According to preliminary findings from the 2020 U.S. census, approximately 19% of American households have some amount of medical debt, and of them, half have debts of $2,000 or more. And, per the linked report, “4% of all households reported high medical debt burden” (defined as “debt that exceeds 20% of a household’s annual income”). For many American families, medical bills are a major source of anxiety and concern.
On rare occasions, though, seemingly random people will buy up medical debt in an effort to help people in their communities get out from under that burden. In 2019, for example, a Los Angeles-area church purchased $5.3 million of such debt for one penny on the dollar as a “Christmas surprise” to its congregation, helping those in need start the new year fresh.
It’s a fantastic gesture, and all too rare. And when Zeal Akaraiwai buys up medical debt, it’s even more special. His gifts aren’t just relieving debt and the associated stress. He’s helping set people free. Literally.
In Nigeria, as well as in many other parts of Africa, medical debt isn’t handled through collection agencies and liens on bank accounts. There, if you need medical attention and go to the hospital, they’ll expect you to pay before you leave. And as a result, the poorest of patients simply aren’t allowed to leave the hospital after treatment. According to a BBC report from 2018, “thousands of patients across Nigeria are thought to have been held in hospital” against their will due to their unpaid medical bills and “globally, hundreds of thousands of patients every year are thought to be affected by the issue.” These modern-day de facto debtors’ prisons have also resulted in some weird corruption; per Stat, “hospital detentions are so common in Nigeria and Ghana that there are many stories of politicians releasing medical detainees in the run-up to elections — a gesture which provides an excellent public relations opportunity. In one bizarre example, the wife of a state governor in Nigeria was heralded as a savior for releasing patients from a hospital governed by her spouse.”
For Akaraiwai, though, there’s no such political angle. According to the BBC, Akaraiwai — a financial advisor in Lagos, Nigeria’s former capital and largest city — just wants to help. He connects with hospital social workers to get a list of patients who are medically clear to leave (as seen above) but are, effectively, prisoners in the hospital due to their unpaid bills. He then talks briefly with those who he thinks he can help to see why they haven’t paid the bills, looking to confirm that they’re truly unable to do so. And then, in many cases, he covers the costs — typically ranging in the $250-$500 range. The patient is then released — and for Akaraiwai, that’s where the story ends. He “does not keep in touch with any of the people he helps,” per the BBC. “He does not even want to be thanked. But there is one thing he would like in return – that one day they might tell a story about him: the story of how when they were in the hospital, an angel came, paid their bill, and left.”
But Akaraiwai’s efforts, per his own admission, aren’t a way to sustainable change. Less then 10% of Nigerians have health insurance, and Akaraiwai hopes his decision to tell the press about his efforts will change that, though: “The mere fact an individual, like me, has to go into a hospital to pay the bills of people who are stranded speaks volumes about the injustice in the system, he told the BBC. “There’s no reason why we cannot have proper health insurance. We have clever people who can think of schemes that can work.”
From the Archives: The Padre for Life: How baseball helps pay some medical bills.