AP research: Hospitals imprison patients in Kenya
AP research: Hospitals imprison patients in Kenya
Kenyatta National Hospital is the largest medical institution in East Africa, home to more than a dozen projects funded by donors with international partners, a "Center of Excellence," according to the US Centers for Disease Control and Prevention. UU
The hospital website proudly proclaims its slogan "We listen ... we care", along with pictures of smiling doctors, a vaccination campaign and staff holding a gold trophy at an awards ceremony.
But there are no photos of Robert Wanyonyi, filmed and paralyzed in a robbery more than a year ago. Kenyatta will not allow him to leave the hospital because he can not pay his bill for almost 4 million Kenyan shillings ($ 39,570). He is stuck in his bed on the fourth floor, unable to go to India, where he believes doctors could help him.
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EDITOR'S NOTE: First in a two-part series about hospitals that detain patients if they can not pay their bills.
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At the Kenyatta National Hospital and at an amazing number of other hospitals around the world, if you do not pay, do not go home.
Hospitals often illegally detain patients long after they have to be medically released, using armed guards, locked doors and even chains to hold those who have not settled their accounts. Mothers and babies sometimes separate. Even death does not guarantee release: hospitals and morgues in Kenya have hundreds of bodies until families can pay bills for their loved ones, government officials say.
Dozens of doctors, nurses, health experts, patients and administrators told The Associated Press about incarcerations in hospitals in at least 30 other countries, including Nigeria and Congo, China and Thailand, Lithuania and Bulgaria, and others in Latin America and the Middle East Medium.
The AP investigation was based on a report last year by the British think tank Chatham House; its experts found more than 60 press reports on the detention of patients in 14 countries in Asia and sub-Saharan Africa.
"The amazing thing about this problem is that the more we look for it, the more we find it," said Dr. Ashish Jha, director of the Harvard Global Health Institute, which was not involved in the British research. "This is likely to affect hundreds of thousands, if not millions of people, all over the world." It is not something that is only happening in a small number of countries, but the problem is that no one is looking at this and it is far away. of the public health radar ". . "
Some examples:
-In the Philippines, Annalyn Manalo was carried out at Mount Carmel Diocesan General Hospital in the city of Lucena for 1½ months starting last December after a treatment for heart problems. Administrators initially refused to allow their family to pay in installments, and the cost of each additional day of detention was added to the bill.
"They treated us like criminals," said Manalo's husband, Sigfredo. "The security guards came and watched us all the time."
In the second city of Lubumbashi, in the Congo, the AP visited more than 20 hospitals and clinics and discovered that all but one of the patients who were routinely arrested did not pay, although the practice is illegal there.
"In Bangalore, India, Emmanuel Malagi was detained in a private hospital for three months after he was treated for a spinal tumor, according to his brother, Christanand." Avoided seeing him, his family rushed to pay his bill almost 1.4 million rupees ($ 19,281), and when he died, the hospital demanded another 10 lakh ($ 13,771) to release the body.
- In Malaysia, a medical student from the Netherlands on a diving trip got the curves. He could not afford his decompression treatment; The hospital locked him in a room for four days, without food or drink, until he was able to get the money, according to Saskia Mostert, a Dutch academic who has investigated arrests at the hospital.
7/8 - In Bolivia, a government ombudsman reported that 49 patients were detained in hospitals or clinics in the past two years because they could not pay, despite a law that prohibits the practice.
During several visits to the Kenyatta National Hospital in August, The Associated Press witnessed armed guards in military uniforms watching patients, and saw where detainees slept in sheets on the floor in cordoned-off rooms. The guards prevented a worried father from seeing his son in detention. All in spite of a judicial ruling years ago that determined that the detentions were illegal.
Health experts denounce hospital incarceration as a violation of human rights. However, the United Nations, the USA. UU And international health agencies, donors and charities have kept quiet while injecting billions of dollars into these countries to support fragmented health systems or to combat outbreaks of diseases such as AIDS and malaria.
"No one wants to talk about the dirty bottom of global health," said Sophie Harman, a health scholar at Queen Mary University in London.
"People know that patients are prisoners, but they probably think they have bigger battles in public health to fight, so they just have to let it go."
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Hospital arrests, some experts argue, can be attributed to policies promoted decades ago by the World Bank, the World Health Organization, UNICEF and others that granted loans to developing countries on the condition that they charge patients fees for medical services. . Without the explicit protections established to protect the poor, they say, the policies gave countries the freedom to obtain health care payments as they saw fit, including the detention of patients.
The practice seems to be more frequent in countries with fragile health systems and with insufficient funds in which there is little governmental responsibility. But the problem has also arisen in richer countries, with patients being held in hospitals in countries such as India, Thailand, China and Iran.
In many countries, when patients can not pay for medical care, they are usually sent to a public hospital where the treatment is covered by the state or they are denied help altogether. In some hospitals in Cameroon and elsewhere, for example, the problem of incarceration of patients was solved by some institutions simply by demanding payment in advance.
When patients are imprisoned, hospitals recognize that it is not necessarily profitable. But many say that it often leads to at least partial payment and serves as a deterrent.
Unlike many hospitals in developed countries, African hospitals do not always provide food, clothing or bedding for patients, so keeping them does not necessarily imply a significant cost. The detained patients generally depend on their relatives to bring them food, while those without forcing their relatives resort to ask for help from staff or other patients.
Dr. Festus Njuguna, a pediatric oncologist at Moi Teaching and Referral Hospital in Eldoret, about 300 kilometers northwest of Nairobi, said the institution regularly attends children with cancer who have finished their treatment, but whose parents can not pay . Usually, children are left in the rooms for weeks and months in a row, long after the treatment is over.
"It's not a very good feeling for the doctors and nurses who have treated these patients, to see them in such a state," Njuguna said.
Even so, some officials openly defend the practice.
"We can not let people leave if they do not pay," said Leedy Nyembo-Mugalu, administrator of the Katuba reference hospital in Congo. He said that retaining patients was not a human rights issue, but simply a way of doing business: "Nobody returns to pay your bill one or two months later."
In many hospitals in Kenya, including Kenyatta, officers armed with rifles patrol the corridors and guard the hospital doors. Patients must show the hospital guards a hospital discharge form to show that they can leave and even visitors sometimes have to give their ID cards before seeing patients.
In its 2016 financial report, the auditor general of Kenyatta said the hospital lost more than $ 470,000 in fees for patients who "leaked" without paying. That year, the hospital reported total revenues of more than $ 115 million.
The arrests of patients in Kenyatta have been marked for years, among other concerns. In January, protesters called for an investigation into allegations of rape and sexual harassment of patients in the hospital. The Kenya Human Rights Commission tried to conduct an audit of Kenyatta, but the officials refused to cooperate and ignored all requests for information about detained patients.
"This is something that the hospital authorities have been trying to keep secret," said George Morara, vice president of the country's national human rights commission. He said the number of Kenyans incarcerated in hospitals is "alarmingly high" and that the practice is "ubiquitous in public and private hospitals."
He said patients have been held in Kenyatta for up to two years, and it was reasonable to suspect that hundreds of patients could be detained there at any time.
The Ministry of Health of Kenya and Kenyatta canceled several scheduled interviews with the PA and refused to respond to repeated requests for comments.
After being elected to the Kenya Parliament, Esther Passaris visited Kenyatta last December to see who were the supporters who were injured in the election violence. She was surprised to discover that the patients were incarcerated.
"There was a lady I met in the hallway and she was crying, 'please, let me go home,'" said Passaris. The woman had hurt her back and hip. He was allowed to leave medically to leave, but was not allowed to go home because he had not paid his bill. "I thought: 'Oh, my God, it's almost Christmas, how can these people not return to their families?'"
Passaris started an online campaign to free patients. Just before the holidays, Kenyatta let go over 450, a victory, says Passaris, although the problem persists.
"Unfortunately," he said, "you can not get water from a rock, so some of these patients stay for a year because they do not have the money."
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Foreign agencies and companies that operate where patients are taken hostage often have very little to say about it. Some experts said that the failure of the international health community to address the problem has undermined its own objectives.
"The aid money becomes ineffective and useless in an environment in which people are terrified of being locked up," said Robert Yates, a health policy expert at Chatham House, the British think tank that reported on incarcerated patients . "It is very embarrassing to the global health community that these arrests are so entrenched in countries that they appear normal, so the whistle should sound in all of us."
Jha from Harvard said: "There are basic human rights abuses that we can not ignore in the 21st century." It is not too much to ask that private companies such as pharmaceutical companies or federal agencies such as the CDC become aware that their partners commit such a violation. of human rights, to hold them accountable and work to put an end to these practices. "
The CDC provides about $ 1.5 million each year to Kenyatta and Pumwani Maternity Hospital, through funds from the President's Emergency Plan for AIDS Relief, or PEPFAR. In Kenyatta, the CDC covers the costs of treatment for patients with HIV and tuberculosis, trains health workers and helps with HIV testing, among other programs. The agency declined to comment if it was aware that patients were regularly detained in Kenyatta and Pumwani or if the agency approves the practice.
Among his other associations, Kenyatta has been working with the University of Washington for more than 30 years. Dr. Carey Farquhar, director of the Kenya Center for Training and Research at the university, said she did not remember seeing any patients being held at Kenyatta, although she was not surprised that it happened; I did not know of any hospital there that did not stop the patients.
"It makes me feel uncomfortable," he said.
Farquhar said the problem "does not cross our radar so much" since his university focuses on medical research, rather than patient care. He added that he could pose the problem to his colleagues in Kenyatta, but that "the solution has to come from within."
The drug manufacturer Novartis also partnered with Kenyatta for several years, helping to pay some of its doctors to study kidney transplant techniques at a hospital in Barcelona. Novartis declined to comment on whether its employees had seen patients detained in Kenyatta or whether they approved the practice.
Dr. Agnes Soucat, of the WHO, said that the US agency was aware of the arrests in hospitals and confirmed that they occurred "quite frequently."
"We do not support this in any way, but the problem has been to document where it happens," said Soucat, director of the department of health systems, financing and governance of WHO. To date, WHO has not attempted to collect data on hospital detentions and says it is difficult to find such information. The PA obtained patient lists, records and bills from a dozen hospitals in the Congo that detail the practices of incarceration.
And while the WHO has issued hundreds of health recommendations, from the treatment of AIDS to Zika, the agency has never published a guide advising countries not to imprison people in their hospitals.
Soucat said that WHO officials in more than a dozen countries had expressed concern about detained patients to health ministers, but that such discussions were private.
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An international organization fought publicly for detained patients.
Researchers at the Center for Reproductive Rights, which works to support women's health around the world, were conducting a study on maternal health care in Kenya in early 2012 when they heard about the cases of Maimuna Awuor Omuya and Margaret Oliele.
Unable to pay her bill at Pumwani Maternity Hospital after the delivery of her sixth child, Omuya and her baby were imprisoned together with more than 60 women in a wet room, in September 2010. She often slept on the damp ground next to a bathroom flood. The mother and child were released after almost a month, but only when one of Omuya's friends asked the mayor to intervene.
Two months later, Oliele arrived in Pumwani. During a failed cesarean, the doctors left a pair of surgical scissors inside Oliele's stomach; It took a second surgery to remove the scissors and later suffered a ruptured bladder and a blood infection. When she could not pay for the hospital expenses, Oliele was taken to a detention room.
"I tried to escape, but when I got to the front door, the security guards took me," Oliele told AP. "I did not have my clothes on and I still had the catheter in my stomach, then the guards took me by force to the hospital, where they handcuffed me to a bed, while they claimed that I had gone crazy." They kept her for six days.
The lawyers of the Center for Reproductive Rights resolved to take the case of the detained patients and file a lawsuit on behalf of Omuya and Oliele.
"These were two very scary cases and their treatment was very degrading," said Evelyne Opondo, regional director of the center who oversaw the case.
They won In September 2015, the High Court of Kenya ruled that the detention of women violated numerous human rights enshrined in the Constitution and, therefore, was illegal. The High Court described the detention of women as "cruel, inhuman and degrading." The court also ordered the government of Kenya to "take the necessary measures to protect all patients from arbitrary detention in health care centers."
But three years later, it seems that little has changed.
"People are still detained," Oliele said. "They should stop treating people like animals and treat them as human beings."
Opondo said that the arrests continue because nobody has asked the hospitals "to provide answers, because they have not been held responsible". He estimated that there could be many thousands of people detained throughout the country, according to information received by the center and the news reports.
Although the court ordered the government to develop guidelines on how hospitals should exempt rates for patients who can not pay, Opondo said the proposed solutions have not gone far enough. A program that provides free maternity care is only available in a select number of private hospitals and does not include postpartum care.
Earlier this month, the Kenya High Court ruled again that imprisoning patients "is not one of the acceptable ways (for hospitals) to recover the debt." The case involved a man detained at the Women's Hospital in Nairobi since June 25; The judge ordered his immediate release despite the pending invoice. Kenyan politicians will also soon discuss a proposed amendment to the country's health law that will explicitly make illegal the arrests of patients.
The latest amendment was introduced by Deputy Jared Okelo, a member of Parliament who described the imprisonment of mothers as "unrestrained."
Omuya is still marked by his arrest in Pumwani. She says she developed chronic pneumonia after having been in humid and cold conditions there and since then she has not been able to work full time.
Omuya and Oliele were paid the damages that the court granted them: Omuya received 1,500,000 shillings ($ 14,842) from the hospital, while Oliele received 500,000 shillings ($ 4,948).
And the Omuya family has had another incident with a hospital in Nairobi.
Several months ago, Omuya's younger brother was admitted to the Mbagathi District Hospital after becoming ill and collapsing.
"We do not know what it was, but the doctors told us that he needed a lot of drugs to treat, which was a poisoning," he said.
The doctors completed their treatment and presented their brother with an invoice of approximately 134,000 shillings ($ 1,326).
When Omuya and her family could not raise the necessary funds, the situation took an unpleasant but familiar turn: her brother was imprisoned. Hospital managers asked the family to pay at least half of the outstanding amount, but after about a month and a half, they had only raised about $ 120. Omuya said his brother was released only when his doctor negotiated his release .
"The arrests continue because there are no rights here," he said. "What I suffered, I do not want anyone else to suffer."
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Desmond Tiro in Nairobi and Paola Flores in La Paz, Bolivia contributed to this report.
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Online:
A selection of some of the hospital detention records obtained by the PA:
https://www.documentcloud.org/search/projectid:41082-Hospital-Hostages
EDITOR'S NOTE: First in a two-part series about hospitals that detain patients if they can not pay their bills.
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