Imagine you come from a remote Aboriginal community. You are old and sick and have been told you need kidney dialysis or you will die.

If you’re from one of the many communities just outside the Northern Territory border in South Australia, you might have expected to get treatment at the hospital in Alice Springs, 1000 kilometres closer to home.

Instead you have to get that dialysis in Adelaide.

The Northern Territory Government already supplies dialysis to a number of interstate patients in Alice Springs, where families can visit and the lifestyle is similar.

Last year, when demand reached critical levels, it stopped taking new patients from South and Western Australia.

Aboriginal people from some of the remotest places in Australia found themselves faced with the choice of living in a far-off city or dying at home.

Some chose the latter.

Award-winning artist Patrick Tjungurrayi forced a rethink of that policy when he went public with details of his illness last year.

The NT Government now accepts new patients from WA, saying the State Government is paying for extra places.

But South Australian patients haven’t been so lucky. Several people from the APY Lands in the state’s north have already been forced to move to Adelaide for long-term treatment.

The South Australian Health Minister said the Territory Government was discriminating against residents of his state.

He wrote this is in letter to an Adelaide-based Aboriginal organisation:

“The Northern Territory Government has simply made a decision to exclude South Australian renal patients and that is very unfortunate. The Northern Territory has not requested anything extra from South Australia, to enable Southern Australian patients to use their service.”

The Northern Territory Government said the decision was South Australia’s, and it stresses that negotiations are ongoing.

The SA Government promised to pay for eight permanent places at the Alice Springs Hospital if Labor won the South Australian election.

Now Mike Rann’s Government looks set to return, but eight is far fewer than the 18 places currently paid for in Alice Springs.

As South Australian patients die, they will be replaced by new patients from the Northern Territory until the number of places fall to eight.

The SA Government says it’s increasing its dialysis places in the regional centres of Port Augusta and Whyalla.

Both are further away from communities on the lands than Alice Springs.

The Government is also investigating placing a dialysis clinic in the APY Lands in the State’s north.

This costly and difficult option is preferred by local health providers, but would take years to establish.

The South Australian Health Department estimates another 20 people from the APY Lands will need dialysis in the coming year.

There’s unlikely to be space for them in Alice Springs, even when a new, 12-chair dialysis unit opens there next month.

The facility will provide 48 dialysis places.

There are 170 people already using the existing 158 ports in Alice Springs.

The Alice Springs Hospital’s now running dialysis seven days a week to cope with the demand.

The hospital’s general manager Vicky Taylor says if all patients turned up for their appointments, the hospital would have to reduce the amount of dialysis time each received.

Aboriginal health groups are stunned that there has not been more planning for the dialysis crisis.

As the effects of poor nutrition, diabetes and, in some cases, alcohol abuse, hit home across Central Australia, authorities can expect the incidence of kidney disease to continue its rapid rise.

Until the bureaucratic wrangling ends, those people just south of the border will continue to face the hardest choice of their lives.