NAIROBI, KENYA — Widowed and HIV-positive, Beatrice Acheing had no money to have her baby delivered in a hospital. But she admitted herself anyway to reduce the risk of transmitting the virus during childbirth.
To her relief, the boy was born HIV-negative. But their ordeal had just begun. Hours after labor, both mother and baby were shunted into a locked, guarded room with other indigent patients. They were given one meal, sometimes two, a day, but no clothes or diapers for the infants. Nurses visited sporadically, mostly harassing them to pay their bills.
After a week in the makeshift patients' prison, Acheing's infant son began to shiver uncontrollably. One night, with no doctors on duty and the guard too far to hear her cries for help, he died in her arms.
The next morning a nurse took the baby away. But hospital officials detained the grieving mother for six more months, demanding $250 in fees. She escaped one morning when the guard fell asleep.
"I never found out what happened to [the body of] my baby," said Acheing, 31.
Tragically, healthcare horror stories are common in Africa, where developing countries rarely have medical safety nets for the poor. But an increase in cases of cash-starved public hospitals and mortuaries detaining patients and even corpses over unpaid bills is spurring outrage in Kenya.
The parents of one 11-year-old girl with kidney disease issued a public appeal in April to clear a $2,000 hospital bill. The girl recovered in January but has been detained since then by the government-run Kenyatta National Hospital here in Nairobi, the capital.
The same facility was pressured this month to release 44 new mothers after a TV station used a hidden camera to prove that they were being held in a padlocked room.
"They know very well these people can never pay those bills," said Njoroge Baiya, a Kenyan lawmaker who has raised the issue in parliament. "A more humane policy should be developed."
Experts say government inaction makes the practice de facto policy, even though its legality has been questioned.
With such policies, it's little wonder that poor Kenyans who are seriously ill or dying often avoid hospitals, even though they might provide treatment or dispense painkillers and help control public contagion.
Instead, many AIDS and cancer patients are pressured by their families to take public buses back to their hometowns, saving the burden of hospital bills, postmortem transportation and ensuring a decent burial. There, some face a painful, lingering death with little more than family members or traditional healers to comfort them.
In Mathare, a slum of tin shacks and open sewage streams in Nairobi, Felista Atieno, 45, is desperately trying to raise money to recover the body of her only son, Peter, who was killed in May by a hit-and-run driver.
Atieno said mortuary officials were demanding $25 -- the equivalent of a month's earnings for most slum-dwellers -- just to view the body. A postmortem exam costs $130, and the city-owned mortuary charges $7 each day it holds the body, adding $210 to her bill over the last month, she said.
Atieno clutched a small notebook with pledges of help from friends and relatives, from 75 cents to $40. But after a month, it totals less than $100. The mortuary has threatened to dispose of the corpse in a mass grave with other unclaimed bodies.
"Under our culture, he has to be buried at his ancestral home," she said. "If I fail, I will be banished from the family. He's my only son. He needs to be buried next to his father."
The mortuary director said he has no authority to waive fees based on claims of poverty.
"We can't make a decision about whether someone has money or not," said David Wanjohi, funeral superintendent at City Mortuary in Nairobi. "If we started doing that, no one would pay."
He said Atieno could appeal to the Nairobi City Council, which makes case-by-case exemptions. But he noted that the city has come to rely on its mortuary as an income- generator, similar to its parking lots.
For Atieno, who is suffering from tuberculosis, the lesson is clear: "It's too expensive to die in a hospital," she said. "For me, I'll go home to die rather than bring more problems to my relatives."
Asked whether she felt anger, she shrugged.
"I can't blame anyone," she said. "I'm the one who doesn't have any money."
Detention of patients and bodies has become widespread in Kenya over the last decade, but it's still illegal, said James Mwamu, vice chairman of the Law Society of Kenya.
"If someone owes money, there is a procedure for collecting the debt, and it's not detaining people or bodies," Mwamu said. "The people must sign a promise to pay, and if they don't, the hospital must file a suit. There is no law that allows hospitals to do what they are doing."
But, Mwamu said, Kenyan police usually treat the matter as a private dispute and victims don't know their rights.
"Most are just at the mercy of the hospital," he said.