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Investigation Finds African and Asian Hospitals Doubling as Debtor Prisons for the Poor

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You can check out, but you can’t leave — until you pay up.

That’s the message at certain sub-Saharan and Asian hospitals, such as in the Congo and Kenya, where some poor patients have been imprisoned for failing to pay their bills, reports the Associated Press (AP).

“What’s striking about this issue is that the more we look for this, the more we find it,” said Dr. Ashish Jha, director of the Harvard Global Health Institute, in an interview with the AP. “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.”

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Following up on a study conducted by British think-tank Chatham House, the AP launched an investigation into more than 60 reports of patient detention in 14 countries in Asia and sub-Saharan Africa.

In case after case around the world, hospitals were found to illegally hold patients long after they should have been medically discharged, employing armed guards, locking doors, and at times using chains to restrain patients who had not settled their accounts, the AP reports.

“We were treated like criminals,” Sigfredo Manalo told the AP. His wife Annalyn was held at Mount Carmel Diocesan General Hospital in Lucena City, Philippines, for 1.5 months following treatment for heart problems — when her initial request to pay in installments was refused. “The security guards would come and check on us all the time.”

Despite laws prohibiting the practice in many countries, detainment persists and was observed by the AP on multiple site visits.

“It’s the dirty underbelly of global health that nobody wants to talk about,” said Sophie Harman, a health academic at Queen Mary University of London, in an interview with the publication. “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.”

To wit, only one of more than 20 hospitals and clinics visited “in the copper-mining metropolis of Lubumbashi” in the Congo did not routinely imprison patients, according to the two-part investigation.

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In many instances, the imprisonment follows an already painful event, adding to the patient’s trauma.

Kimenua Ngoie has been held at Katuba Reference Hospital for nearly four months after losing her first baby in a complicated cesarean section.

Her case is not uncommon.

According to an earlier report by Stat, medical detention is rife in the Democratic Republic of Congo, where one study found that “54% of women who had given birth and were eligible for discharge were detained for the nonpayment of user fees.”

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Those aware of the problem contend that if donor organizations get involved or threatened to withhold funding, the illegal practice could be halted.

“As part of their drive for universal health care, WHO could sit down all the health ministers and say we publicly commit to ensuring we’re not illegally locking up people in our health facilities,” Robert Yates, a health policy expert at Chatham House, told the AP. “As uncomfortable as this might be for everyone, the UN, governments, and donors need to confront this issue as a human rights abuse and then actively monitor this so that it can be officially banned and ended.”