GOMA, DEMOCRATIC REPUBLIC OF CONGO – At the hospital, they are held behind a gate, these mothers with infants in their arms. They’ve been here for months. With furrowed brows, they stare at passersby carrying packages, holding out hope that a good Samaritan might bring them something to eat.
These moms and their babies haven’t been allowed to leave the hospital since they gave birth because they have not been able to pay for the costs of their deliveries. The hospital won’t let them leave until they do.
“I’ve no money,” says Rachel Mufungizi, a 35-year-old mother of four, who together with her baby, Esther, is – in her words – “held hostage” at the North Kivu Provincial Hospital. She’s been there nearly seven months. The hospital says she must pay $150 before she can leave.
Like other mothers in her situation, Mufungizi says she has little hope of raising the funds needed to leave. Her husband is penniless and unemployed, she says.
“Everything he manages to earn is spent on food for our other kids I left behind at home,” she says.
Holding women in hospitals after delivery has become common in Goma, the capital of the North Kivu province in Democratic Republic of Congo (DRC). Mothers who deliver via cesarean section or those whose babies are admitted to the neonatal intensive care unit are most vulnerable, because their bills are the highest.
Some pregnant women who are afraid of being detained choose midwives for delivery, despite the risk of infections or other birth complications.
Dr. José Kayumba, a physician in the obstetrics and gynecology department of North Kivu Provincial Hospital, says the facility would go bankrupt if it let women leave without paying for the more expensive care, because the institution receives no government support.
“The hospital relies solely on medical bills to pay staff bonuses, procure medical supplies and cover operating costs,” he says. “This places the hospital in a vulnerable economic situation, as it’s expected to be financed by the patients who in most cases are found among the have-nots.”
Kayumba says about one woman in 10 is detained after giving birth. The average cost of vaginal delivery at North Kivu Provincial Hospital is $30 to $40. Poor women who have a natural birth are released even if they are unable to pay the bill, because the costs are easily covered by the hospital, he says. But for those who deliver via cesarean section or those who experience postpartum complications, the bill can often amount to more than $150.
The hospital is finalizing a support project with the European Union, and, if everything goes well, the plan will start operating this year. “If the project is implemented, we will be able to find solutions to many such problems and also provide assistance to patients who are indigent, especially poor women experiencing delivery complications,” Kayumba says.
In the meantime, three months have passed since Marceline Bujiriri was held in the hospital because of her inability to pay medical bills. She gave birth via C-section. After returning home, her incision didn’t heal on its own, so she went back to the hospital for care.
She had to have four operations. The bill is $400, a large sum in a country where 59 percent of the population lives on less than $1.25 per day.
“My husband has spent all his savings on me,” she says. All day, her husband searches for ways to make money, she adds. At night, he also makes the hospital his home, leaving their two other children with neighbors.
“I had no alternative but to make the general ward of the hospital accommodate my family. We live in the hospital, and the hospital serves as our family room,” she says.
Glorieuse Kambi, a 22-year-old student, gave birth to twins. Like many twins, hers were born preterm and needed intensive care in a neonatal incubator. After two weeks, one baby died, and Kambi was presented with a $600 bill. After another month of care for the surviving infant, her bill totaled $2,024.
The father has contributed $700 – all he could, she says.
“I’m placed in a situation from which I cannot extract myself if not by a miracle of God’s doing,” she says.
While North Kivu Provincial Hospital works on a funding project with the E.U., Bernadette Sivya Kavira, 23, who lives in Goma’s suburb of Katindo II, decided to play it fiscally safe and choose a neighborhood midwife rather than give birth in a hospital. She didn’t want to run the risk of being detained there for lack of money.
To pay a midwife, she says, “one merely needs to prepare 10 new razor blades, a dozen diapers and have a can of Kasiksi,” a fermented alcoholic beverage made from bananas.
“We can later give the midwife a gift of a loincloth worth $7, and childbirth occurs without any problems,” Kavira says. “This way, delivery will cost $10 in total.”
Mariam Aboubakar Esperance, GPJ reporter, translated some interviews from Swahili to French. Sylvestre Ndahayo, GPJ, translated this article from French.