Naming the Hospital-Prison

Images of Haitian mothers giving birth, struggling between life and death is an all too familiar image to aid workers and Christaian missionaries working across Haiti. In elite fundraisers across the globe, in megachurches as well as hospital galas, it is used to pull on heartstrings, loosen checkbooks, and invoke feelings of both pity and charity. Much has been said about the difficulties of giving birth in Haiti. But far less has been said about what happens after they give birth, when mothers who cannot pay face abuse, indefinite imprisonment, and isolation from their communities.

This is what we are calling the hospital-prison. The term hospital-prison  is meant to highlight the mutual entwining of western medical care and carceral strategies across the globe, within the space of hospitals and clinics. This intertwinement extracts capital from human bodies within and around these spaces, and extracts it differently based on race, gender, class, and ability. The practice of hospital detention is only one version of birth injustice in what we call hospital-prisons, but it is one that makes it abundantly clear how care and carcerality bleed into one another in neoliberal hospital spaces. Mothers start out as potential subjects of care at gates, and hospital-prison practices of debt management attempt to transform women into bodily collateral, a form of property held to insure their debt. In so doing they treating their living, surviving flesh as something “stolen” from the hospital pocketbook. 

It is the mutual entanglement of medical care and carcerality that made it possible not only to conceive of imprisoning babies and mothers for the value of their birth, but to make it routine hospital policy in institutions across at least 52 nations. It’s what makes it possible for medical volunteers, missionaries, hospital administrators, nurses and doctors, Haitian nurses and doctors, security guards, US administrators, boards of directors, donors, academic researchers, to create a system that insists saving Haitian mothers lives, requires stripping them freedom. It is connected to the globalization of a capitalism that is racial capitalism, as Cedric Johnson termed it, to the rise of carcerality as a means of sustaining this capitalism, and particular interest that these capitalist and carceral systems have in coercing and controling the reproductive power of black womens, indigenous womens, women of color’s, and trans birthing bodies.

Naomi’s story is the story of hundreds of mothers in Haiti and an untold number of mothers in parts of Africa. These mothers are denied their fundamental human rights, are forcibly restricted from caring for themselves and their families and are denied access to any opportunities to themselves pay their incurred medical fees.  

In Haiti the kind of exposure Naomi faced was not only unjust but was potentially deadly to her and her child. Exposure to cold, wind, rain, and dirt is certainly not ideal for women right after birth in the United States. But its not deadly in western medicine. In contrast, this exposure is the most deadly and dangerous things you could inflict upon a new mother and her baby in Haitian traditional medicine.

Nel remembers when she left the safety of her home, which she knows now was far too early after having given birth:

“You stay inside the house, so  you don’t get exposed outside. If you venture outside into the open air, during that time, you catch a disease called fredi, See? And even me, that happened to me. When I was giving birth to one of my first children. My poor baby. She ended up dying from it… My mother was there with me, and she had already seen it starting to happen and had time to fetch the herbs, she began boiling them for me, she bathed my body three times in hot water steeped in herbs, inside the house there, and I stayed inside in my home for many days, That is the only reason I lived.

Nel, March 2019

In a space that is created to be dangerous, unlivable, and give families the highest motivation to find money, these women find ways of resisting. Following in the work of Julia Chinyereh Oparah, we want to share stories of hospital-prison as stories of resistance, highlighting the direct actions that prisoners, families, and allies use to challenge this injustice. 

We conscientiously have chosen to center our discussion and our project within and through birthing peoples stories, and the stories of their surviving families. We envision this as a way of intervening on economically-centered defenses of hospital detention practices that center and legitimize administrators struggles for sustainability, profit, and expediency while treating the voices, experiences, and visions of black mothers as unreliable ways of knowing and understanding the problem. There are powerful circulating logics in global health practice in Haiti that treat women’s stories and their voices as compromised because they are Haitian, because they are poor, and because they are black mothers. In fact, it has become clear in our conversations and interactions with hospital administrators, boards of directors, and even medical scholars, that their ability to listen is often limited voices that are non-Haitian, non-woman, non-poor voices of administrators who carry out these practices. We have found how easy it is to unlock such listeners ears when, and only when, we bring in the voices of the American and European hospital administrators that admit to the practice as a precusor to defending it. This way of hearing and centering non-Haitian experts is part of a trap that consistently unhears and silences women’s voices in global health, birthing people’s voices, and the voices of the global majority. In resistance to that, we want to use this platform to hear and speak of their stories, while painfully aware that we need to work towards a world where such stories are heard and listened to by people wielding resources, power, and medicine when they are spoken on the ground.

Naomi, a mother who gave birth in a mission hospital that is run by American hospitals and administrators two hours from Philadelphia, was imprisoned, and finally released after more than a month, when a nearby birth center rallied funds for the outstanding bills.

I am a mother that ended up giving birth in a hospital. A foreign mission hospital, you understand, not a State hospital. After the birth, he wasn’t okay. Things weren’t okay. There was something wrong with him. They needed to put him into an incubator. When he was in the incubator, we mothers who had given birth at that time were directed to an area in the open yard of the hospital, they ordered us to stay there. After God delivered me and the baby from death. But I was in a really tough spot economically, and didn’t have any money or means.

So that was were we had to stay, all of us mothers together, with our babies. The rain falling upon us. The sun burning us. The dirt and soil of the road hitting us. A new baby has no place being exposed that way. But if you thought of moving from that spot, you couldn’t! The guards didn’t authorize you to move at all, whether a few paces left or a few paces right. If you didn’t have someone from your home and your family who could bring you clean clothing, you had to stay there dirty. In the soiled clothes you gave birth in. That’s how it was, that’s what happened at the hospital. That’s our misery and our calamity.  They…they really abused us. We need to make things better.

Naomi, Nov 2019

The women and family members we feature in this program have stories of being held prisoner in foreign-operated mission hospitals, and they report that mission hospitals are notorious for the practice.  An organizer against the practice in Haiti explained to us that this practice of forced debt captivity seems unique to the medical system and is widespread throughout Haiti. It is endemic to the functioning of many foreign-operated NGO-hospitals in the nation, and it is also found in other private hospitals and clinics, but it also happens in precarious public hospitals that routinely close because they don’t have enough funds to function. 

The practice is not limited to Haiti. Birthing people of color are imprisoned in over 80 countries across the globe. Postpartum women and newborn babies are the most common targets of this practice, they are also the patients most often in need of emergency surgical interventions, and those least able to run away or escape by scaling fences and evading guards. The practice is an open secret in public health, as Karen Cowgill and Abel Ntambue discuss in their piece on hospital detention in Lubumbashi, which names the practice as gendered violence.  Robert Yates, who has co-authored a report on hospital detention across the globe, is the executive director of Universal Health Coverage at Chatham House, and he speaks often of the global complicities that sustain this open secret. 

While investigating the growth of hospital detention across the world, scholars including Maria Cheng (2018),  Kakudji Yumba Pascal (2018), Robert Yates and Eloise Whittaker (2017), have concluded that the global rise in the practice over the past thirty years is related to public health restructuring initiatives in the late 80’s, such as the 1989 Bamako Accords in Africa. These accords shifted the onus of healthcare costs onto patients themselves in the form of pay-to-play user fees. The intense pressure hospitals experience to settle debts is related to broader international public health initiatives to prioritize funding and support for those health systems that are most “sustainable.” One central measure of sustainability is whether hospitals can successfully recoup hospital costs, largely in the form of user fees.  Over the past thirty years, anthropological, legal, and public health research has argued that the pressures created by user-fee based systems have dire consequences on the healthcare outcomes of the poorest and most vulnerable users of health systems. These consequences can be particularly intense during life-threatening emergencies, such as complex obstetric deliveries.  

 A solution that many hospitals developed to these troubles of health financing was the practice of imprisoning patients within hospitals in order to motivate families to collect funds to free them. Not all countries have decided to live with the practice. In response to a widely circulated report on hospital detention in 2006, the nation of Burundi mandated free healthcare for women and children under the age of five, reallocating funds from within the country and from international aid.

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