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Hospitals Worldwide Detain Patients If They Cant Pay The Bill

Earlier this month, the High Court ruled again that imprisoning patients “is not one of the acceptable avenues [for hospitals] to recover debt.

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Margaret Oliele, a former detained patient, poses for a portrait in her home in Nairobi, Kenya. VOA

Doctors at Nairobi’s Kenyatta National Hospital have told Robert Wanyonyi there’s nothing more they can do for him. Yet more than a year after he first arrived, shot and paralyzed in a robbery, the ex-shopkeeper remains trapped in the hospital.

Because Wanyonyi cannot pay his bill of nearly 4 million Kenyan shillings ($39,570), administrators are refusing to let him leave his fourth-floor bed.

At Kenyatta National Hospital and at an astonishing number of hospitals around the world, if you don’t pay up, you don’t go home.

The hospitals often illegally detain patients long after they should be medically discharged, using armed guards, locked doors and even chains to hold those who have not settled their accounts. Even death does not guarantee release: Kenyan hospitals and morgues are holding hundreds of bodies until families can pay their loved ones’ bills, government officials say.

An Associated Press investigation has found evidence of hospital imprisonments in more than 30 countries worldwide, according to hospital records, patient lists and interviews with dozens of doctors, nurses, health academics, patients and administrators. The detentions were found in countries including the Philippines, India, China, Thailand, Lithuania, Bulgaria, Bolivia and Iran. Of more than 20 hospitals visited by the AP in Congo, only one did not detain patients.

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A relative adjusts the oxygen mask of a tuberculosis patient at a TB hospital on World Tuberculosis Day in Hyderabad, India. VOA

Millions possibly affected

“What’s striking about this issue is that the more we look for this, the more we find it,” said Dr. Ashish Jha, director of the Harvard Global Health Institute. “It’s probably hundreds of thousands, if not millions of people that this affects worldwide.”

During several August visits to Kenyatta National Hospital — a major medical institution designated a Center of Excellence by the U.S. Centers for Disease Control and Prevention — the AP witnessed armed guards in military fatigues standing watch over patients. Detainees slept on bedsheets on the floor in cordoned-off rooms. Guards prevented one worried father from seeing his detained toddler.

Kenya’s ministry of health and Kenyatta canceled several scheduled interviews with the AP and declined to respond to repeated requests for comment.

Health experts decry hospital imprisonment as a human rights violation. Yet the United Nations, U.S. and international health agencies, donors and charities have all remained silent while pumping billions of dollars into these countries to support their splintered health systems or to fight outbreaks of diseases including AIDS and malaria.

“People know patients are being held prisoner, but they probably think they have bigger battles in public health to fight, so they just have to let this go,” said Sophie Harman, a global health expert at Queen Mary University of London.

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Detained patients lie on beds in the Kenyatta National Hospital in Nairobi, Kenya. VOA

Hospitals often acknowledge detaining patients isn’t profitable, but many say it can sometimes result in a partial payment and serves as a deterrent.

‘A way to conduct business’

Festus Njuguna, an oncologist at the Moi Teaching and Referral Hospital in Eldoret, about 300 kilometers northwest of Nairobi, said the institution regularly detains children with cancer who have finished their treatment, but whose parents cannot pay.

“It’s not a very good feeling for the doctors and nurses who have treated these patients, to see them kept like this,” Njuguna said.

Still, many officials openly defend the practice.

“We can’t just let people leave if they don’t pay,” said Leedy Nyembo-Mugalu, administrator of Congo’s Katuba Reference Hospital. He said holding patients wasn’t an issue of human rights, but simply a way to conduct business: “No one ever comes back to pay their bill a month or two later.”

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FILE – A Yemeni woman suspected of being infected with cholera receives treatment at a hospital in the capital Sanaa. VOA

Global health agencies and companies that operate where patients are held hostage often have very little to say about it.

The CDC provides about $1.5 million every year to Kenyatta National Hospital and Pumwani Maternity Hospital, helping to cover treatment costs for patients with HIV and tuberculosis, among other programs. The CDC declined to comment on whether it was aware that patients were regularly detained at the two hospitals or if it condones the practice.

Dr. Agnes Soucat of the World Health Organization said it does not support patient detentions, but has been unable to document where it happens. And while the WHO has issued hundreds of health recommendations on issues from AIDS to Zika virus, the agency has never published any guidance advising countries not to imprison people in their hospitals.

‘Cruel, inhuman and degrading’

Many Kenyan human rights advocates lament that hospitals continue to hold patients despite what was seen as a landmark judgment in 2015.

Back then, the High Court ruled that the detention of two women at Pumwani who couldn’t pay their delivery fees — Maimuna Omuya and Margaret Oliele — was “cruel, inhuman and degrading.” Omuya and her newborn were held for almost a month next to a flooded toilet while Oliele was handcuffed to her bed after trying to escape.

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A doctor gestures outside a hospital in the Algerian town of Boufarik, as the country faces a cholera outbreak. VOA

Earlier this month, the High Court ruled again that imprisoning patients “is not one of the acceptable avenues [for hospitals] to recover debt.”

Omuya said she is still psychologically scarred by her detention at Pumwani, especially after another recent run-in with a Nairobi hospital.

Also Read: Kenya’s First Breast Milk Bank to Combat Newborn Mortality

Several months ago, her youngest brother was treated for a suspected poisoning. When Omuya and her family were unable to pay the bill, the situation took a familiar but unwelcome turn: he was imprisoned. Her brother was only freed after his doctor intervened.

“Detentions still go on because there are no rights here,” Omuya said. “What I suffered, I want no one else to suffer.” (VOA)

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More Science Careers: African School Of Physics on Mission To Educate New African Generation Through Traveling Program

"Science is increasingly recognized as an important engine of economic growth and societal advancement," she wrote in an email. She noted "increasing numbers of such programs on the African continent, where there is a surging young population entering the workforce."

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Ketevi Assamagan, a particle physicist at the U.S.-based Brookhaven National Laboratory, co-founded the African School of Physics, a training program for graduate students in math and sciences. (Photo courtesy of Brookhaven National Laboratory) VOA

Africa-born particle physicist Ketevi Assamagan is a man on a mission. His goal is to bring science education to a new generation of young Africans through a traveling program known as the African School of Fundamental Physics and Applications, or ASP.

“Sometimes, people just need some help to be able to find the right resources,” said Assamagan, an ASP founder who works at the U.S. Energy Department’s Brookhaven National Laboratory here on Long Island. “So, together with some colleagues, we decided to create this school.”

Born in Guinea, Assamagan grew up in Togo and earned a doctorate from the University of Virginia in 1995. Gratitude to past mentors fueled his desire to start the ASP, he said.

Positive elements

The ASP program runs for three weeks every two years in a different African country. The first was in 2010 in South Africa, with subsequent gatherings in Ghana, Senegal, Rwanda and Namibia. The next is planned for July 2020 in Marrakesh, Morocco.

Each workshop brings together up to 80 students, who are treated to intensive lectures and training by top-flight physicists.

Physicist Ketevi Assamagan demonstrates how a cloud chamber works. (A. Phillips/VOA)
Physicist Ketevi Assamagan demonstrates how a cloud chamber works. (A. Phillips/VOA)

“We get students from all over Africa [who] have at least three years of university education,” Assamagan said. “The majority of them are usually at the master’s level and they come from different fields: nuclear and high energy physics, medical applications, computing, mathematics and theoretical physics.”

The students’ expenses are covered by roughly 20 international sponsors, including the Brookhaven lab; the International Center for Theoretical Physics in Trieste, Italy; the South African Department of Science and Technology; and Italy’s National Institute for Nuclear Physics.

Another sponsor has been the European Center for Nuclear Research, known as CERN, in Geneva. Assamagan worked on CERN’s particle accelerator for several years while conducting research on the elusive Higgs boson subatomic particle. He left in 2001 to join Brookhaven.

Sustained support

After the program, participants are paired with senior mentors who offer advice on additional education, teaching and research opportunities, both in Africa and abroad.

For Zimbabwe native Last Feremenga, participation in the 2010 ASP workshop served as a springboard to a doctorate in physics from the University of Texas. Now he’s a data scientist with Digital Reasoning, an artificial intelligence firm headquartered in Nashville, Tennessee.

“I sift through large datasets of written text in search of rare forms of conversations/language. These rare conversations are useful for our clients from health care to finance,” the 32-year-old told VOA in an email. He added that he’s using “similar tactics” to those he learned at ASP.

Julia MacKenzie, senior director of international affairs for the American Association for the Advancement of Science, says training programs such as ASP are especially important in developing countries.

“Science is increasingly recognized as an important engine of economic growth and societal advancement,” she wrote in an email. She noted “increasing numbers of such programs on the African continent, where there is a surging young population entering the workforce.”

“A potential impact of graduate training is exposure to new ideas and people,” MacKenzie added. “Any time graduate students can come together, it’s likely that new friendships will form, and those relationships can provide support through inevitable challenges and spawn new collaborations.”

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“We get students from all over Africa [who] have at least three years of university education,” Assamagan said. “The majority of them are usually at the master’s level and they come from different fields: nuclear and high energy physics, medical applications, computing, mathematics and theoretical physics.” Pixabay
Hands-on learning

Assamagan says that when he was in high school in Togo, science was taught from second-hand textbooks from abroad. There was no experimentation.

“Direct involvement … in terms of playing with things and getting mental challenge to try to figure it out was not really there,” he said. “We want to resolve that” through ASP.

The 70 or so science teachers at the workshop last year in Namibia learned hands-on experiments that could be replicated with scant equipment and resources.

For example, using only a small plastic box with an aluminum plate, tin foil, Styrofoam, pure alcohol and dry ice, high school students could build a tabletop “cloud chamber” to simulate the detection of cosmic particles from outer space. Another experiment taught physics to elementary school children by way of art. The children could drip paint on a canvas tilted at various angles, then observe the patterns the paint made as it descended.

Also Read: E-Commerce Policy: Centre To Regulate Cross-Border Flow Of Data

“You can then start introducing the idea of gravity,” Assamagan said. “And then relating things falling down to the Earth going around the sun as being driven by the same force.”

Assamagan predicts a bright future for physics research in Africa. He says he sees talent and commitment, but that more digital libraries, along with continent-wide access to high-speed internet connections and the political will to provide them, are needed. (VOA)