在非洲坐“醫(yī)院牢”

Well， in some parts of the world， if you dont have money or insurance， the problem isnt getting into the hospital， its getting out. Journalist Cindy Shiner got a first-hand look at the problem in the Democratic Republic of Congo.

Cindy：I went to the citys main hospital， Kinshasa General. My initial impression was positive. You see， Id 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. In fact， on my recent visit， the benches in the hospitals 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， all of these women—at least six—had lost their children in childbirth. And it was here that a nurse Kavita Masenga said something that brought me up short.

Kavita：（via translator） Generally， these women stay here more or less a week， but if they dont have the means to pay the hospital bill， they stay a little longer.

Cindy： Thats right—if they cant pay， they stay longer. You see， patients cant 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. When I met her， she said she had been at the hospital for more than three weeks. The reason？“Its expensive，” she said， and she doesnt have enough money to pay her bill. She gave birth to a stillborn child and then became 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 help get her out of the hospital， but there seemed to be little incentive for her family to help her. Lorette doesnt have a job. In poverty-stricken Kinshasa， shes 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 $10 would be added to her bill. She already owed more than $200 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 cant pay. Her family would presumably end up paying whatever they could manage.

But sometimes its not that easy. Families will enlist the help of a policeman or a soldier to exert pressure and negotiate a patients release.

The broader problem， though， is the system that both the 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 doesnt. So the only way the doctors can continue to practice—and to buy medicine—is to charge higher fees to patients. And the doctors say the only way to ensure that patients pay is not to discharge them until they settle their bills.

Its an ad hoc system implemented all across Africa， and it leaves patients like Lorette with few options.

好吧，在世界的某些地方，如果你沒有錢，或者沒有買保險(xiǎn)，你面臨的問題不是如何進(jìn)入醫(yī)院接受治療，而是怎么樣才能出院。記者辛迪·希納在剛果民主共和國親眼看到了這一點(diǎn)。

辛迪：我來到金沙薩市的主要醫(yī)院，金沙薩總醫(yī)院。這家醫(yī)院一開始給我的印象是不錯(cuò)的。你要知道，我20年前就來過這家醫(yī)院，那時(shí)剛剛發(fā)生了一系列大規(guī)模的搶劫事件，病房幾乎空無一人。

從那以后，情況顯然有所好轉(zhuǎn)。如今，草地有人打理，地板有人清潔，窗戶也都修好了。還有，醫(yī)院里有病人。實(shí)際上，我最近一次到醫(yī)院的時(shí)候，醫(yī)院戶外走廊的長凳上坐滿了人。

我來到醫(yī)院的產(chǎn)科病房，看到一個(gè)剛當(dāng)母親的婦女懷里抱著她的健康寶寶。要吃奶的小寶寶在母親懷里動(dòng)個(gè)不停，而那位母親正來回地?fù)u著寶寶，想讓寶寶安靜下來。

我走到另一個(gè)病房，那里所有的婦女——至少有六個(gè)——都在分娩時(shí)失去了自己的孩子。而正是在這里，護(hù)士卡維塔·馬辛加的話讓我愣住了。

卡維塔：（通過翻譯）通常，這里的婦女會(huì)在這里呆上一個(gè)星期左右，但如果她們沒錢交住院費(fèi)，她們呆的時(shí)間就會(huì)更長一點(diǎn)。

辛迪：是的，如果她們交不了錢，她們呆的時(shí)間就長些。你明白吧，也就是說病人如果不付清帳單，是不能出院的，這就意味著有些病人有可能會(huì)呆在醫(yī)院很長時(shí)間。

23歲的洛雷特正是這種情況。我見到她的時(shí)候，她說她已經(jīng)在醫(yī)院里呆了三個(gè)多星期了。是什么原因呢？“太貴了，”她說。她沒有足夠的錢支付她的住院費(fèi)?！?br>