease.
Today, many undergo blood purification around the country, usually subsidised in part by the various healthcare schemes, creating piles of dialysis packages which cost money to get rid of.
Mr Thanadol said the packages are made of top-quality plastic and are normally discarded and incinerated. However, the club realised that the packages need not end up as waste.
The club decided the bags could be re-used, after being thoroughly cleaned with anti-bacterial solution and put out in the sun to dry.
The bags are cut into square pieces which are sewn together and re-invented as new products such as bags, aprons, suit covers and even bed sheets.
Only discarded dialysis fluid bags are re-processed, not those containing liquid waste from humans, according to the club as it tries to dispel concerns of buyers and sceptics to re-used products and hygiene.
"These innovative products from the dialysis fluid bags are not only spurring the interest of people within the country, but also from overseas," said Mr Thanadol, adding the items were once displayed in the internationally recognised Prince Mahidol Award Conference.
Participants of a previous conference also joined a trip to Banphaeo Hospital in Samut Sakhon, where they observed how the products were made, he said.
In the northeastern province of Nong Khai, Seka Hospital produced air beds for patients from the dialysis bags and found a market for them.
In addition to developing the discarded bags into everyday products, the club has a plan to buy used dialysis bags from hospitals at 10 baht a kilo and resell them to waste plastic recycling plants at 17 baht a kilo. The plastic bags -- six of them weigh one kilo -- are thick and durable. Other auxiliary parts such as plastic stoppers and catheters can be sold to factories.
Proceeds from the sale of the products go to a fund to financially support poor dialysis patients, Mr Thanadol said.
The production of the reused plastic items is expanding, with patients suffering from a kidney disease forming a network of producers.
In the Northeast alone, the network extends to about 15 places, including Loengnoktha Crown Prince Hospital in Yasothon's Loeng Nok Tha district.
The hospital's deputy director, Dr Kittima Setboonsang, said her medical facility has registered 839 patients suffering from renal diseases. Eighty-seven of them are in the final stage and require three times the usual peritoneal dialysis a day.
The patients are, however, trained to carry out self-dialysis at home. The National Health Security Office (NHSO) has made a deal with Thailand Post Co to deliver dialysis fluid to the patients at home. A patient produces around 0.8kg of dialysis fluid per day.
Dr Kittima said her hospital supports the reuse of the dialysis bags. In fact, outpatients who regularly visit the hospital to receive treatment are asked to carry with them the bags made from the reused plastic in which they can put the prescription drugs they take home.
The dialysis bags have also been transformed into plastic sheets for covering patients' beds, aprons and cushions for the resting the arm during vein puncture.
Atthaporn Limpanyalert, the NHSO assistant secretary-general, has praised the campaign to give the discarded packages a new life, saying this could help boost incomes for patients who produce the items.
He said renal diseases are very expensive to treat, adding the NHSO has earmarked 6.31 billion baht for the treatment of 44,411 dialysis patients who are covered by the NHSO this year.
"I admire Loengnoktha Crown Prince Hospital for its innovative campaign which adds value to containers which would otherwise be thrown away. The campaign should be widely publicised and offered as an example to other hospitals across the country," Mr Atthaporn said.
According to the Public Health Ministry, about 40,000 final-stage kidney disease patients are waiting for kidney replacements. Each year, only 400 patients on average undergo a kidney transplant due to the shortage of organ donors.
The patients usually undergo haemodialysis, or peritoneal dialysis, to purify their blood. Every year, there are about 10,000 new renal disease patients.
Most are unaware they are inflicted with kidney problems until they enter the stage of chronic renal disease.
Sufferers of the disease are put on a strict regime comprising a low-salt diet and they must also exercise properly.
In 2008, the national health security board agreed to add peritoneal dialysis to the universal healthcare scheme to help patients, many of them need dozens of dialyses a month, to offset the expense of the procedure.
During the process of peritoneal dialysis, which can be done at home, the patients are required to stay in a room with doors and windows shut to guard against airborne dirt and germs.
"Peritoneal dialysis takes hours at a time. Some people need it four times a day, so patients are in danger of falling ill from the heat trapped inside an enclosed room, particularly in the summer," said Dr Kittima, adding her hospital has a plan to buy ventilating fans for the patients, although financial support is necessary.
Poor patients still need to go to the hospital to undergo dialysis. They sometimes have to make a long journey for treatment and have to fork out for travel expenses. Funds from the sale of the items produced from reused dialysis bags can help ease the financial burden, she said.
What the hospital sees now is that patients and people in their communities have learned how to separate rubbish and regard waste as something of use and value.
"At the heart of it, we have managed to get rid of hundreds of kilos of waste and discards, and this is a good cause," said Dr Kittima.
The durability afforded by the tough plastic makes the dialysis bags an ideal material for producing accessories. The housewives are busy stitching together the bags as a part-time job.