Photo credit: Sunday Punch
Sweeping the floor of the female ward at the Imo Specialist Hospital, Umuguma, Owerri, the Imo State capital, Mrs. Chinyere Nlemuwa cut the picture of a cleaner in the hospital. But she is not.
Nlemuwa gave birth to a baby boy at the hospital on December 10 last year amid joy. But the joy soon vanished when her husband, a bricklayer, struggling to make ends meet, disappeared shortly after she was delivered of the baby. That marked the genesis of her trouble.
She kept hoping to see her husband but the man did not show up. Five days after she gave birth, doctors at the hospital declared her fit to be discharged. She was excited to finally leave the hospital and go home when the nurses confronted her with the question, “Have you paid your bills?” This poser instantly turned to a source of worry for her.
Because she could not offset her medical bills, the hospital “detained” her until the money was paid. Nlemuwa claimed her bill was N25, 000. She has been finding it hard to cope with the reality of staying at the hospital pending the payment of her debt.
Nlemuwa lived with her husband in a one-room apartment in an uncompleted building in the Owerri suburb. Her new child is her fifth. The other children are in the care of her relatives.
“The nurses said if I don’t pay, they won’t release me to go home. My husband is nowhere to be found. Before I came to the hospital, his behaviour changed. He used to come in every day to check on me but after he heard I gave birth, he stopped coming.
“I used to call him on his mobile and he would tell me that he would be back. Then, in a week, he came in twice and when I asked him where he had been, he said he was negotiating what to do. But now, I don’t know where he is,” Nlemuwa, who could not contain her sadness as she told her story, said.
Clad in a striped shirt whose colour had known better days, she cradled her sleeping baby in her arms. Her weary face advertised her disillusionment. It is the third month after her child’s delivery but Nlemuwa, a trader, is not finding it easy. It appears she may remain in the hospital for long because her relatives have long deserted her. When she would leave the hospital is sadly uncertain.
While she prays for a miracle to happen, Nlemuwa told SUNDAY PUNCH that she had been informally engaged in the hospital by cleaning the premises and doing other menial jobs, pending the payment of the money she owed.
“The nurses said if I don’t pay, they won’t release me to go home. I divide my time breastfeeding the baby, nursing him and cleaning the hospital. This is not what I want to do. I am a trader and would like to go back to my trade,” she told our SUNDAY PUNCH.
When our correspondent asked her how she feeds herself and her baby in the hospital, she said, “I take any food given to me by the nurses or other patients. I am calling for help from the public and other individuals so that I can leave this place. When I leave, another big concern is what the baby will be eating. I am also praying that God will touch my husband’s heart for him to return.”
There are other Nlemuwas
Detaining new mothers in hospitals for their inability to offset their medical bills is a common problem in the Nigerian public and private hospitals.
Like Nlemuwa, most people detained in such hospitals are usually poor mothers held for long periods and made to endure the agony of abuse from health workers.
Mrs. Evelyn Anthony is also among the ‘detainees’ at the Imo Specialist Hospital because she had yet paid her bills. On Tuesday, the petty trader was delivered of a baby boy through Caesarean Section.
It appears that Anthony, an indigene of Uvuru in the Aboh Mbaise Local Government Area of Imo State, may stay in the hospital for long except help comes her way.
It was learnt that Anthony’s husband was a commercial tricycle operator before the state government banned their operation in the Owerri metropolis. This sent many men in the Imo State capital to the labour market, leading to the inability of most of them to feed their families.
Anthony, who described the hospital’s gesture of treating her before payment as wonderful, expressed uncertainty about when she would leave the hospital.
The new mum said, “When I went into labour and came to the hospital, my husband and I had no money. We could not even pay the deposit of N50, 000 that was demanded when the CS was recommended. However, I must thank the hospital because they went ahead and conducted the operation.
“We have been fervently praying to God to design a miraculous means for us to go when discharged. We don’t want to constitute a nuisance to the hospital. We came in with nothing. The hospital has been trying its best for us, while we still call on our relations to come to our aid.”
Another woman, Mrs. Amarachi Lemchi, is in the same situation. Last week, Lemchi was delivered of twins at a private hospital, Obioma Hospital and Maternity Centre, in Aboh Mbaise, Imo State.
Lemchi owed the hospital N75, 600 after paying N20, 000 of the N95, 600 bill charged by the hospital. She and her husband, Azubuike, both from Imo State, married in December 2016.
The 30-year-old woman reportedly became pregnant early 2017 and was registered with Robert Maternity Centre, Ezinwe in the Isiala Mbano LGA of the state. However, on her due date on December 22, 2017, she developed complications, compelling the centre to refer her to the private hospital. Lemchi underwent a Caesarian Section during which one of the babies died.
She said, “I never planned to have a CS. Everything was fine until the day of my delivery when I started bleeding. I was pregnant with twins, a boy and a girl. It was the female baby that attempted to come out first. However, the midwife told me that she didn’t come out through the right position. She said the baby was coming out through the buttocks.
“I tried my best, but the bleeding was excessive and my husband rushed me to Obioma Hospital. The doctor said I could not deliver normally and it would be through a CS. During the delivery, the girl died, but the boy survived.”
She noted that a week after the operation, while the nurses were dressing the wounds, there was a problem which necessitated another surgery. In the end, she said her family was given a bill which her husband could not raise.
“We are facing financial difficulty. I don’t have a job and my husband struggled to pay N20,000 out of the money, but we still owe and that is why I have not been able to leave the hospital,” she added.
Her husband, 35-year-old Azubuike, lamented that his efforts to raise the funds had been abortive, saying the family needed help. As of Thursday, Amarachi lamented that the hospital had not released her.
“Nothing has changed. I am still at the hospital. The hospital management insisted that I must pay and that I can’t leave until I do that. We tried to negotiate with the management but it was to no avail,” she said in a voice laden with grief on the telephone.
Medical service is on the high side in Nigeria where less than five per cent of the population is covered by the National Health Insurance Scheme, which could have allowed these indigent mothers to access adequate health care.
Detention of patients in hospital is illegal according to a lawyer, Wahab Shittu, but the hospitals seem to capitalise on the ignorance of its patients to hold them for long.
Shittu stressed that the detention of patients by private and public hospitals for their inability to meet their financial obligations to the hospital was illegal.
“The trend continues unabated because the victims are unaware of their rights. The right thing to do when the hospitals has exhausted all avenues to recoup their funds from patients is to sue the patient for failing to pay and employ other debt recovery platforms,” the lawyer said.
In January, the Women Advocates Research and Documentation Centre and the Centre for Reproductive Rights released a report which condemned the widespread detention of women who could not pay medical bills after they were delivered of their babies.
In the report, the Founding Director of WARDC, Dr. Abiola Akiyode-Afolabi, shared a study of 446 women who gave birth at the Enugu State University Teaching Hospital in 2012.
Out of the 446 under study, 98 women were reportedly detained because they could not pay their bills. Although the study was done in 2012, the problem appears to have worsened as many cases are reported on a weekly basis.
Our traumatic experiences —Former ‘detainees’
Other patients, who had been detained in hospitals, told SUNDAY PUNCH their experiences while they were held by hospital authorities and separated from their families.
A pastor with a Pentecostal ministry, Rockson Chinedu, whose wife was held by the management of a hospital in the Ajangbadi area of Lagos State, described the experience as “deeply psychologically distressing” for his wife.
Chinedu claimed that his wife’s bladder was damaged during childbirth, adding that his wife was detained because of their inability to the pay N50, 000 they owed.
The hospital performed a Caesarean Section on the 42-year-old after her husband signed some documents to that effect. He stated that although his wife had recovered from the ordeal, she still nursed the scars.
He told SUNDAY PUNCH, “It was a very ugly experience. The hospital charged N200, 000 for the operation and we negotiated to N150, 000. I paid a deposit of N30, 000 and they started the operation. After a week, they said I should come and clear my bill of N50, 000 so they could discharge her.
“I called a senior pastor, who presented them with a cheque. But they said they would keep her for the two weeks that the cheque would be cleared. Detaining her was the height of torture for me because it exposed my wife to trauma.”
Blessing Agbo experienced a similar situation when she couldn’t pay her medical bills. For more than four months after Agbo was delivered of a baby boy through a Caesarean Section in a Lagos hospital, she was detained over a bill of N215, 000.
Like Nlemuwa’s husband, Agbo’s live-in lover, Chibugo Duru, abandoned both mother and child at the medical facility. The 27-year-old man later said he left Agbo and their baby because he could not raise the bill charged for the operation.
He said he couldn’t raise the money having lost his job as a truck driver, adding that efforts to seek the understanding of the hospital management were futile.
Last year, a new mother, Sarah Ademola, fled the Felken Maternity Centre in the Somolu area of Lagos State for her inability to pay medical bills after she was delivered of twins.
She left her two female babies at the centre. Sarah sneaked out when her husband, Adeyemi Ademola, couldn’t pay the N150, 000 owed the hospital.
It took the intervention of the wife of the Lagos State Governor, Bolanle Ambode; a member of the Senate representing Lagos East, Senator Gbenga Asafa; a retired military officer, Gen. Oviemo Ovadje; and non-governmental organisations, among other Nigerians before the babies could be released from the hospital.
Negative effects on new mums
A lecturer in the Department of Psychology, Obafemi Awolowo University, Ile-Ife, Osun State, Prof. Toba Elegbeleye, says women detained in hospitals after childbirth suffers psychological trauma which subsequently affects their children.
Elegbeleye described the period after childbirth as a crucial one for mothers as they were just recovering physically and blending emotionally with the new realities of nurturing their new children.
The psychologist explained that the period of detention could mar a baby’s health having suffered from negative emotions from the mother and the environment.
He said as early as possible, a child needed to be smiled at, adding that an unhappy mother would not perform her motherly obligation well.
The don added, “Even a baby in the womb suffers from the mother’s emotional stress not to talk of postnatal period of growth. When you are detained in the hospital against your wish, emotional tussle sets in. A child needs to be nurtured in a good atmosphere. The mother has to be happy in order to lactate properly. She has to feed well to lactate properly. Besides, the child depends heavily on breastfeeding.
“If there is emotional stress, the breast milk won’t flow as it should. If the source of the problem is economic, it is going to have a bandwagon effect on the woman and the child.
“A baby at that level has begun to understand emotions because the mother smiles, lift the child up and playfully interacts with the child. A child brought up in an unhappy state would probably develop some emotional problems too that might manifest later in life. The child will grow morose and cry. The child will wake up crying and sleep crying simply because the mother is not happy.
“Living in the hospital also predisposes them to diseases. These have a telling effect on the mental and social growth of the child.”
Shittu noted that detention of patients by hospital management amounted to forced imprisonment under the law.
According to him, if the victims of such experiences are properly advised, they can approach the court to seek redress for illegal imprisonment.
He added, “The hospitals are merely taking the laws into their own hands. Asking a patient to work in the hospital against her wish is forced labour with dire consequences. It is unfortunate that there are lots of infractions that people do not redress because of ignorance and sometimes, because of the delay in our criminal justice delivery.
“But ultimately, our government needs to be more responsible by providing for the welfare of its citizens. The public hospitals should have social welfare programmes run at the expense of the state to accommodate indigent mother.”
Why we detain patients who owe us — MD
The Medical Director of Imo State Specialist Hospital, Dr. Uche Uduji, said the failure of patients to pay their medical bills was affecting the hospital.
He said some patients deliberately refused to pay up because “it’s a government-owned hospital.”
Uduji said, “Refusal of patients to pay is a common problem. This is one of the major things we are fighting. We are not happy about that. However, one of the major reasons why this is prevalent can be linked to the economic situation in the country.”
When asked to speak on when the detained Nlemuwa and her baby would be released from the hospital, he promised to get back to our correspondent but had yet to do so as of the time of filing this report.
Also, the owner of the medical facility where Lemchi is detained, who identified himself only as Dr. Obioma, said he would not authorise her release until the payment of the bill.
When asked if he knew that the detention of patients was illegal, Obioma said the best thing was for the patients to sue him if they wished to.
The medical doctor said the patient knew that medical service in the hospital was not free and that the hospital sustained itself with money paid by patients.
He said, “This is somebody I have treated and she is in a good state. Don’t I deserve payment for my medical services? If she does not pay, we won’t release her.
“Medical services can be likened to goods in the market. Can you go to the market and take an item and refuse to pay and then turn to go home?”
Compulsory NHIS for all is way out –NMA
The President of the Nigeria Medical Association, Dr. Mike Ogirima, who decried the trend, added that illegal detention of patients persisted because the Federal Government had failed to make the National Health Insurance Scheme compulsory for all Nigerians.
The NMA president said while the health centres needed the payments of their patients to run their systems, the practice of detaining their patients over their failure to pay medical bills was unacceptable.
Ogirima also condemned men who abandoned their wives in the hospital on the excuse of poverty, adding that nine months was enough time to prepare for the arrival of their babies.
He stated, “I don’t see any reason why somebody, who impregnated a woman, will decide to abandon his duties. It’s a bad habit but it’s a reflection of the system. We are working in a failed system and everything has gone bad.
“The government knows the solution and we have been canvassing this for long. The government should make the NHIS mandatory. The coverage of the NHIS is low, less than five per cent. Whether you are in the informal or formal sector, every Nigerian should be made to enrol in it. People in the informal sector can pay little sums weekly to the scheme.
“Illegal detention of new mothers is a serious problem that the government should look into. When there is a mass enrollment in the scheme, people can go to the hospitals without necessarily going with money.
Ogirima urged the government to provide enough funds in the annual budget for health. “The National Health Act establishes a Basic Health Care Provision Fund with a government annual grant of not less than one per cent of the Consolidated Revenue Fund.
“The Act makes a number of provisions which potentially will improve maternal, and child health. The government needs to give room for the provisions of the Act in its budget to cater for the poor,” the NMA president added.
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