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."
