Africa Asia Associated Press Breaking Business By MARIA CHENG China Court decisions Diagnosis and treatment Diseases and conditions East Africa East Asia Education Elections Europe General news Government and politics Greater China Health Health care costs Health care facility operation Health care industry Health care services Higher education HIV and AIDS Hospital and clinic services Human rights and civil liberties india Infectious diseases International Kenya Law and order Legal proceedings Nairobi Netherlands Parliamentary elections Personal finance Personal spending Pharmaceutical manufacturing Social affairs Social issues South Asia Southeast Asia Thailand West Africa Western Europe

AP Investigation: Hospitals imprison patients in Kenya

Associated Press Photo

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Associated Press Photo

Margaret Oliele, former detained affected person, poses for a portrait in her house in Nairobi, Kenya. Throughout a botched cesarean part in 2010, docs left a pair of surgical scissors inside her abdomen; a second surgical procedure was wanted to take away the scissors and she or he later suffered a ruptured bladder and a blood an infection. When she couldn’t pay her hospital charges, Oliele was taken to a detention ward. “I tried to escape, but when I got to the main gate, I was taken by the security guards.” (AP Photograph/Bram Janssen)

NAIROBI, Kenya (AP) — The Kenyatta Nationwide Hospital is east Africa’s largest medical establishment, residence to greater than a dozen donor-funded tasks with worldwide companions — a “Center of Excellence,” says the U.S. Facilities for Illness Management and Prevention.

The hospital’s web site proudly proclaims its motto — “We Listen … We Care” — together with photographs of smiling docs, a vaccination marketing campaign and staffers holding aloft a gold trophy at an awards ceremony.

However there are not any footage of Robert Wanyonyi, shot and paralyzed in a theft greater than a yr in the past. Kenyatta won’t permit him to go away the hospital as a result of he can’t pay his invoice of almost four million Kenyan shillings ($39,570). He’s trapped in his fourth-floor mattress, unable to go to India, the place he believes docs may assist him.


EDITOR’S NOTE: First in a two-part collection on hospitals that detain patients if they can’t pay their payments.


At Kenyatta Nationwide Hospital and at an astonishing variety of different hospitals around the globe, in the event you don’t pay up, you don’t go residence.

The hospitals typically illegally detain patients lengthy after they need to be medically discharged, utilizing armed guards, locked doorways and even chains to carry those that haven’t settled their accounts. Moms and infants are typically separated. Even dying doesn’t assure launch: Kenyan hospitals and morgues are holding tons of of our bodies till households pays their family members’ payments, authorities officers say.

Dozens of docs, nurses, well being specialists, patients and directors informed The Related Press of imprisonments in hospitals in no less than 30 different nations, together with Nigeria and Congo, China and Thailand, Lithuania and Bulgaria, and others in Latin America and the Center East.

The AP investigation constructed on a report final yr by the British think-tank Chatham Home; its specialists discovered greater than 60 press stories of affected person detention in 14 nations in Asia and sub-Saharan Africa.

“What’s striking about this issue is that the more we look for this, the more we find it,” stated Dr. Ashish Jha, director of the Harvard International Well being Institute, who was not concerned in the British analysis. “It’s probably hundreds of thousands if not millions of people that this affects worldwide. It is not something that is only happening in a small number of countries, but the problem is that nobody is looking at this and it is way off the public health radar.”

Some examples:

—Within the Philippines, Annalyn Manalo was held at Mount Carmel Diocesan Basic Hospital in Lucena Metropolis for 1½ months beginning final December following remedy for coronary heart issues. Directors refused initially to permit her household to pay in installments — and the price of every additional day in detention was added to the invoice.

“We were treated like criminals,” stated Manalo’s husband, Sigfredo. “The security guards would come and check on us all the time.”

—In Congo’s second metropolis of Lubumbashi, the AP visited greater than 20 hospitals and clinics and located that each one however one routinely detained patients who did not pay, despite the fact that the apply is prohibited there.

—In Bangalore, India, Emmanuel Malagi was detained in a personal hospital for 3 months after he was handled for a spinal tumor, in response to his brother, Christanand. Prevented from seeing him, his household scrambled unsuccessfully to pay his almost 1.four million rupee ($19,281) invoice — and when he died, the hospital demanded one other 10 lakh ($13,771) to launch the physique.

—In Malaysia, a medical scholar from the Netherlands on a diving journey received the bends. He couldn’t afford his decompression remedy; the hospital locked him in a room for 4 days, with no meals or drink, till he was capable of get the cash, in response to Saskia Mostert, a Dutch educational who has researched hospital detentions.

7/8_In Bolivia, a authorities ombudsman reported that 49 patients have been detained in hospitals or clinics in the final two years as a result of they couldn’t pay, regardless of a regulation that prohibits the follow.

Throughout a number of August visits to Kenyatta Nationwide Hospital, The Related Press witnessed armed guards in army fatigues standing watch over patients, and noticed the place detainees slept on bedsheets on the ground in cordoned-off rooms. Guards prevented one nervous father from seeing his detained toddler. All regardless of a courtroom ruling years in the past that discovered the detentions have been unlawful.

Well being specialists decry hospital imprisonment as a human rights violation. But the United Nations, U.S. and worldwide well being businesses, donors and charities all have remained silent whereas pumping billions of dollars into these nations to help splintered well being techniques or to battle outbreaks of illnesses together with AIDS and malaria.

“It’s the dirty underbelly of global health that nobody wants to talk about,” stated Sophie Harman, a well being educational at Queen Mary College of London.

“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.”


Hospital detentions, some specialists argue, may be traced to insurance policies pushed many years in the past by the World Financial institution, the World Well being Group, UNICEF and others who made loans to creating nations given that they cost patients charges for medical providers. With out specific protections in place to guard the poor, they are saying, the insurance policies gave nations the liberty to extract well being care funds nevertheless they noticed match — together with detaining patients.

The follow seems to be most prevalent in nations with fragile, underfunded well being techniques the place there’s little authorities accountability. However the issue has additionally surfaced in wealthier nations, with patients being detained in hospitals in nations together with India, Thailand, China and Iran.

In lots of nations when patients can’t afford to pay for well being care, they’re often both despatched to a public hospital the place remedy is roofed by the state or refused assist altogether. In some hospitals in Cameroon and elsewhere, for instance, the issue of affected person imprisonment was solved by some establishments by merely demanding cost upfront.

The place patients are imprisoned, hospitals acknowledge it isn’t essentially worthwhile. However many say it typically leads a minimum of to partial cost and serves as a deterrent.

In contrast to many hospitals in developed nations, African hospitals don’t all the time present meals, clothes or bedding for patients, so holding onto them doesn’t essentially incur a big value. Detained patients sometimes depend on family members to convey them meals whereas these with out obliging relations resort to begging for assist from employees or different patients.

Dr. Festus Njuguna, a pediatric oncologist on the Moi Educating and Referral Hospital in Eldoret, about 300 kilometers northwest of Nairobi, stated the establishment frequently holds youngsters with most cancers who’ve completed their remedy, however whose mother and father can’t pay. The youngsters are sometimes left on the wards for weeks and months at a time, lengthy after their remedy has ended.

“It’s not a very good feeling for the doctors and nurses who have treated these patients, to see them kept like this,” Njuguna stated.

Nonetheless, some officers brazenly defend the apply.

“We can’t just let people leave if they don’t pay,” stated Leedy Nyembo-Mugalu administrator of Congo’s Katuba Reference Hospital. He stated holding patients wasn’t a problem of human rights, however merely a strategy to conduct enterprise: “No one ever comes back to pay their bill a month or two later.”

At many Kenyan hospitals, together with Kenyatta, officers armed with rifles patrol the hallways and guard the hospital’s gates. Patients should present hospital guards a discharge type to show they’re allowed to go away and even guests should typically give up their identification playing cards earlier than seeing patients.

In its 2016 monetary report, Kenyatta’s auditor-general stated the hospital misplaced greater than $470,000 in charges from patients who “absconded” with out paying. That yr, the hospital reported complete income of greater than $115 million.

Affected person detentions at Kenyatta have been flagged for years, amongst different considerations. In January, demonstrators referred to as for an investigation into allegations of rape and sexual harassment of patients on the hospital. Kenya’s Human Rights Fee tried to conduct an audit of Kenyatta, however officers refused to cooperate and have ignored all requests for details about detained patients.

“This is something that hospital authorities have been trying to keep under wraps,” stated George Morara, vice chairperson of the nation’s nationwide fee on human rights. He stated the variety of Kenyans imprisoned in hospitals is “disturbingly high” and that the follow is “ubiquitous in public and private hospitals.”

He stated patients have been held at Kenyatta for as much as two years, and it was affordable to suspect that lots of of patients might be detained there at any time.

Kenya’s ministry of well being and Kenyatta canceled a number of scheduled interviews with the AP and declined to answer repeated requests for remark.

After she was elected to Kenya’s Parliament, Esther Passaris visited Kenyatta final December to verify on supporters who have been injured in election violence. She was surprised to seek out that patients have been incarcerated.

“There was one lady I met in the corridor and she was crying, ‘please let me go home,’” Passaris stated. The lady had harm her again and hip. She had been medically cleared to go away, however wasn’t allowed to go residence as a result of she hadn’t paid her invoice. “I just thought, ‘Oh my goodness, it’s almost Christmas, how can these people not go back to their families?’”

Passaris began a web-based marketing campaign to have the patients launched. Simply earlier than the vacations, Kenyatta let greater than 450 depart — a victory, Passaris says, although the issue stays.

“Unfortunately,” she stated, “you can’t get water from a rock, so some of these patients stay for a year because they don’t have the money.”


Overseas businesses and corporations that function the place patients are held hostage sometimes have little or no to say about it. Some specialists stated the worldwide well being group’s failure to deal with the difficulty has undermined its personal objectives.

“Aid money becomes ineffective and useless in an environment where people are terrified they’re going to be locked up,” stated Robert Yates, a well being coverage skilled at Chatham Home, the British assume tank that reported on imprisoned patients. “It’s very embarrassing for the global health community that these detentions have become so embedded into countries that they seem normal, and so the whistle needs blowing on all of us.”

Stated Harvard’s Jha: “There are basic human rights abuses that we cannot ignore in the 21st century. It is not too much to ask that when private companies like pharmaceuticals or federal agencies like the CDC become aware that their partners engage in such a fundamental violation of human rights, that they hold them accountable and work to end these practices.”

The CDC offers about $1.5 million yearly to Kenyatta and Pumwani Maternity Hospital, by way of funding from the President’s Emergency Plan for AIDS Aid, or PEPFAR. At Kenyatta, the CDC covers remedy prices for patients with HIV and tuberculosis, trains well being staff and helps with HIV testing, amongst different packages. The company declined to touch upon whether or not it was conscious that patients have been repeatedly detained at Kenyatta and Pumwani or if the company condones the apply.

Amongst its different partnerships, Kenyatta has been working with the College of Washington for greater than 30 years. Dr. Carey Farquhar, director of the college’s Kenya Analysis and Coaching Middle, stated she didn’t recall seeing any detained patients at Kenyatta, although was not stunned that it occurred — she knew of no hospitals there that didn’t detain patients.

“It does make me uncomfortable,” she stated.

Farquhar stated the difficulty “doesn’t cross our radar as much” since her college is concentrated on medical analysis, relatively than affected person care. She added that she may increase the difficulty together with her colleagues at Kenyatta however that “the solution has to come from within.”

The drugmaker Novartis additionally partnered with Kenyatta for a number of years, serving to pay for a few of its docs to review kidney transplant methods at a Barcelona hospital. Novartis declined to touch upon whether or not its staffers had seen detained patients at Kenyatta or whether or not it permitted of the apply.

Dr. Agnes Soucat of WHO stated the U.N. company was conscious of hospital detentions and confirmed they occurred “quite frequently.”

“We do not support this in any way, but the problem has been documenting where it happens,” stated Soucat, director of WHO’s division of well being techniques, financing and governance. Thus far, WHO has made no try to gather knowledge on hospital detentions and says such info is tough to seek out. The AP obtained affected person lists, data and payments from a few dozen hospitals in Congo detailing imprisonment practices.

And although WHO has issued tons of of well being suggestions — from treating AIDS to Zika — the company has by no means revealed any steerage advising nations to not imprison individuals in their hospitals.

Soucat stated WHO officers in greater than a dozen nations had expressed their considerations about detained patients to ministers of well being, however that these discussions have been personal.


One worldwide group did struggle publicly for detained patients.

Researchers for the Middle for Reproductive Rights, which acts to help ladies’s well being all over the world, have been conducting a research of maternal well being care in Kenya in early 2012 once they discovered of the instances of Maimuna Awuor Omuya and Margaret Oliele.

Unable to pay her invoice at Pumwani Maternity Hospital after the supply of her sixth baby, Omuya and her child have been imprisoned together with greater than 60 different ladies in a humid ward, in September 2010. She typically slept on the moist floor subsequent to a flooded rest room. Mom and baby have been launched after almost a month, however solely when certainly one of Omuya’s pals appealed to the mayor to intervene.

Two months later, Oliele arrived at Pumwani. Throughout a botched cesarean part, docs left a pair of surgical scissors inside Oliele’s abdomen; a second surgical procedure was wanted to take away the scissors and she or he later suffered a ruptured bladder and a blood an infection. When she couldn’t pay her hospital charges, Oliele was taken to a detention ward.

“I tried to escape, but when I got to the main gate, I was taken by the security guards,” Oliele informed AP. “I had no clothes on and still had the catheter in my stomach. The guards then forcefully took me back to the hospital where they handcuffed me to a bed, while claiming that I had gone mad.” She was held for six days.

Middle for Reproductive Rights legal professionals resolved to take up the reason for detained patients, bringing go well with on behalf of Omuya and Oliele.

“These were two very appalling cases and their treatment was very degrading,” stated Evelyne Opondo, a senior regional director on the middle who oversaw the case.

They gained. In September 2015, Kenya’s Excessive Courtroom dominated the ladies’s detention violated quite a few human rights enshrined in the structure and was subsequently unlawful. The Excessive Courtroom described the ladies’s detention as “cruel, inhuman and degrading.” The courtroom additional ordered the Kenyan authorities to “take the necessary steps to protect all patients from arbitrary detention in health care facilities.”

However three years later, it seems little has modified.

“People are still being detained,” Oliele stated. “They should stop treating people like animals and treat them as fellow human beings.”

Opondo stated detentions proceed as a result of no one has requested hospitals “to provide answers, because they’ve not been held accountable.” She estimated there could possibly be many hundreds of individuals throughout the nation detained, based mostly on info acquired by the middle and information stories.

Though the courtroom instructed the federal government to supply tips on how hospitals ought to waive charges for patients unable to pay, Opondo stated the proposed fixes haven’t gone far sufficient. A program that gives free maternity care is simply obtainable at a choose variety of personal hospitals and doesn’t embrace post-delivery care.

Earlier this month, Kenya’s Excessive Courtroom dominated once more that imprisoning patients “is not one of the acceptable avenues (for hospitals) to recover debt.” The case concerned a person detained at Nairobi Ladies’s Hospital since June 25; the decide ordered his instant launch regardless of the excellent invoice. Kenyan politicians additionally will quickly debate a proposed modification to the nation’s well being regulation that may explicitly make affected person detentions unlawful.

The newest modification was submitted by MP Jared Okelo, a member of Parliament who described the imprisonment of moms as “rampant.”

Omuya continues to be scarred by her detention at Pumwani. She says she developed continual pneumonia after being held in the damp, chilly circumstances there and has not been capable of work full-time since.

Neither Omuya nor Oliele have been paid the damages awarded to them by the courtroom: Omuya was to obtain 1,500,000 shillings ($14,842) from the hospital whereas Oliele was to obtain 500,000 shillings ($four,948).

And Omuya’s household has had one other run-in with a Nairobi hospital.

A number of months in the past, Omuya’s youngest brother was admitted to Mbagathi District Hospital after falling sick and collapsing.

“We don’t know what it was, but the doctors told us he needed many medications to treat, that it was a poisoning,” she stated.

Docs accomplished their remedy and introduced her brother with a invoice of about 134,000 shillings ($1,326).

When Omuya and her household have been unable to boost the required funds, the state of affairs took an unwelcome however acquainted flip: her brother was imprisoned. Hospital managers requested the household to pay at the least half the excellent quantity, however after a few month and a half, that they had solely scraped collectively about $120. Omuya stated her brother was freed solely when his physician negotiated his launch.

“Detentions still go on because there are no rights here,” she stated. “What I suffered, I want no one else to suffer.”


Desmond Tiro in Nairobi and Paola Flores in La Paz, Bolivia contributed to this report.



A choice of a number of the hospital detention data obtained by the AP:

EDITOR’S NOTE: First in a two-part collection on hospitals that detain patients if they can’t pay their payments.

About the author