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Margaret Oliele, above bedfast patient, poses for a account in her home in Nairobi, Kenya. During a adulterated cesarean area in 2010, doctors larboard a brace of surgical scissors central her stomach; a additional anaplasty was bare to aish the scissors and she afterwards suffered a burst float and a claret infection. Aback she couldn’t pay her hospital fees, Oliele was taken to a apprehension ward. “I accustomed to escape, but aback I got to the capital gate, I was taken by the aegis guards.” (AP Photo/Bram Janssen)

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NAIROBI, Kenya (AP) — The Kenyatta Civic Hospital is east Africa’s better medical institution, home to added than a dozen donor-funded projects with all-embracing ally — a “Center of Excellence,” says the U.S. Centers for Disease Control and Prevention.

The hospital’s website proudly proclaims its adage — “We Listen … We Care” — forth with photos of animated doctors, a anesthetic attack and staffers captivation aloft a gold bays at an awards ceremony.

But there are no pictures of Robert Wanyonyi, attack and bedridden in a robbery added than a year ago. Kenyatta will not acquiesce him to leave the hospital because he cannot pay his bill of about 4 actor Kenyan shillings ($39,570). He is trapped in his fourth-floor bed, clumsy to go to India, area he believes doctors ability advice him.

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EDITOR’S NOTE: First in a two-part alternation on hospitals that apprehend patients if they cannot pay their bills.

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At Kenyatta Civic Hospital and at an amazing cardinal of added hospitals about the world, if you don’t pay up, you don’t go home.

The hospitals generally illegally apprehend patients continued afterwards they should be medically discharged, application armed guards, bound doors and alike chains to authority those who accept not acclimatized their accounts. Mothers and babies are sometimes separated. Alike afterlife does not agreement release: Kenyan hospitals and morgues are captivation hundreds of bodies until families can pay their admired ones’ bills, government admiral say.

Dozens of doctors, nurses, bloom experts, patients and administrators told The Associated Columnist of imprisonments in hospitals in at atomic 30 added countries, including Nigeria and Congo, China and Thailand, Lithuania and Bulgaria, and others in Latin America and the Middle East.

The AP analysis congenital on a abode aftermost year by the British think-tank Chatham House; its experts begin added than 60 columnist letters of accommodating apprehension in 14 countries in Asia and sub-Saharan Africa.

“What’s arresting about this affair is that the added we attending for this, the added we acquisition it,” said Dr. Ashish Jha, ambassador of the Harvard All-around Bloom Institute, who was not complex in the British research. “It’s apparently hundreds of bags if not millions of bodies that this affects worldwide. It is not article that is alone accident in a babyish cardinal of countries, but the botheration is that cipher is attractive at this and it is way off the accessible bloom radar.”

Some examples:

–In the Philippines, Annalyn Manalo was captivated at Mount Carmel Diocesan General Hospital in Lucena Burghal for 1½ months starting aftermost December afterward analysis for affection problems. Administrators banned initially to acquiesce her ancestors to pay in installments — and the bulk of anniversary added day in apprehension was added to the bill.

“We were advised like criminals,” said Manalo’s husband, Sigfredo. “The aegis guards would appear and analysis on us all the time.”

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–In Congo’s additional burghal of Lubumbashi, the AP visited added than 20 hospitals and clinics and begin that all but one commonly bedfast patients who bootless to pay, alike admitting the convenance is actionable there.

–In Bangalore, India, Emmanuel Malagi was bedfast in a clandestine hospital for three months afterwards he was advised for a analgesic tumor, according to his brother, Christanand. Prevented from seeing him, his ancestors accolade abominably to pay his about 1.4 actor rupee ($19,281) bill — and aback he died, the hospital accepted addition 10 lakh ($13,771) to absolution the body.

–In Malaysia, a medical apprentice from the Netherlands on a diving cruise got the bends. He couldn’t allow his decompression treatment; the hospital bound him in a allowance for four days, with no aliment or drink, until he was able to get the money, according to Saskia Mostert, a Dutch bookish who has researched hospital detentions.

–In Bolivia, a government ombudsman appear that 49 patients were bedfast in hospitals or clinics in the aftermost two years because they couldn’t pay, admitting a law that prohibits the practice.

During several August visits to Kenyatta Civic Hospital, The Associated Columnist witnessed armed guards in aggressive fatigues continuing watch over patients, and saw area detainees slept on bedsheets on the attic in cordoned-off rooms. Guards prevented one afraid ancestor from seeing his bedfast toddler. All admitting a cloister cardinal years ago that begin the detentions were illegal.

Health experts abuse hospital imprisonment as a animal rights violation. Yet the United Nations, U.S. and all-embracing bloom agencies, donors and charities all accept remained bashful while pumping billions of dollars into these countries to abutment splintered bloom systems or to action outbreaks of diseases including AIDS and malaria.

“It’s the bedraggled base of all-around bloom that cipher wants to allocution about,” said Sophie Harman, a bloom bookish at Queen Mary University of London.

“People apperceive patients are actuality captivated prisoner, but they apparently anticipate they accept bigger battles in accessible bloom to fight, so they aloof accept to let this go.”

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Hospital detentions, some experts argue, can be traced to behavior pushed decades ago by the Apple Bank, the Apple Bloom Organization, UNICEF and others who fabricated loans to developing countries on action that they allegation patients fees for medical services. Afterwards absolute protections in abode to assure the poor, they say, the behavior gave countries the abandon to abstract bloom affliction payments about they saw fit — including detaining patients.

The convenance appears to be best accustomed in countries with fragile, underfunded bloom systems area there is little government accountability. But the botheration has additionally alike in wealthier countries, with patients actuality bedfast in hospitals in countries including India, Thailand, China and Iran.

In abounding countries aback patients cannot allow to pay for bloom care, they are usually either beatific to a accessible hospital area analysis is covered by the accompaniment or banned advice altogether. In some hospitals in Cameroon and elsewhere, for example, the botheration of accommodating imprisonment was apparent by some institutions by artlessly ambitious acquittal upfront.

Where patients are imprisoned, hospitals accede it is not necessarily profitable. But abounding say it generally leads at atomic to fractional acquittal and serves as a deterrent.

Unlike abounding hospitals in developed countries, African hospitals don’t consistently accommodate food, accouterment or bedding for patients, so captivation assimilate them does not necessarily acquire a cogent cost. Bedfast patients about await on ancestors to accompany them aliment while those afterwards accommodating ancestors associates resort to allurement for advice from agents or added patients.

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Dr. Festus Njuguna, a pediatric oncologist at the Moi Teaching and Referral Hospital in Eldoret, about 300 kilometers northwest of Nairobi, said the academy consistently holds accouchement with blight who accept accomplished their treatment, but whose parents cannot pay. The accouchement are about larboard on the wards for weeks and months at a time, continued afterwards their analysis has ended.

“It’s not a actual adequate activity for the doctors and nurses who accept advised these patients, to see them kept like this,” Njuguna said.

Still, some admiral aboveboard avert the practice.

“We can’t aloof let bodies leave if they don’t pay,” said Leedy Nyembo-Mugalu ambassador of Congo’s Katuba Reference Hospital. He said captivation patients wasn’t an affair of animal rights, but artlessly a way to conduct business: “No one anytime comes aback to pay their bill a ages or two later.”

At abounding Kenyan hospitals, including Kenyatta, admiral armed with rifles convoying the hallways and bouncer the hospital’s gates. Patients charge appearance hospital guards a acquittal anatomy to prove they’re accustomed to leave and alike visitors charge sometimes abandonment their identification cards afore seeing patients.

In its 2016 banking report, Kenyatta’s auditor-general said the hospital absent added than $470,000 in fees from patients who “absconded” afterwards paying. That year, the hospital appear absolute acquirement of added than $115 million.

Patient detentions at Kenyatta accept been flagged for years, amid added concerns. In January, demonstrators alleged for an analysis into allegations of abduction and animal aggravation of patients at the hospital. Kenya’s Animal Rights Bureau attempted to conduct an analysis of Kenyatta, but admiral banned to abet and accept abandoned all requests for advice about bedfast patients.

“This is article that hospital authorities accept been aggravating to accumulate beneath wraps,” said George Morara, carnality administrator of the country’s civic bureau on animal rights. He said the cardinal of Kenyans confined in hospitals is “disturbingly high” and that the convenance is “ubiquitous in accessible and clandestine hospitals.”

He said patients accept been captivated at Kenyatta for up to two years, and it was reasonable to doubtable that hundreds of patients could be bedfast there at any time.

Kenya’s admiral of bloom and Kenyatta canceled several appointed interviews with the AP and beneath to acknowledge to afresh requests for comment.

After she was adopted to Kenya’s Parliament, Esther Passaris visited Kenyatta aftermost December to analysis on supporters who were afflicted in acclamation violence. She was abashed to acquisition that patients were incarcerated.

“There was one adult I met in the aisle and she was crying, ‘please let me go home,’” Passaris said. The woman had aching her aback and hip. She had been medically austere to leave, but wasn’t accustomed to go home because she hadn’t paid her bill. “I aloof thought, ‘Oh my goodness, it’s about Christmas, how can these bodies not go aback to their families?’”

Passaris started an online attack to accept the patients released. Aloof afore the holidays, Kenyatta let added than 450 leave — a victory, Passaris says, admitting the botheration remains.

“Unfortunately,” she said, “you can’t get baptize from a rock, so some of these patients break for a year because they don’t accept the money.”

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Foreign agencies and companies that accomplish area patients are captivated earnest about accept actual little to say about it. Some experts said the all-embracing bloom community’s abortion to abode the affair has debilitated its own goals.

“Aid money becomes abortive and abortive in an ambiance area bodies are abashed they’re activity to be bound up,” said Robert Yates, a bloom action able at Chatham House, the British anticipate catchbasin that appear on confined patients. “It’s actual awkward for the all-around bloom association that these detentions accept become so anchored into countries that they assume normal, and so the blare needs alarming on all of us.”

Said Harvard’s Jha: “There are basal animal rights abuses that we cannot avoid in the 21st century. It is not too abundant to ask that aback clandestine companies like pharmaceuticals or federal agencies like the CDC become acquainted that their ally appoint in such a axiological abuse of animal rights, that they authority them answerable and assignment to end these practices.”

The CDC provides about $1.5 actor every year to Kenyatta and Pumwani Maternology Hospital, via allotment from the President’s Emergency Plan for AIDS Relief, or PEPFAR. At Kenyatta, the CDC covers analysis costs for patients with HIV and tuberculosis, trains bloom workers and helps with HIV testing, amid added programs. The bureau beneath to animadversion on whether it was acquainted that patients were consistently bedfast at Kenyatta and Pumwani or if the bureau condones the practice.

Among its added partnerships, Kenyatta has been alive with the University of Washington for added than 30 years. Dr. Carey Farquhar, ambassador of the university’s Kenya Analysis and Training Center, said she didn’t anamnesis seeing any bedfast patients at Kenyatta, admitting was not afraid that it happened — she knew of no hospitals there that did not apprehend patients.

“It does accomplish me uncomfortable,” she said.

Farquhar said the affair “doesn’t cantankerous our alarm as much” aback her university is focused on medical research, rather than accommodating care. She added that she ability accession the affair with her colleagues at Kenyatta but that “the band-aid has to appear from within.”

The drugmaker Novartis additionally partnered with Kenyatta for several years, allowance pay for some of its doctors to abstraction branch displace techniques at a Barcelona hospital. Novartis beneath to animadversion on whether its staffers had apparent bedfast patients at Kenyatta or whether it accustomed of the practice.

Dr. Agnes Soucat of WHO said the U.N. bureau was acquainted of hospital detentions and accepted they happened “quite frequently.”

“We do not abutment this in any way, but the botheration has been documenting area it happens,” said Soucat, ambassador of WHO’s administration of bloom systems, costs and governance. To date, WHO has fabricated no attack to aggregate abstracts on hospital detentions and says such advice is adamantine to find. The AP acquired accommodating lists, annal and bills from about a dozen hospitals in Congo account imprisonment practices.

And admitting WHO has issued hundreds of bloom recommendations — from alleviative AIDS to Zika — the bureau has never appear any advice advising countries not to apprehend bodies in their hospitals.

Soucat said WHO admiral in added than a dozen countries had bidding their apropos about bedfast patients to ministers of health, but that those discussions were private.

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One all-embracing alignment did action about for bedfast patients.

Researchers for the Centermost for Reproductive Rights, which acts to abutment women’s bloom about the world, were administering a abstraction of affectionate bloom affliction in Kenya in aboriginal 2012 aback they abstruse of the cases of Maimuna Awuor Omuya and Margaret Oliele.

Unable to pay her bill at Pumwani Maternology Hospital afterwards the commitment of her sixth child, Omuya and her babyish were confined forth with added than 60 added women in a clammy ward, in September 2010. She generally slept on the wet arena aing to a abounding toilet. Mother and adolescent were appear afterwards about a month, but alone aback one of Omuya’s accompany appealed to the ambassador to intervene.

Two months later, Oliele accustomed at Pumwani. During a adulterated cesarean section, doctors larboard a brace of surgical scissors central Oliele’s stomach; a additional anaplasty was bare to aish the scissors and she afterwards suffered a burst float and a claret infection. Aback she couldn’t pay her hospital fees, Oliele was taken to a apprehension ward.

“I accustomed to escape, but aback I got to the capital gate, I was taken by the aegis guards,” Oliele told AP. “I had no clothes on and still had the catheter in my stomach. The guards afresh angrily took me aback to the hospital area they abandoned me to a bed, while claiming that I had gone mad.” She was captivated for six days.

Center for Reproductive Rights attorneys bound to booty up the account of bedfast patients, bringing clothing on account of Omuya and Oliele.

“These were two actual alarming cases and their analysis was actual degrading,” said Evelyne Opondo, a chief bounded ambassador at the centermost who oversaw the case.

They won. In September 2015, Kenya’s High Cloister disqualified the women’s apprehension abandoned abundant animal rights anointed in the architecture and was accordingly illegal. The High Cloister declared the women’s apprehension as “cruel, barbaric and degrading.” The cloister added ordered the Kenyan government to “take the all-important accomplish to assure all patients from approximate apprehension in bloom affliction facilities.”

But three years later, it appears little has changed.

“People are still actuality detained,” Oliele said. “They should stop alleviative bodies like animals and amusement them as adolescent animal beings.”

Opondo said detentions abide because cipher has asked hospitals “to accommodate answers, because they’ve not been captivated accountable.” She estimated there could be abounding bags of bodies beyond the country detained, based on advice accustomed by the centermost and account reports.

Although the cloister instructed the government to aftermath guidelines on how hospitals should abandon fees for patients clumsy to pay, Opondo said the proposed fixes accept not gone far enough. A affairs that provides chargeless maternology affliction is alone accessible at a baddest cardinal of clandestine hospitals and does not accommodate post-delivery care.

Earlier this month, Kenya’s High Cloister disqualified afresh that imprisoning patients “is not one of the adequate avenues (for hospitals) to balance debt.” The case complex a man bedfast at Nairobi Women’s Hospital aback June 25; the adjudicator ordered his actual absolution admitting the outstanding bill. Kenyan politicians additionally will anon agitation a proposed alteration to the country’s bloom law that will absolutely accomplish accommodating detentions illegal.

The latest alteration was submitted by MP Jared Okelo, a affiliate of Parliament who declared the imprisonment of mothers as “rampant.”

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Omuya is still aching by her apprehension at Pumwani. She says she developed abiding pneumonia afterwards actuality captivated in the damp, algid altitude there and has not been able to assignment full-time since.

Neither Omuya nor Oliele accept been paid the amercement awarded to them by the court: Omuya was to accept 1,500,000 shillings ($14,842) from the hospital while Oliele was to accept 500,000 shillings ($4,948).

And Omuya’s ancestors has had addition altercation with a Nairobi hospital.

Several months ago, Omuya’s youngest brother was accepted to Mbagathi District Hospital afterwards falling ill and collapsing.

“We don’t apperceive what it was, but the doctors told us he bare abounding medications to treat, that it was a poisoning,” she said.

Doctors completed their analysis and presented her brother with a bill of about 134,000 shillings ($1,326).

When Omuya and her ancestors were clumsy to accession the all-important funds, the bearings took an blackballed but accustomed turn: her brother was imprisoned. Hospital managers asked the ancestors to pay at atomic bisected the outstanding amount, but afterwards about a ages and a half, they had alone aching calm about $120. Omuya said her brother was freed alone aback his doctor adjourned his release.

“Detentions still go on because there are no rights here,” she said. “What I suffered, I appetite no one abroad to suffer.”

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Desmond Tiro in Nairobi and Paola Flores in La Paz, Bolivia contributed to this report.

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Online:

A alternative of some of the hospital apprehension annal acquired by the AP:

https://www.documentcloud.org/search/projectid:41082-Hospital-Hostages

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EDITOR’S NOTE: First in a two-part alternation on hospitals that apprehend patients if they cannot pay their bills.

Copyright © The Associated Press. All rights reserved. This actual may not be published, broadcast, rewritten or redistributed.

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