Inside Kigali’s Hospitals “Detaining” Patients Unable to Pay Treatment Bills

A 40 year-old mother has been living in the University Teaching Hospital (CHUK) since June when the treatment of her child ended. She is confined there against her will; because, she is unable to clear a Rwf 90,000 ($98) bill.

This mother is not alone. There are many others in the same facility.

A two-week investigation The Chronicles conducted in five referral hospitals in Kigali discovered that at least 90 people are being held in these facilities. The investigation was done between July 9-21.

For some of the patients, they are waiting for family members to return with the money. For others, the bill is simply too high to afford and are waiting for some kind of miracle to happen or a Good Samaritan to appear.

The ‘detention’ of patients is not new; as it happens in many hospitals around the country, despite the Health Ministry’s public statements warning health facilities against keeping people for failure to clear bills. The directive thedirectivesued in August 2016, after reports of such acts became public.

“There are no rules that oblige hospitals to detain patients over non-payment and they should not be doing it,” said Dr Jean Pierre Nyemanzi, the Permanent Secretary, at the time, but added: “However, it is important that bills are paid so that the hospital can be able to pay salaries and purchase medical equipment. We will keep sensitizing citizens to ensure they pay mutuelle de sante contributions. Many of those affected usually have no insurance cover.”

In facilities like CHUK and Kibagabaga Hospitals, the oversight on patients is so strict that it is impossible to escape, at least for those who may want to try. At the main gate, you have to show a clearance card issued by the unit which handles payments; otherwise the guards won’t let you step outside the gate.

However, for one facility among those we visited, as the full report below illustrates, the hospital has a system where senior officials from the Ministry that control it conduct regular inspections. For any patient found with payment issues, a review of their welfare is conducted immediately. If they can’t pay the money, they will be allowed to leave and be given time to come back with the payment. And if you cannot pay at all, they will let you go. This hospital is the exception!

When these patients are “detained”, some hospitals do give them food. For a bed to sleep, some facilities keep the patients on the bed where they were admitted but will be removed once a new patient shows up. For some, though, the affected patients are not given anything and have to fend for themselves; many depend on good Samaritans, often religious groups.

The Chronicles could not have accessed these hospitals as media. So, our team used covert methods we can’t outline here to ensure future usage. We interviewed the affected patients themselves. But to obtain specific numbers of how many are kept in a particular hospital, we got them from hospital officials. In most of the hospitals, we spoke to an official directly in charge of patient welfare, who were happy to tell us the numbers.

Here is how The Chronicles investigations unfolded:

University Teaching Hospital of Kigali (CHUK) – 37 patients

At 11:34am on July 16, our reporter arrived at the main gate of the University Teaching Hospital of Kigali (CHUK).

One official told us that as the main national referral hospital, it receives thousands of patients from across the country. Many come with extreme emergency cases like accident victims, who are treated. However, by the time they have to leave, the bill is way too high. The official said the hospital reviews patients on case by case basis and let’s go of those deemed completely unable to clear the costs.

Some families leave the patient behind and return with help to cover the bill from religious groups or good Samaritans. The hospital official told us that there are between 20-30 patients with payment problems.

Our reporter moved to the finance office, which is closer to the exit gate. There we found hospital guides, who are hospital employees standing around to help people with directions around the vast facility. Two of them confirmed that indeed there are people kept in the hospital for nonpayment. Both of these guides confirmed separately the figure 37.

One said: “You will find them scattered all over the place. For those who have been here for longer, they have a special room where they live. You will find them loitering around the hospital looking for food. They cannot leave the hospital.”

The Chronicles reporter managed to find a mother with a child from Bumbogo sector in Gasabo district. Looking exhausted, she appears older than her 40 years age. The woman was brought to CHUK in April after developing complications with her pregnancy. She owes the hospital Rwf 90,000.

Kibagabaga Hospital – 31 patients

At 11:17am on July 9, we arrived at Kibagabaga hospital located in Kimironko Sector of Gasabo district.

While there, we found a woman, who, compared to CHUK did not seem bothered at all. The words of her sentences were punctuated by long intervals before she pronounced another word. It was not stammering; instead it was clear she does not like her job much. Finally, she responded to our query as to how many people need help with covering hospital bills, revealing that they were 31.

She retorted: “They are not supposed to leave until the bill is covered. By the kindness of God, good people come and clear bills for some. Don’t misunderstand me though, we are not a prison. We release them to work with their families to pay.”

We met a mother with two children suffering from mental illness. The family was admitted to Kibagabaga in May and were discharged after three weeks. She owes the hospital Rwf 30,000 ($32). Her husband and family supported her during the treatment period, but have since stopped coming. Attempts to borrow money from family and friends were unsuccessful.

They have nowhere to sleep in the hospital and keep changing places. For food, the mother tells us she depends on people that deliver free meals in the hospital and families of other patients.

Rwanda Military Hospital – 1 patient

On July 16, at 9:30am, we arrived at the hospital reception and there three soldiers including two women. Their military uniforms have name-tags.

As we entered the main hall where there is also the finance area, we noticed two military officers questioning patients. For some patients, they spend seconds, asking for their particulars, while it is longer for others. We later established that these officers were conducting inspection of the hospital.

As we walked around the hospital, we found a 60 year-old man washing clothes. He is from Gatsibo district in eastern province. He is taking care of his son admitted with a rare swelling around the neck. They had been waiting to meet a doctor, who had come two weeks earlier. The elderly man’s complaint was that he was spending money to stay in Kigali and had paid Rwf 20,000 for dressings, more of which he needed.

During our encounters with different people, we found out there was a 26 year-old man who was recovering from accident and had left a few days earlier after spending two months admitted. The patient was not able to pay, and the hospital had let him go, but had to leave behind addresses.

We were told that during the previous week, three women unable to clear hospital bills were also released during the hospital inspection.

However, we found a father whose son had undergone surgery and was remaining with a bill of Rwf 60,000. The parent told us that the hospital did not find his name in the health insurance system yet he has a mutuelle de sante card, and so was asked to pay the full bill. He says the son has recovered and would like to go home, where he could possibly find the money to pay the hospital bill.

It is this patient we found who was unable to leave the Rwanda Military Hospital, though they had been there for a few days, suggesting that they may have been identified by the regular inspection team later.

Bringing food into Rwandan hospitals is not allowed, but is stricter with Rwanda Military Hospital. Family members are also not allowed to sleep with patients. For those who categorically refuse to leave their loved ones alone, the hospital reluctantly allows them to sleep in the visitors’ area.

We found out that it was due to the inspections by military officers we met earlier when we arrived that patients do not spend long if they are unable to clear the bills. The Chronicles did not speak directly to the officers to avoid attracting attention.

It is the only hospital, among those we visited, which has such a strict system aimed at ensuring patients or families do not stay in the facility after the treatment is completed. Perhaps, the reason could be that the inspections are done for security reasons, but even still, it helps patients in need.

Muhima Hospital – 14 patients

At the Muhima Hospital, The chronicles arrived there at 19h22 on July 19.

At the consultations office, there were many people. There, an old woman from Nyanza district, southern province, was ranting that the hospital was not clearing her to leave because she did not have all the money. Her hospital admission had ended two weeks earlier, owing Rwf 60,000.

A hospital guide informed us they have 14 patients who have failed to pay their bills. The same figure was confirmed by two separate family members of patients “detained”.

Muhima Hospital is a very large facility, and it is easy to identify people with problems. They will usually be seated outside wards. Those unable to leave, mingle freely with patient-helpers.

Kacyiru Hospital – 7 patients

Formerly the Rwanda National Police Hospital, the Kacyiru Hospital is located in Kacyiru sector, Gasabo district. Our reporter arrived there at 12h23 on July 17, which is during lunch hours.

We continued moving around the hospital, exchanging greetings with different people. We encounter a cleaner carrying tools and a bucket. We start a conversation about whether there were any patients who could not leave because of unpaid bills.

We find out that the figure is “about 10 people” known around the hospital as the number of patients having issues with payments. We meet a woman who is caring for her young sister. They have a bill of Rwf 50,000. The doctors cleared them for discharge but have not been able to leave due to the bill. She tells us that there are other 6 patients, all in the same room. We managed to access the room briefly, as there was no one guarding the entrance.

However, The Chronicles counted 7 patients in this particular room, some of whom have been there for weeks. No patient or family member was willing to speak to our reporter.