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Campaigners say practice of detaining people for unpaid medical bills is widespread

• Xan Rice in Nairobi
• guardian.co.uk, Thursday 13 August 2009 19.25 BST

 

 As a poor woman from the slums, Monica Wanjiku knew that gaining admission into a maternity hospital would be difficult. Leaving was to prove much harder.

Three weeks past her due date, Wanjiku was referred as an emergency case to Nairobi's Pumwani hospital, the biggest maternity facility in east Africa. She gave birth to Aftab, a healthy boy weighing 3.9kg (8lb 5oz).

But when she was unable to pay the £27 delivery fee the hospital refused to discharge her. Instead, Wanjiku was moved to a special detention ward housing 42 other poor mothers and allocated a bed already shared by two women with babies. She and Aftab would not be allowed to leave until she cleared her bill, which would rise daily, the nurses told her.

"I kept explaining that I had no money and another child at home to take care of, but the hospital said I was lying," said Wanjiku, 24, a single mother from a slum in Kamukunji. "I felt like a prisoner."

After eight weeks, when a civil society group shamed the hospital into releasing her, Wanjiku's bill had increased to £120 and her breast milk had dried up, causing Aftab's weight to fall.

Her story is not unique. Cash-strapped state and private hospitals in Kenya are routinely locking up patients to press family members and friends to pay up – and to send a message to poor people to stay away.

In May, the scandal received national prominence when a local television station used a hidden camera to show how 44 new mothers were being held in a locked room at the Kenyatta National hospital. A shocked viewer paid nearly £10,000 to clear their bills, but the exposé did little to change practices. While Pumwani publicly denies detaining patients, the Kenya Network of Grassroots Organisations (Kengo) found 34 mothers being held there against their will on Monday in "inhuman" conditions.

In government and council-run hospitals social workers are meant to waive the bills for the poorest patients, but the policy is rarely applied properly – even in the case of a child dying. Another recently detained mother, Aisha Munyira, 25, said she was held in a guarded ward at Pumwani with about 60 other women and their babies for more than a month after her child died soon after birth in March. She said that she had no choice but to allow the hospital to bury the body anonymously.

"These detentions are a form of psychological torture," said Evelyn Opondo, senior programme officer at the Federation of Women Lawyers, in Nairobi, who has documented a case of a mother being held with her baby at a private hospital in western Kenya for more than two years due to non-payment.

"The hospitals do not publicly declare it, but the practice is widespread."

Despite pledges by the main political parties before the last election to introduce free maternity care, state hospitals have continued a 20-year policy, originally pushed by the World Bank, that requires "cost-sharing" for all public services.

In Nairobi's slums, where the majority of people live below the poverty line, most mothers give birth at home in potentially dangerous conditions, or, if they can afford the transport, in cheap government clinics, where the delivery fee is less than 20p. But pregnant women with complications have little choice but to seek hospital admission.

Alice Otieno, a midwife in Mathare, a sprawling slum near the city centre, who typically delivers at least one child a day in her living room, said she felt bad sending patients to hospital.

"I know that there is a good chance they are going to be detained," she said.

According to mothers who have been locked up, the security is tight – guards control access to the wards, the patients' civilian clothes are taken away and visitors are discouraged. The food is poor – mostly rice and cabbage and one portion of fruit a week. Sending babies home with relatives is forbidden. Even those who manage to clear their original bills are not released if they cannot also pay the additional charges of up to £3.60 a day.

The situation causes desperation. Munyira, the woman who lost her child, said a mother in her ward had jumped out of the window to try to get away, breaking her leg. But some do manage to escape.

Beatrice Achieng, a 31-year-old HIV positive widow from the Mathare Mums support group, who went to Pumwani in the hope of preventing transmission of the virus to her baby, managed to slip past a sleeping guard after being detained in a ward for several months after her child died. Regina Wanza, 19, who had just arrived alone in Nairobi from eastern Kenya when she went into labour, crawled through a hole in the hospital fence.

"Some of the mothers were sleeping on the floor. It was very bad to be locked in there," Wanza said.

Wangui Mbatia, the executive director of the Kengo, said her organisation was going to ask western donors to stop funding health programmes in Kenya until the hospitals changed their practices. She is also exploring ways to help patients who have been detained to sue for compensation.

"This policy is illegal, unnecessary and nonsensical because there's no way that most of these women can settle their bills. It's a government working against its people," she said.

When asked about the detentions, Dr Charles Wanyonyi, medical superintendent of Pumwani hospital, said: "I am not aware of any of these cases. We have a very nice waiver committee, so I don't think it is possible that people have been detained."

A spokesman for Kenyatta National hospital, which is currently holding about 400 patients – not only women – for non-payment of bills, defended the policy and said that all of the people detained had the ability to pay.

"We are unable to procure new equipment and drugs because of the problems of bad debt," said Simon Githai, chief public relations officer for the hospital. "The culture of not planning for unforeseen circumstances in this country needs to change."

Peter Anyang' Nyong'o, the medical services minister, has announced plans for a national heath insurance scheme, funded by a new tax on workers, to help the poor get access to hospital care. During a parliamentary debate he expressed sympathy for the detained patients – but also for the hospitals.

He said it was an "inhuman situation" for mothers to be locked up "but also absolutely out of order for a patient to be treated and expect not to pay his medical bill".

cash-strapped: bez grosza

detain: zatrzymywać, aresztować

detention ward: oddział zatrzymań

donor: ofiarodawca

midwife: położna

pledge: obietnica

procure: zdbywać

prominence: waga, znaczenie

slip past: przemknąć się  

sprawling: bezładnie zbudowany

waive: uchylać się  

waiver: zrzeczenie się

widespread: szeroko rozpowszechniony

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