在非洲坐“医院牢”

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，如果你没有钱，或者没有买保险，你面临的问题不是如何进入医院接受治疗，而是怎么样才能出院。记者辛迪·希纳在刚果民主共和国亲眼看到了这一点。

辛迪：我来到金沙萨市的主要医院，金沙萨总医院。这家医院一开始给我的印象是不错的。你要知道，我20年前就来过这家医院，那时刚刚发生了一系列大规模的抢劫事件，病房几乎空无一人。

从那以后，情况显然有所好转。如今，草地有人打理，地板有人清洁，窗户也都修好了。还有，医院里有病人。实际上，我最近一次到医院的时候，医院户外走廊的长凳上坐满了人。

我来到医院的产科病房，看到一个刚当母亲的妇女怀里抱着她的健康宝宝。要吃奶的小宝宝在母亲怀里动个不停，而那位母亲正来回地摇着宝宝，想让宝宝安静下来。

我走到另一个病房，那里所有的妇女——至少有六个——都在分娩时失去了自己的孩子。而正是在这里，护士卡维塔·马辛加的话让我愣住了。

卡维塔：（通过翻译）通常，这里的妇女会在这里呆上一个星期左右，但如果她们没钱交住院费，她们呆的时间就会更长一点。

辛迪：是的，如果她们交不了钱，她们呆的时间就长些。你明白吧，也就是说病人如果不付清帐单，是不能出院的，这就意味着有些病人有可能会呆在医院很长时间。

23岁的洛雷特正是这种情况。我见到她的时候，她说她已经在医院里呆了三个多星期了。是什么原因呢？“太贵了，”她说。她没有足够的钱支付她的住院费。她生下来的是死婴，然后就因为自身的贫困而失去了自由。她有智力障碍，连用阅读来打发时间也不可能，只能坐在病房里等待，病房的蓝色铁门紧闭。

洛雷特说她的母亲正在努力挣钱，想把她弄出医院，但她的家人似乎没有多少动力向她伸出援手，因为洛雷特没有工作。而在极度贫困的金沙萨，她对于家人来说是一个负担，而不是有用的资源。

但随着她在医院停留的时间不断延长，她的问题会更糟糕。她在医院每呆一天，住院费就会增加十美元。而在我见到她时，她已经欠医院两百多美元了，这相当于普通刚果人一年的收入。

最终，医务人员会被迫让洛雷特出院，即使仅仅是因为医院要腾出地方，让那些同样是不可能付费的病人住进来。届时，她的家人应该会尽他们的所能支付部分费用。

可有的时候，事情并不是那么简单。病人的家属就会动用警察或军人向医院施压，通过谈判让病人出院。

但更为严重的问题是医患双方所处的机制。

在这里的公立医院，病人本应享受非常便宜的医疗服务，而政府则要向医生支付每个月的工资，问题是政府并没有做到这一点。于是，医生得以继续行医，并且购买药品的办法就只有向病人收取高额费用了。医生说，要确保病人付帐的惟一手段就是，病人不给钱，就不让他们出院。

这是整个非洲都在采用的特有机制，其结果就是让像洛雷特这样的病人没有多少选择的余地。

刚果民主共和国（法语：République Démocratique du Congo）位于非洲中部，简称民主刚果、刚果（金），以区分国名相似的刚果共和国，首都为金沙萨。该国陆地面积约234.5万平方公里，是非洲第二大和世界第十一大的国家；其人口超过7100万，是非洲人口第四多的国家。刚果民主共和国是联合国公布的世界最不发达国家之一。其采矿业占经济主导地位，加工工业不发达，农业落后，粮食不能自给。2011年，它的估计人均GDP仅有216美元。