An AP investigation by Maria Cheng, Medical Writer
LUBUMBASHI, Congo – Perhaps the most surprising thing about the fact that hospitals in Congo detain patients who cannot pay their bills is that it’s no secret: Administrators, doctors and nurses openly discuss it, and the patients are held in plain sight.
An Associated Press investigation found that only one of more than 20 hospitals visited in the copper-mining metropolis of Lubumbashi did not routinely imprison patients. Though government officials condemn the illegal practice, a Ministry of Health official in Kinshasa noted that “health officials cannot be everywhere.”
The only ones who claim they don’t know what’s happening in Congo, it seems, are more than a dozen major health donors and agencies who invest billions of dollars in the country and have major operations there — including the European Union, UNICEF, the International Committee of the Red Cross, PATH, Save the Children, the U.S. Agency for International Development and World Vision.
They all told the AP they had no knowledge of patient detentions or insufficient information to act. But at the Katuba Reference Hospital in Lubumbashi, officials made no effort to hide their detainment of Kimenua Ngoie and Gabriel Mutamba, the institution’s longest-staying residents.
Ngoie, 22, has been there for nearly four months since losing her first baby in a cesarean section and Mutamba, in his 80s, arrived with a broken leg more than a year ago. While both are healthy enough to be discharged, they are effectively imprisoned in their shared grimy, roach-infested room because neither can afford their bill. Ngoie’s bill stands at $360 while Mutamba’s is $1,477.
“My deepest desire right now is just to leave the hospital,” Ngoie said.
Such detentions are not unusual, in Congo, across much of Africa or in places ranging from the Philippines to Bolivia.
“When we detain patients, this is not something that is unique to our hospital,” said Leedy Nyembo-Mugalu, administrator of the Katuba hospital. “This happens everywhere.”
For the hospitals, holding patients is mostly an act of financial desperation. Most lack basic drugs, running water and regular electricity. Bed shortages are often so severe that two patients must squeeze onto a single mattress. At Katuba, sterilizing surgical tools means placing them in a pot of boiling water.
“It’s very hard when we have to detain somebody, but we have to recuperate the costs of the products we use,” said Dr. Veronique Kashala at the Centre Medicale de la Victoire.
Kashala recalled a baby who was held for a month this spring after being treated for meningitis, when her family failed to pay $63.
The infant’s parents finally brought in their pastor, who contributed about $50. That was enough to convince the clinic to release her.
Given how brazenly transparent hospitals are about imprisoning patients in Congo, it is difficult to believe international agencies working in the country could be unaware of the practice.
At Lubumbashi’s Hopital General de Reference Kenya, where stickers showed that computers, printers and even office fans were paid for by USAID, administrator Aimerance Kapapa said some detained patients sweep hallways, mop corridors or mow the grass to offset their debt.
USAID did not respond to questions about whether it was aware of hospital detentions in Congo or elsewhere.
Karen Cowgill, an assistant professor at the University of Washington who has studied patient detentions, said funders tend to stick to specific programs, like those for AIDS, rather than investing in general health care.
“It’s really tough because donors are worried about their funds disappearing in a broken system, so they just focus on how their particular program is working,” she said.
Robert Yates, a health policy expert at the British think tank Chatham House, said the World Health Organization could at the very least issue a resolution condemning the practice.
“As part of their drive for universal health care, WHO could sit down all the health ministers and say, ‘we publicly commit to ensuring we’re not illegally locking up people in our health facilities,'” he said.
For some, the fear that a hospital stay might be interminable seems very real. At Sendwe Hospital, Lubumbashi’s biggest public institution, some surgical patients were detained for five to six years when they couldn’t pay, according to Abel Ntambue, a Congolese doctor at the University of Lubumbashi. Ntambue said Sendwe eventually released them when they needed the space.
At the Polyclinique Goschen, medical director Dr. Disashi Tshimpuki described the case of a former soldier who was detained for nearly two years after both his legs were amputated due to gangrene. His family paid only a fraction of the $9,290 bill.
“At first, he had a lot of family that came to visit him,” Tshimpuko said, “but then they deserted him.”