As the Kingdom of Tonga wrestles with a diabetes crisis it's resisting pressure to set up a costly dialysis centre.
It's estimated around 15,000 people out of a population of just over 100,000 have diabetes.
As there is no dialysis available in Tonga, those with end stage kidney disease - around 60 people at any one given time - are basically handed a death sentence unless they can travel overseas for costly dialysis or a kidney transplant.
Sione Vaiamounga is trapped in Romania with kidney failure because his home, Tonga, has no dialysis facilities.
That number includes rugby player Sione Vaiomo'unga who has been stranded in Romania for three years as it's the only place he can receive free dialysis treatment. If he returns home to Tonga, he'll die.
Specialist physician with Tonga's Ministry of Health, Dr Sione Latu, says the country has looked at setting up dialysis in the Kingdom but it is too expensive.
"To spend a big amount of money we have to talk costs on a small group of people. It's just not feasible at the moment with the budget allocation we are getting," he said.
Instead the ministry is trying to reduce soaring rates of mostly preventable type two diabetes.
Dr Latu says kidney disease doesn't develop overnight and people have the opportunity to manage it before it gets to a critical stage.
"I think our culture tends to be food based - if you visit someone you'll probably take a bunch of roses and a bottle of wine. But not here in Tonga. You carry a basket of food with a suckling pig. The food is calorie dense," he said.
The Tonga Dialysis Foundation is trying to set up a centre with the government and foreign partners.
But Dr Latu says the government doesn't want to commit to a programme unless it's sure it's going to work, otherwise it will be reliant on the goodwill of people to donate money.
"That's not a firm basis to run this type of project so we want the financial plan to be clearer, firmer before we can commit. But if they want to do it all private I'm all for it. We can even provide technical support," he said.
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