LUBUMBASHI: The most surprising thing about the fact that Congolese hospitals detain patients who fail to 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 and clinics visited in the copper-mining metropolis of Lubumbashi did not routinely imprison patients. Though government officials condemn the illegal practice and say they stop it when they can, 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 such imprisonment practices would be obvious to anyone who follows a long, dark corridor at the Katuba Reference Hospital to a grimy, roach-infested room that houses the hospital's longest-staying residents: Kimenua Ngoie, who has been there for nearly four months since losing her first baby in a complicated cesarean section and Gabriel Mutamba, in his 80s, who arrived with a broken leg more than a year ago.
Though Ngoie and Mutamba are now healthy enough to be discharged, they have been effectively imprisoned because they cannot pay. Ngoie's bill stands at USD 360 while Mutamba's is USD 1,477.
"There is a God so I'm not afraid to give birth again," said Ngoie, 22. "But my deepest desire right now is just to leave the hospital."
Such detentions are not unusual, in Congo, across much of Africa or in places ranging from the Philippines to Bolivia.
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 the Katuba Reference Hospital, 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, or else we can't treat other patients," said Dr. Veronique Kashala at the Centre Medical de la Victoire.
Kashala recalled a baby girl who was held for a month this spring after being treated for meningitis when her family failed to pay USD 63.
Given how brazenly transparent hospitals are about imprisoning patients in Congo, it is difficult to believe that international agencies in Congo could be unaware of patient detentions.
At Lubumbashi's Sendwe Hospital, Columbia University's ICAP and other partners run an AIDS program funded by the U.S. President's Emergency Plan for AIDS Relief (known as PEPFAR). The program is housed in a separate, recently built unit on the hospital grounds — just a short walk away from the hospital's maternity center. There, seven women who couldn't pay their delivery charges were being detained with their babies in early August in a ward with gaping holes in the ceiling.
Some organizations, such as the Global Fund, make grants contingent on countries upholding certain standards. The fund has invested about $1.5 billion in Congo, mostly for programs for HIV, tuberculosis and malaria, including hospitals and health centers, and its contracts specify that medical detentions "are to be used only as a last resort."
Nicolas Farcy, who runs the fund's Congo portfolio, says fund staffers have never encountered hospital detentions.
Administrators at the Polyclinique Medicare said they would have to shut their doors if patients like 3-year-old Adrielle Nyembwe didn't pay. The boy was being held at the central Lubumbashi clinic in August after being treated for sickle-cell anemia. He had been medically cleared to be released, but had an outstanding bill of USD 850.
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"Nobody in our family has the money to pay," said Adrielle's 23-year-old mother, Ado Ntanga, cradling him in her arms. "I hope we can find someone to help us soon. Because if it's up to the hospital, we will never be free."
More than two months later, Adrielle is still being detained at the clinic.
For some, the fear that a hospital stay might be interminable seems very real. At Sendwe Hospital, Lubumbashi's biggest public institution, a few surgical patients were detained for five to six years, according to Abel Ntambue, a Congolese doctor at the University of Lubumbashi. Ntambue said the patients lacked the means to pay for their treatment and that 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. Both of his legs had been amputated after he developed gangrene; his family had paid only a fraction of the USD 9,290 bill .
"At first, he had a lot of family that came to visit him," Tshimpuko said, "but then they deserted him."