In some parts of the world, not being able to pay your medical bills can get you stuck in the hospital. Journalist Cindy Shiner of AllAfrica.com got a first-hand look at the problem on a recent trip to the Democratic Republic of Congo. She offers this reporter's notebook from the capital city, Kinshasa.
I visited Kinshasa to report on the health of women and children — to find out what this African country is doing to keep mothers alive and to prevent their children from dying before they're even born.
I went to the city's main hospital, Kinshasa General. My initial impression was positive. You see, I'd been to this hospital before — 20 years ago. It was just after massive looting sprees, and the wards were nearly vacant.
Things have clearly improved since then. The grass is cut. The floors are swept. Windows have been repaired.
And there are patients. On my recent visit, the benches in the hospital's outdoor corridors were full.
I went through the maternity ward. A new mother cradled her healthy child. The baby squirmed in her lap while trying to nurse, as the woman rocked back and forth to get the infant settled.
I walked to another room where all of the women — at least six — had lost their children in childbirth. And it was here that nurse Kavita Masenga said something that brought me up short.
"Generally, these women stay here more or less a week," she said. "But if they don't have the means to pay the hospital bill, they stay a little longer."
That's right — if they can't pay, they stay longer. Patients can't leave the hospital until they settle their bills, which means some of them can end up staying for a long time.
That was the case for a 23-year-old named Lorette.
Stuck Behind an Iron Gate
When I met Lorette, she said she had been at the hospital for more than three weeks. She said her medical care was expensive, and she didn't have enough money to pay her bill.
Lorette had given birth to a stillborn child and was now a virtual prisoner of her poverty. Mentally disabled, unable to even read to pass the time, she sat in a ward closed behind a blue iron gate, waiting.
Lorette said her mother was working to earn money to get her out of the hospital, but there seemed to be little incentive for her family to help her. Lorette doesn't have a job. In poverty-stricken Kinshasa, she's a drain rather than a resource for her family.
And her problem would only worsen the longer she stayed. Each day she remained in the hospital, another ten dollars would be added to her bill. She already owed more than 200 dollars when I met her, about what the average Congolese makes in an entire year.
Eventually, the medical workers would have to discharge Lorette, if only to make room for other patients who can't pay. Her family would presumably end up paying whatever they could manage.
But sometimes it's not that easy. Families will enlist the help of a policeman or a soldier to exert pressure and negotiate a patient's release.
The broader problem, though, is the system that both patients and doctors find themselves in.
At public hospitals here, patients are supposed to receive medical care at a greatly reduced cost. The government is supposed to pay doctors' monthly salaries, except it often doesn't.
So the only way the doctors can continue to practice — and buy medicine — is to charge higher fees to patients. And doctors say the only way to ensure that patients pay is not to discharge them until they settle their bills.
It's an ad hoc system implemented all across Africa, and it leaves patients like Lorette with few options.
The more I spoke to Lorette, the more I realized that she was attempting a new solution. She wanted me to pay her bill.
As a reporter in Africa, these judgment calls come up all the time. I wanted to help, but if I paid her bill, the next time a Western reporter visited the hospital, there would be that expectation. At some point, fees could be demanded of reporters up front.
The best I could do was to tell Lorette's story.
Ed Note: We believe Lorette has left the hospital. We are looking into her status and will provide an update here when we have it.