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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)

Next Story

No More Schoolgirls Examined For Female Genital Mutilation in Kenya

We are not going to line up all the girls and test them — you can't do that as they can be stigmatized

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FILE - A T-shirt warns against female genital mutilation. Its wearer attends an event, discouraging harmful practices such as FGM, at a girls high school in Imbirikani, Kenya, April 21, 2016. VOA

No schoolgirls in western Kenya are being forced to undergo examinations for female genital mutilation, Kenyan authorities said Tuesday, after a government official sparked outrage by proposing compulsory tests to curb the crime.

George Natembeya, commissioner for Narok County, said on Friday that girls returning to school after the Christmas break were being screened for female genital mutilation (FGM) in order to prosecute their parents and traditional cutters.

Rights groups condemned the move, saying examining the girls — aged between nine and 17 — was demeaning and contravened their right to privacy and dignity.

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Maasai girls and a man watch a video on a mobile phone prior to the start of a social event advocating against harmful practices such as female genital mutilation at the Imbirikani Girls High School in Imbirikani, Kenya. VOA

Kenya’s Anti-FGM Board said they had conducted an investigation in Narok after Natembeya’s statement and found no evidence of girls being tested.

“The Board hereby confirms that no girl has been paraded for FGM screening as per allegations that have been circulating in the last few days,” the semi-autonomous government agency said in a statement.

“The Board recognises and appreciates the role played by different stakeholders in complementing the government’s efforts in the FGM campaigns but we want to reiterate that all interventions must uphold the law.”

FGM, which usually involves the partial or total removal of the external genitalia, is prevalent across parts of Africa, Asia and the Middle East — and is seen as necessary for social acceptance and increasing a girl’s marriage prospects.

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KAMELI, KENYA – AUGUST 12: A Masaai villager displays the traditional blade used to circumcise young girls August 12, 2007 in Kameli, Kenya. VOA

FGM dangers

It is usually performed by traditional cutters, often with unsterilized blades or knives. In some cases, girls can bleed to death or die from infections. It can also cause lifelong painful conditions such as fistula and fatal childbirth complications.

Kenya criminalized FGM in 2011, but the deep-rooted practice persists. According to the United Nations, one in five Kenyan women and girls aged between 15 and 49 have undergone FGM.

Natembeya said he had announced the compulsory tests to warn communities not to practice FGM on their daughters, but that there was no intention to force all girls to undergo screening.

Rights groups said the policy was rolled back following outrage.

Also Read: The Risk of FGM Hangs Above British Schoolgirls During Holiday Break

“We are not going to line up all the girls and test them — you can’t do that as they can be stigmatized,” he told Reuters.

“What we are doing is that if we get reports from schools that a girl has undergone FGM, it becomes a police case and the girl is taken to hospital and medically examined. Then the parents or caregivers will be arrested and taken to court.” (VOA)