In Kenya, patients held hostage to medical bills

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.

Kenya's lawmakers, often ranked among Africa's highest-paid yet least productive, have repeatedly failed to tackle rising healthcare costs and inadequate insurance.

A spokesman for Kenyatta National Hospital said his facility was struggling to stay afloat amid government cutbacks over the last 20 years.

Kenyatta, in the heart of Nairobi, receives the bulk of the city's poor patients, from road accident victims to abandoned babies. Whereas private hospitals can demand payment upfront, Kenyatta takes everyone.

The hospital, so crowded that some patients are forced to temporarily sleep in congested corridors, still detains nonpaying patients long after their treatment is completed, usually in dank rooms, separated from the other wards.

In the late 1980s, the government slashed funding to hospitals and implemented "cost-sharing" measures for patients who previously did not have to pay, spokesman George Ojuondo said. Since then, he said, the government has paid salaries but forced facilities to bill patients to raise money for equipment, supplies and drugs.

"The only way we can run the hospital is by charging patients," he said. "If people walk in and don't pay, how are we going to pay for the next patient?"

The cost of detaining patients is minimal, particularly since public hospitals typically don't provide adequate food even for paying patients, forcing families to deliver meals to their loved ones. Meanwhile, hospitals continue to charge detained patients an average of $5 to $7 a day, so their debt continues to grow like a high-interest credit card balance.

If even a few detained patients manage to pay off the debts, the policy is profitable. And it makes people think twice about failing to pay their bills, health officials said.

Ojuondo said the hospital employs social workers to determine which patients can't pay. But such mechanisms don't always work.

Regina Wamza was orphaned at 10; she dropped out of school after sixth grade and ran away from her home in eastern Kenya to Nairobi, where she found herself pregnant and living in the slums. When it came time to deliver, she opted for a cheaper mid-wife, but complications landed her at the government's Pumwani Maternity Hospital.

Unable to pay the $60 delivery fee or the $7 daily charge, she said, she was held in a room with three other mothers. She was given only a thin blanket for the baby, which served as both clothing and diaper. For four months, her baby boy did not go outdoors.

"The nurses were so hard," said Wamza, 19. "They just accused me of taking up space. They didn't care."

Hospital officials did not return phone calls for comment.

In desperation, Wamza said, she caught the attention of a stranger through the window and persuaded her to help smuggle the child out. Then Wamza covered her head with a Muslim-style scarf and sneaked past the guard.

"I will never go back there," she said. "It was like prison."

--

edmund.sanders@ latimes.com