Sick newborns, piling bills turn joy into anguish for young mothers

A paediatrician weighs a newborn baby on a digital scale in a maternity ward. [iStockphoto]

They yearn to leave the hospital and join their loved ones in celebrating the arrival of their newborns.

Instead, they remain confined to the wards, unable to leave because they cannot settle their accumulated maternity and newborn care bills.

Raising money to enrol and pay premiums for the Social Health Insurance Fund (SHIF) is a struggle for these young women.

Aged between 18 and 25, they survive on the ‘kadogo’ economy.

The women were admitted as emergencies and received care at a time when hospitals have restricted admissions because of the persistent nurses’ strike.

Their babies were treated in newborn units, some for days, others for weeks.

But after recovery, the mothers found themselves unable to leave the hospital because of accumulated bills. The majority had not registered for, or paid premiums towards, SHIF.

Eighteen-year-old Purity Alivitsa is among them.

The young mother is overwhelmed with emotion as she narrates her ordeal to The Standard.

She delivered normally at Kangemi Health Centre on July 21, but was referred to Mbagathi Hospital after her newborn was found to have low blood sugar and needed specialised care.

She arrived at Mbagathi on July 27, where her baby was admitted to the nursery for four days.

Alivitsa had initially paid Sh400 to open a file. But after her baby was admitted, she was told she could not leave because she did not have SHA cover.

Her bill had by then accumulated to about Sh30,000.

While at the discharge area, the baby developed a fever and was readmitted to the newborn unit, where he stayed for another 14 days.

By Tuesday, September 1, The Standard found Alivitsa with a bill of Sh74,440.

“It disorients me being at the hospital. My baby was treated for sugar for four days, then went back to the nursery because of fever. “I have been stuck here for two weeks and, sadly, I might stay longer because I have no money,” she says.

Alivitsa lives with her mother in Kangemi, who relies on casual jobs, including washing clothes, to make a living.

The income, she says, is barely enough to support the family.

The baby’s father, a 23-year-old, also walked away after learning that the newborn had been referred to Mbagathi, fearing the medical bills.

Alivitsa sat her Kenya Certificate of Secondary Education (KCSE) examination last year and currently has no employment.

“I do not have employment. I do not know how I will offset the bill that is still accumulating,” she says, tears rolling down her cheeks.

Nineteen-year-old Mary Masaa is also stranded at the facility.

Holding her three-week-old baby boy, she struggles to comprehend how she will settle a bill of Sh64,000.

Masaa delivered at Mbagathi on August 2, after being admitted as an emergency following prolonged labour.

She had not registered, nor paid her SHA premiums.

Masaa has now spent four weeks at the hospital.

Of her Sh64,000 bill, Sh10,600 is for her normal delivery, while Sh54,000 has accumulated from treatment of her baby.

The newborn was taken to the nursery for specialised care after birth after developing episodes of convulsions

“I have been at the hospital for four weeks. From today, I was told I will be paying Sh2,100 every day for food and services offered at the hospital,” says Masaa.

She has no source of income.

Before delivery, she lived with her elder sister in Ngong, a single mother who also struggles to make ends meet.

“I used to cook chapatis. I have pleaded with SHA to let me go and get casual work and pay Sh100 every day, but they have not listened to me. I do not have a husband. I am a single mother,” she says.

For Christine Naro, 21, she was convinced that she had been enrolled for SHA cover through her husband during her admission.

She does not have an identification card.

Naro delivered at Mbagathi on August 31, following a referral from Kangemi Health Centre and booked as an emergency.

“I gave birth at the entrance of the labour ward immediately after I arrived at the hospital. However, I cannot leave the facility because I do not have money to offset the bill,” she says.

“I am waiting for my husband to settle the bill, but I do not know when.”

Her bill stands at Sh15,000.

Also stranded at the facility is Scoviar Ijaka, who owes about Sh300,000.

Ijaka delivered normally on July 2 at a cost of Sh10,600 after being admitted as an emergency because of excessive bleeding.

The pregnancy was preterm and required specialised care for the baby, who weighed 1.6 kilogrammes.

The newborn was placed on oxygen for 28 days and was later cleared for discharge.

But Ijaka could not settle the bill.

While waiting in the discharge area, the baby developed an infection and was taken back to the intensive care unit. He also required Sh14,000 for an eye examination and treatment.

A doctor at the newborn unit referred the baby to Kenyatta National Hospital (KNH), where his eyes were examined, having appealed to a colleague doctor to intervene and prevent possible sight problems.

Premature babies require routine eye screening to detect conditions that can cause blindness.

The baby is also required to have his heart checked, but Mbagathi lacks a paediatric cardiologist dedicated to newborns. This means some babies have to wait for appointments at KNH, while others are referred to private facilities where they cannot afford the cost.

The provider says some families wait for weeks for specialised appointments, even when babies are too sick to be moved.

Ijaka was discharged on August 28, but remains unable to settle the Sh300,000 bill.

A Ugandan living in Kenya, Ijaka did not have identification documents when she was admitted.

She initially came to Kenya three years ago as a house help before starting a roadside kiosk in Waithaka, where she prepared and sold food.

The business has since closed.

The man she says was responsible for the pregnancy also disappeared after she was admitted to hospital.

“I am pleading with the hospital to discharge me. Even with my continued stay, I might still not have money, while the bill keeps accumulating,” she says.

“During admission, I also did not know I was supposed to pay for SHA. I also do not have a Kenyan ID. If allowed to leave, I would go, run my business and pay in instalments,” she adds.

For 19-year-old Refa Atemo, the fear of a growing hospital bill began even before she delivered.

Atemo arrived at Mbagathi on August 20 while in labour and was referred to KNH as an emergency.

At KNH, she says, she was turned away because the hospital was full.

In severe pain, she returned to Mbagathi the following morning, where she was rushed to theatre and delivered a baby boy.

During admission, her mother, who depends on well-wishers for support, sent the Sh2,700 that she paid for SHA premiums, against a requirement of Sh8,700.

On August 28, she was discharged, but was required to pay Sh30,000 for a C-section delivery, money she did not have.

She could not raise the amount and was told she would have to pay Sh30,000 because she did not have adequate SHA cover.

By September 2, she was informed that her bill would continue accumulating at Sh2,100 a day.

Atemo has no job. She previously worked in a hotel kiosk, doubling as a cook and a waiter.

Her three-year-old child, whom she had at the age of 16, is now staying with a neighbour after she got stuck at the hospital. The whereabouts of the newborn's father remains scanty.

“I have tried to talk to SHA and asked them to allow me to pay Lipa Pole Pole when I leave the hospital, but they have not listened to me. They are demanding Sh30,000 before I can leave,” she says.

However, when contacted by The Standard, Mbagathi Hospital Chief Executive Officer (CEO) Dr Alexander Irungu dismissed claims that patients are detained over unpaid SHA bills.

“Nobody is locked because of being unable to pay bills. There are SHA arrangements where payments are made for women unable to offset their bills,” says Irungu.

The experiences of the young mothers point to a wider concern for newborns, particularly premature babies requiring prolonged specialised care.

Dr Christine Manyasi, a neonatologist, says premature babies are particularly vulnerable to infections because of their low immunity.

“Mix-ups of babies in hospitals and poor hygiene contribute to infections,” she explains.

She advises mothers to wash their hands with soap every three hours when handling their babies.

“Infections circulate in wards and get to the Newborn Unit (NBU). There is no way you can stay with poor hygiene and avoid infections,” she adds.

Manyasi says prolonged hospital stays can expose babies to more infections.

The concerns extend beyond newborn care, with experts warning that financial barriers to maternity services could also undermine efforts to reduce maternal deaths.

Dr Kireki Omanwa, president of the Kenya Obstetrical and Gynaecological Society (KOGS), warns that lack of medical cover could reverse gains made in averting maternal and newborn deaths.

Repealing Linda Mama by Linda Jamii, according to Omanwa, is likely to reverse gains made in averting maternal and newborn deaths.

Under Linda Mama, women unable to pay would register under the defunct NHIF and have their bill settled.

However, with Linda Jamii, women are required to register and pay their annual premiums, which, according to maternal experts, the majority cannot afford.

“The majority of pregnant women are unable to pay for SHA, thanks to an increase in poverty levels. Families are surviving on a hand-to-mouth economy, with husbands working as casual labourers and using whatever they earn to feed their families,” regrets Omanwa.

“Expectant mothers are being told to go to hospital and pay SHA, but for a family living hand to mouth, raising such amounts is a challenge,” he adds.

With financial constraints, he warns that women are likely to deliver at home, or in small facilities that lack the capacity to manage complications.

“As far as the Government is saying SHA is working, there are areas that need to be tightened, especially maternal and neonatal care. Maternal mortality and neonatal mortality are key indicators. When the numbers are high, it means our deployment is poorly done,” he says.

Omanwa adds that hospitals are also registering increased sick babies, partly because some mothers do not attend Antenatal Clinics (ANC) because of poverty.

SHA officials, however, maintain that individuals must register and pay to access SHIF services.

“To access SHIF services, individuals must register and pay,” said SHA Chief Executive Officer (CEO) Dr Mercy Mwangangi during a health summit attended by President William Ruto.

Mwangangi added that registration and payment must be completed before admission.

For teenagers, SHA says a special card is available.

However, The Standard did not come across specialised SHA cards issued to teenagers admitted at hospitals visited across the country.

For disadvantaged women, financial circumstances put them in a difficult position, with many unable to afford Lipa Pole Pole.