. 2020 Feb 28;21:71. doi: 10.1186/s12882-020-01732-w

Table 2.

Representative quotes

Theme	Representative quote
Resource limitations and allocation	“You have 200 patients, and you have 75 machines to use, so how do you choose? So the only thing that we can do, because we cannot evaluate all the patients at the same time, the only thing we can do is look at objective data, such as times of the last hemodialysis, see where the patient comes from, the age of the patient, if he is elderly or is a kid, and if he already had peritoneal dialysis [i.e., a patient previously on peritoneal dialysis who is no longer able to continue with the modality], because if he already had peritoneal dialysis, he has no other option.” -Physician “Our patients are standing all the time waiting for their consultations, and I cannot even say, ‘Sit here, because I have a free chair,’ because I only have two chairs.” -Allied health professional “The limits on time and space are so frustrating, and mainly the resource limitations. Because we would like to give them all their medicines, but we truly cannot. We only give you what is truly within our reach. And there are many people who do not get any medicine because they do not have the resources to obtain them.” -Allied health professional
Emotional challenges	“The worst challenge, from my point of view, is the fact that the patient is not receiving their three treatments a week. Why? I am nothing more than a little soldier in the ranks of combat. I know that the patient will come to me intoxicated, uremic, with cardiac deficiencies—grandparents of 70 years that I know I am going to connect to the machine, and I know that at that moment they are going to have a complication.” -Allied health professional “For me it is a challenge every day to keep the patient alive, because the patient enters breathing, but [if something] goes wrong … The fact is that the machine is not magic. The machine is not going to change your life overnight.” -Allied health professional “Many times we feel disappointed as providers. We experience what is called ‘burnout’—and we are already burned out—but then, we move on.” -Physician “[I see it] as a challenge … to meet the needs of our patients—the needs of our patients from the medical point of view. I always make a half-joke with the patient who arrives, ‘What are your problems? Please tell me they are not economic, anything but economic, because that I will not be able to solve for you.’” -Physician
Suggestions for improvement	“You see how crowded we are, right? It would make me happy to have a larger place where we could better serve patients. First physical space, is what we need more of.” -Administrator “Sure, we have to expand services, we have to decentralize, but...what we have to do is not only open dialysis centers and that’s it. In other words, to do that is not to do nothing—it would only be for those who are sick, but we will not help the ones who will come later. So that’s what should be done: prevent, treat the sick, and transplant.” -Physician “Have more people trained in kidney nutrition, and psychologists, because at UNAERC there is a single psychologist to see the large number of patients, and the truth is that that is not enough. She was being asked to treat patients and that is impossible, because with each patient it would take at least an hour, what, at least half an hour, and the truth is that with the large list of people, that is impossible...Also the issue of social workers, because there are two, but that is not enough for all the problems of the patients.” -Physician

Theme

Representative quote

Resource limitations and allocation

“You have 200 patients, and you have 75 machines to use, so how do you choose? So the only thing that we can do, because we cannot evaluate all the patients at the same time, the only thing we can do is look at objective data, such as times of the last hemodialysis, see where the patient comes from, the age of the patient, if he is elderly or is a kid, and if he already had peritoneal dialysis [i.e., a patient previously on peritoneal dialysis who is no longer able to continue with the modality], because if he already had peritoneal dialysis, he has no other option.”

-Physician

“Our patients are standing all the time waiting for their consultations, and I cannot even say, ‘Sit here, because I have a free chair,’ because I only have two chairs.”

-Allied health professional

“The limits on time and space are so frustrating, and mainly the resource limitations. Because we would like to give them all their medicines, but we truly cannot. We only give you what is truly within our reach. And there are many people who do not get any medicine because they do not have the resources to obtain them.”

-Allied health professional

Emotional challenges

“The worst challenge, from my point of view, is the fact that the patient is not receiving their three treatments a week. Why? I am nothing more than a little soldier in the ranks of combat. I know that the patient will come to me intoxicated, uremic, with cardiac deficiencies—grandparents of 70 years that I know I am going to connect to the machine, and I know that at that moment they are going to have a complication.”

-Allied health professional

“For me it is a challenge every day to keep the patient alive, because the patient enters breathing, but [if something] goes wrong … The fact is that the machine is not magic. The machine is not going to change your life overnight.”

-Allied health professional

“Many times we feel disappointed as providers. We experience what is called ‘burnout’—and we are already burned out—but then, we move on.”

-Physician

“[I see it] as a challenge … to meet the needs of our patients—the needs of our patients from the medical point of view. I always make a half-joke with the patient who arrives, ‘What are your problems? Please tell me they are not economic, anything but economic, because that I will not be able to solve for you.’”

-Physician

Suggestions for improvement

“You see how crowded we are, right? It would make me happy to have a larger place where we could better serve patients. First physical space, is what we need more of.”

-Administrator

“Sure, we have to expand services, we have to decentralize, but...what we have to do is not only open dialysis centers and that’s it. In other words, to do that is not to do nothing—it would only be for those who are sick, but we will not help the ones who will come later. So that’s what should be done: prevent, treat the sick, and transplant.”

-Physician

“Have more people trained in kidney nutrition, and psychologists, because at UNAERC there is a single psychologist to see the large number of patients, and the truth is that that is not enough. She was being asked to treat patients and that is impossible, because with each patient it would take at least an hour, what, at least half an hour, and the truth is that with the large list of people, that is impossible...Also the issue of social workers, because there are two, but that is not enough for all the problems of the patients.”

-Physician