在非洲坐“醫院牢”

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，你面臨的問題不是如何進入醫院接受治療，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。

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

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

我來到醫院的產科病房，看到一個剛當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個不停，而那位母親正來回地搖著寶寶，想讓寶寶安靜下來。

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

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

辛迪：是的，如果她們交不了錢，她們呆的時間就長些。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呆在醫院很長時間。

23歲的洛雷特正是這種情況。我見到她的時候，她說她已經在醫院里呆了三個多星期了。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。她生下來的是死嬰，然后就因為自身的貧困而失去了自由。她有智力障礙，連用閱讀來打發時間也不可能，只能坐在病房里等待，病房的藍色鐵門緊閉。

洛雷特說她的母親正在努力掙錢，想把她弄出醫院，但她的家人似乎沒有多少動力向她伸出援手，因為洛雷特沒有工作。而在極度貧困的金沙薩，她對于家人來說是一個負擔，而不是有用的資源。

但隨著她在醫院停留的時間不斷延長，她的問題會更糟糕。她在醫院每呆一天，住院費就會增加十美元。而在我見到她時，她已經欠醫院兩百多美元了，這相當于普通剛果人一年的收入。

最終，醫務人員會被迫讓洛雷特出院，即使僅僅是因為醫院要騰出地方，讓那些同樣是不可能付費的病人住進來。屆時，她的家人應該會盡他們的所能支付部分費用。

可有的時候，事情并不是那么簡單。病人的家屬就會動用警察或軍人向醫院施壓，通過談判讓病人出院。

但更為嚴重的問題是醫患雙方所處的機制。

在這里的公立醫院，病人本應享受非常便宜的醫療服務，而政府則要向醫生支付每個月的工資，問題是政府并沒有做到這一點。于是，醫生得以繼續行醫，并且購買藥品的辦法就只有向病人收取高額費用了。醫生說，要確保病人付帳的惟一手段就是，病人不給錢，就不讓他們出院。

這是整個非洲都在采用的特有機制，其結果就是讓像洛雷特這樣的病人沒有多少選擇的余地。

剛果民主共和國（法語：République Démocratique du Congo）位于非洲中部，簡稱民主剛果、剛果（金），以區分國名相似的剛果共和國，首都為金沙薩。該國陸地面積約234.5萬平方公里，是非洲第二大和世界第十一大的國家；其人口超過7100萬，是非洲人口第四多的國家。剛果民主共和國是聯合國公布的世界最不發達國家之一。其采礦業占經濟主導地位，加工工業不發達，農業落后，糧食不能自給。2011年，它的估計人均GDP僅有216美元。