Penan couple forced to borrow to pay hospital bill

ANTIDOTE A young Penan couple from Long Napir, a tiny farming settlement in Ulu Limbang, Sarawak, were forced to pay admission charges to the Miri Hospital, even though their newborn baby girl died the day after she was delivered.

Roy Dumai, 26, and his wife Seri Yung, 25, were told by the hospital's accounting section staff that they had to settle their bill. Otherwise, they were warned, Seri's ‘medical antenatal card', a record of her pregnancy and delivery, would be confiscated.

"After Seri was discharged, we were ordered to pay RM180, and we were treated very badly," Roy said. "Some (billing) counter staff had their name tags turned the wrong way round, but I identified two of their names. They all behaved roughly.

"They told me off angrily. ‘Everyone must pay, no matter what your race is or where you come from. If you don't pay, then we'll knock your head'.

"I tried to explain that we are poor people, and we have a letter from the state health director saying poor people can have free hospital care," Roy said, "but they treated us like we were blind to the regulations."

The letter Roy referred to was a photocopied document in the Malay language, detailing "guidelines for allowing exemption to poor patients in hospitals/health clinics/dental clinics".

The guidelines, translated by Malaysiakini, state that "patients considered poor qualify for exemption from hospital charges. For the definition of ‘poor', Poverty Line Income Guidelines produced by the Economic Planning Unit (EPU), in the Prime Minister's Department, may be used."
EPU examples of monthly household incomes below the poverty line are provided for 2004: less than RM661 for Peninsular Malaysia, RM888 for Sabah, and RM765 for Sarawak.

The document stipulates that patients receiving welfare aid, disability allowances, or assistance from Islamic religious councils or registered NGOs, may also be exempted from paying hospital bills.

There is a tradition in government hospitals, too, of waiving the charges for a patient's family, if the patient dies in the ward. Roy and Seri were unaware of this.

They plant rice and rubber in Long Napir. The rubber trees are still saplings, Roy says, and the rice they harvest is only enough for their family.

Neither the Miri Hospital director nor the state health director could be reached for comment, despite repeated attempts.

The only staff member in the hospital director's office in Miri willing to be quoted was Henry Pengiran, head supervisor. He said hospital bill exemption was "on a case by case basis. Everyone would like to have it subsidised or free. Everyone would say they are poor." He was not aware of any income level for exemption.

Not satisfied with this explanation, I called up both the Sarawak Health Department headquarters and Miri Hospital five times, but the respective directors were "in meetings" each time I called.

I emailed them and they said they had replied but no reply ever arrived. The Ketua Penyelia asked me how a Penan from Long Napir could manage to talk to Malaysiakini. When I asked for a translation of Ketua Penyelia, he replied, "Malaysiakini is serving orang putih or Malaysians?"

The death of a newborn

Seri had delivered their first child five years ago, by Caesarean section in Limbang, a quick and uncomplicated operation. But this second pregnancy was considered more risky.

In June, when Seri was five months pregnant, they decided to travel from Long Napir to the nearest coastal town of Limbang, taking some six hours on a rutted logging track to traverse 150km. A boat ride would have taken more than a day.

The expectant couple attended their clinic appointments without fail.
When Seri was admitted with labour contractions on the early hours of Oct 13, the doctor in the small district hospital in Limbang explained that she would have to be transferred to Miri.
Seri was told Miri had obstetric specialists, better equipment and healthier blood bank stocks.

The couple agreed to make the anxious four-hour journey to Miri by ambulance, and arrived at Miri Hospital at 10am on Oct 13.

"From 10am until 2am the next day, Seri was in labour. We were worried, but they said the (baby's) heartbeat was still okay, and they told us to wait," Roy recounted.

"The veteran specialist doctors, Chinese and Malay, were very good, and I don't blame them (for our baby's death). But the trainee doctors were bad.
"They were rude, exposing the women when examining them, without any privacy. Their name tags were turned around, too," Roy went on.

"When Seri asked the trainee doctor to operate to deliver the baby, the doctor, a man, scolded her: ‘Who are you? What do you know? We are the doctors. We are the ones who know!'

"Only after the baby suffocated, then he knew," Roy said quietly.
"After that, he didn't come to see my wife anymore. The younger nurses and the trainee doctors have no manners. Maybe there is no discipline in schools any longer."

The Caesarean section went ahead in the early hours of the morning. Their baby girl survived for barely a day. Seri left the hospital the following day, after scraping together the payment.

"Deprived and prejudiced against"

While Roy was making preparations for their baby's funeral in Miri, he told his story to See Chee How, a human rights lawyer, and a PKR elected representative.
See promised to throw light on the policy of hospital charges for the poor at the next State Assembly sitting.

See (left) is also writing to the Health Department to seek representation for the parents in an inquest into the baby's death, and to request the reports on a neonatal mortality review.

"It appears that the poor rural folk, particularly the Penans, are deprived, and prejudiced against, in the provision of public services and care, especially in health and education," the lawyer said, showing rare anger.

"This indifference, this apathetic attitude shown towards our fellow human beings, from the most deprived native communities, is a heinous crime against humanity.
"Our society has failed ourselves, and this poor Penan couple, to a disgusting extent. They had to resort to borrowing from friends and relatives to pay the RM180 medical fees demanded by the hospital."

Roy remains worried for the families of other babies he saw in the hospital, saying several had died there during his baby's brief stay.

"This is my hope, that these letters (of complaint) will help other people, and other babies."