Psychosocial Effects of Medical Detention for Unpaid Bills in South Kivu, DRC: Implications for Medical Social Work and Ubuntu-Centred Care

Abstract

Various patterns and contexts of wartime, poverty, and lack of health insurance raise mental health and social issues for inpatients, especially for Recovered Patients Detained (RPDs). This study examines the psychological and social implications of detaining patients for unpaid medical bills in healthcare facilities in South Kivu, DRC. It applies the qualitative approach and Ubuntu theory with an exploratory, cross-sectional research design. Using the Kessler Psychological Distress Scale (K10) of mental health and an in-depth interview guide on 30 participants, the research explores the experiences of RPDs, healthcare providers, and family members. Findings revealed that RPDs present psychological effects, translating into moderate depressive and anxiety symptoms. These symptoms are often expressed in sadness, sleep and eating disorders, remarkable anxiety, fatigue, agitation, etc. Social consequences were equally profound, with patients experiencing stigma, loss of dignity, family conflicts, and children dropping out of school, especially if the patient is the main breadwinner in the family. Factors exacerbating these effects include prior trauma, poor detention conditions, strained relationships with healthcare staff, and socio-economic vulnerabilities. Drawing from the Ubuntu philosophy, the study highlights the urgent need for psychosocial interventions, such as counselling services, payment instalment systems, and improved patient-staff communication.