No one responding so far on this thread has any experience with the Dialysis Clinic of the SMMC in Sint Maarten. It is a specialty practice with dedicated professionals. If your friend is willing to pursue going to SXM, outside the comfort zone of the friend's normal routine and local resources, such pursuit being admirable, I suggest that your friend or someone for your friend call the Clinic and ask questions, try to get some local references. Anyone on dialysis knows the anxiety and risks of any travel and how much risk they can tolerate. Best of luck.