When the swelling began, Pamela Bang Soppi assumed it would pass. A fever had come and gone. A clinic visit resulted in a prescription but no diagnosis. Within days her feet ballooned. Her face followed. She grew too weak to stand for long.
For months, there was no name for what was happening to her. Only waiting.
Bang Soppi, 31, had recently moved to Garoua in northern Cameroon to look for work and be closer to her 11-year-old son. As her condition worsened, she returned south to her family’s village. Eventually, her mother, Moke Hortense, drove her overnight to Laquintinie Hospital in the city of Douala. Nurses drew blood and told them to return for the results.
At the follow-up appointment, a physician finally explained what the swelling meant: chronic kidney disease, a progressive illness in which the kidneys gradually lose their ability to filter waste and excess fluid from the blood. In its early stages, the damage can often be slowed with medication and careful management of blood pressure and diabetes. But once the disease reaches what doctors call end-stage kidney failure, the damage is generally considered irreversible. At that point, patients must undergo regular dialysis treatments or receive a transplant to survive.
“At the hospital, I cried,” Hortense said. “When they told me the situation, I was very worried for my daughter.”
Her family raised nearly 400,000 CFA francs (around $700) to cover the first hospital admission, roughly eight months of Cameroon’s minimum monthly wage. Soon after, Bang Soppi began dialysis. Although the clinical standard calls for three sessions per week, she currently receives two. Cost plays a role. So does capacity. With too many patients and too few machines, hospitals ration access.
Her trajectory into dialysis is not unusual in Cameroon. What is unusual is what the government is now attempting in response.
A Disease That Hides in Plain Sight
Chronic kidney disease frequently advances without early symptoms. In Cameroon, roughly half of patients who see a specialist for the first time begin dialysis within weeks—some the same day—having arrived at hospitals in crisis, according to Dr. Jean-Yves Balepna, a nephrologist at Laquintinie Hospital.
What is unfolding in Cameroon—as World Kidney Day is marked on March 12—reflects a broader vulnerability in modern health systems. Even in wealthier countries, kidney disease often progresses unnoticed because early stage illness rarely produces visible warning signs.
Globally, over 850 million people are living with chronic kidney disease, according to the International Society of Nephrology (ISN). In the United States alone, roughly 35.5 million adults are estimated to have chronic kidney disease, and about 9 in 10 are unaware they have it, according to the Centers for Disease Control and Prevention (CDC). A 2018 forecasting study published in The Lancet projected that by 2040, chronic kidney disease could become the fifth leading cause of death worldwide.
In wealthy countries, late detection drives dialysis costs into the billions and strains transplant systems. In lower resource settings, it can mean death.
As of early 2026, Cameroon’s health system was serving a population of approximately 30.6 million people, and at the end of 2021 the country had 28 nephrologists. About half are concentrated in Douala and Yaoundé. The ratio amounts to roughly one kidney specialist per million people.
Dialysis machines are limited. Travel is expensive. Even with government subsidies, annual out-of-pocket treatment costs can climb into the equivalent of $4,114 per year in total out-of-pocket costs, according to a 2017 peer-reviewed cost analysis of public dialysis facilities in Cameroon published in the African Journal of Nephrology, equivalent to roughly 18 months of minimum wage earnings.
Clinicians and Ministry of Public Health leaders agree that the central problem is timing. Patients arrive too late.
A National Shift Upstream
Facing a system defined by emergency dialysis starts, Cameroon’s Ministry of Public Health, led by Minister Malachie Manaouda, has begun promoting a national strategy centered on early detection. The effort includes a partnership with Carna Health, a Boston-based digital health company, to expand kidney screening nationwide.
“We include kidney disease awareness in all our public campaigns,” Manaouda said. “With Carna Health, we can now launch broad diagnostic campaigns to determine each person’s status and act earlier.”
The screening protocol is simple: a urine strip analyzed through a smartphone application, a small blood sample and a blood-pressure check. The ministry says the process takes about 10 minutes.
Between August and December 2025, roughly 35,000 people were enrolled and screened under the ministry-funded initiative, according to Carna Health. The ministry declined to disclose the total budget. Screening data is jointly managed by Carna Health and the ministry through a centralized registry that tracks disease stage, referrals and follow-up visits.
Manaouda said the goal is to identify patients at earlier stages of disease, connect them to care pathways and expand public understanding of kidney risk before symptoms appear. Patients identified in early stages are counseled on blood pressure control, diet and medication adherence. Those with more advanced disease are referred to internal medicine or nephrology services.
Screening, however, is only one part of the intervention.
With roughly one nephrologist per million people, most Cameroonians are first seen by general practitioners, nurses or community health workers. The program includes training modules and decision support tools designed to help non-specialists recognize early kidney disease and interpret abnormal results.
Dr. Salvatore Viscomi, chief executive officer of Carna Health, said the initiative is structured around workforce support as much as testing. “The technology is not meant to replace physicians,” he said. “It is meant to support nurses and primary care clinicians who are often the first point of contact. If they can identify kidney disease earlier and know what to do next, you change the trajectory.”
Whether that trajectory changes will depend less on software than on the health system’s capacity.
Dr. Yauba Saidu, country director of the Clinton Health Access Initiative in Cameroon, said the science behind early detection is not in dispute. “In Cameroon, kidney disease is usually diagnosed when it is already advanced because early screening is not routine,” he said. “But testing alone is not enough. Referral pathways must be clear. Medications must be available. Follow-up must be consistent.”
The measure of success, Saidu said, will not be how many people are screened, but what happens afterward. “Are fewer patients initiating dialysis urgently? Are more being managed in earlier stages? That is what will tell us if the system has shifted.”
The ministry has framed the screening program as complementary to reforms in dialysis financing. Under a revised model aligned with the first phase of universal health coverage, patients pay a flat annual enrollment fee of 15,000 CFA francs ($26) and receive dialysis sessions throughout the year without additional per-visit charges. Previously, patients paid up to 5,000 francs ($8.50) per session, three times per week—a cost that reached 780,000 CFA francs ($1,330) per year in session fees alone, and more than 52 times the new flat enrollment fee.
A 2016 review of acute kidney injury cases at Douala General Hospital found that 45.5 percent of patients with a clinical indication for dialysis did not receive it. Among those cases, financial constraints accounted for 28 percent of non-access.
Manaouda said the combined approach is intended to stabilize patients already on dialysis while reducing the number who reach that stage in the first place.
The minister described the screening and financing reforms as part of a longer arc that extends toward kidney transplantation—what he called a definitive solution.
Yaoundé General Hospital performed Cameroon’s first kidney transplant in November 2021 through a living-related donor program launched with support from the University Hospitals of Geneva and has completed roughly 20 such procedures since then. The country later passed legislation in July 2025 formally authorizing organ transplantation nationwide.
Manaouda said he is preparing a public campaign to build a culture of organ donation, arguing that the country cannot rely on dialysis alone to manage a growing patient population. “When I am no longer minister, what will people say I did for those who suffer from kidney failure?” he said. “I want them to say we gave them the possibility of a transplant.”
A System Under Strain
Inside Laquintinie Hospital, where Bang Soppi now returns several times a week, scarcity sets the pace. Patients wait for machines to open. Families hover nearby with bags of supplies. The units run constantly, but capacity does not meet demand.
Dr. Jean-Yves Balepna, a nephrologist at Laquintinie, said many chronic kidney disease patients he treats are far younger than those typically seen in Europe or the United States. One study of dialysis patients in Cameroon found a mean age of 47 years, with most patients between 40 and 59 years old. In the United States, by contrast, chronic kidney disease is most common among adults 65 and older, according to the CDC.
“Chronic kidney disease is insidious,” Balepna said. “There are no symptoms at the start. When symptoms appear, the disease is usually already advanced.”
About half of the patients he sees for the first time begin dialysis within weeks. Some start the same day. Emergency initiation significantly increases mortality risk.
Hypertension and diabetes account for the majority of cases he sees, Balepna said, a pattern consistent with global data showing hypertension and diabetes as the two leading causes of kidney failure worldwide. He also cited counterfeit medications and unregulated herbal remedies as contributing factors he has observed clinically. The minister echoed this concern, describing the fight against counterfeit street medicines as an explicit component of Cameroon’s kidney disease strategy.
Bang Soppi believes natural medicines may have played a role in her illness. Before her diagnosis, she relied on herbal treatments when her symptoms did not improve. A 2023 survey of 307 Cameroonian adults published in BMC Complementary Medicine and Therapies found that 89 percent had used herbal remedies within the previous two years, most commonly to treat or prevent illness when formal care was delayed or unaffordable. In a separate survey of African adults already living with chronic kidney disease, 70 percent reported using traditional medicine, a pattern that nephrologists have flagged as a clinical concern, since several plant compounds used across the continent have been linked to kidney damage and accelerated disease progression.
Balepna said pregnancy-related hypertension is another major driver. Women who experience preeclampsia or eclampsia and do not receive kidney follow-up care after delivery can progress to kidney failure within a few years.
Missing a dialysis session means another day of symptoms and another day of lost income for relatives who accompany patients. Bang Soppi’s 18-year-old brother now hauls sacks of flour to help cover expenses. Some weeks she makes both sessions. Other weeks she does not.
Measuring Progress
The Ministry of Public Health has pointed to the program’s early reach as evidence that a prevention-first model is possible. But scale alone does not answer the harder question of what changes downstream.
Balepna said the shift will be visible in who arrives for specialty care in the years ahead. If more patients are referred in earlier stages of disease, when progression can still be slowed, the impact will show up long before national mortality figures do. If most continue to arrive when dialysis is the only option, the underlying pattern will not have changed.
Saidu argued that durability will depend on whether screening becomes routine rather than episodic. “It must be part of primary care,” he said. “It cannot function as a campaign. It has to be embedded.” That requires consistent follow-up, steady supplies and financing that holds after the first phase of rollout. Prevention, he said, is less visible than crisis care and often harder to sustain politically.
For now, the dialysis ward at Laquintinie remains full.
On treatment days, Bang Soppi sits quietly while the machine hums beside her. At home, she still talks about reopening the small cosmetics business she once planned. The illness has narrowed her days, but it has not ended them.
“You can live with a disease for years and not feel it,” she said. “Then one day it comes and shuts you down.”
Cameroon’s wager is that more people can be reached before that day arrives. Whether early detection can gradually shift a system long defined by late diagnosis will take time to measure. The screening tables are in place. The registry is growing. What happens next will determine whether fewer families learn about kidney disease for the first time in a dialysis chair.
Interviews with Malachie Manaouda, Cameroon’s minister of public health, and Moke Hortense, Pamela Bang Soppi’s mother, were conducted in French and translated by the reporter.
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