Health

18 months after crash, Congolese patient still stuck at University of Iowa Hospitals and Clinics

With no money and no close family, legal U.S. resident has nowhere else to go

Jean-Claude Shako holds up a photo of his wife, Nadege Zola, that he carries in his wallet during an interview Thursday
Jean-Claude Shako holds up a photo of his wife, Nadege Zola, that he carries in his wallet during an interview Thursday at the University of Iowa Hospitals and Clinics in Iowa City. His wife and children remain in Kinshasa, Democratic Republic of the Congo. Shako won a green card lottery that allows him to be a permanent resident of the United States. (Liz Martin/The Gazette)
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IOWA CITY — Iowa is now home to Jean-Claude Shako — a Congolese national who in June 2018 had just won the green card lottery granting him permanent U.S. residency when a morning drive to work forever altered his life.

He had come to Cedar Rapids alone, speaking little English, and was settling in when he and four others — all from the Democratic Republic of Congo — on June 25, 2018, were heading west on Highway 30 to work at the Iowa Premium meat packing plant in Tama.

The group’s Hyundai Elantra veered into the eastbound lane, smashing head-on into a construction vehicle, killing two passengers.

Shako and the driver were airlifted to the University of Iowa Hospitals and Clinics, while the fifth person in the car and the driver of the other vehicle were taken to UnityPoint Health St. Luke’s Hospital.

The driver airlifted with Shako since has been released from the university hospital. But 18 months after the crash — three-quarters of his life in Iowa — Shako remains at the hospital, with no memory of the crash and no family support system to help him.

“I’m getting stronger,” Shako said through an interpreter last week at a nondescript meeting room at UIHC. “If my family would take me, I would go. But I don’t have family here.”

In a quandary

In dress pants and a button-up shirt donned for a crowd of special visitors — including reporters and Congolese friends that had him beaming upon arrival — Shako made clear he wants to stay in Iowa, his new home. He wants to get back to work, a message he stressed despite struggling to communicate since the crash.

But one message he also made clear is that the hospital — with all the good it and its doctors have done for him — is not his new home, nor should it be, according to his friend and legal guardian Peter Nkumu, 52, of Iowa City.

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“They have done a lot,” Nkumu said. “Without them, I don’t think he would have made it this far. But they just want him out of the hospital because he doesn’t have a reason to be in the hospital right now.”

Shako suffers from severe brain trauma that impairs his mobility, speech and memory. Friends say he needs 24-hour care because he can’t always comprehend what’s happening, make decisions or perform self-care like cooking and cleaning.

So while he’s well enough to be discharged from the high-cost acute care hospital, he has no family to move in with, lacks money for a rehabilitation center and is not yet eligible for assistance through Medicaid — leaving him stuck.

“I don’t know if he realizes he doesn’t have a home to go to,” Nkumu, president of the Congolese community of Iowa, told The Gazette.

With an obligation to care for the sick, UIHC is in a difficult situation, and its Chief Financial Officer Bradley Haws spelled out as much over a year ago to the Iowa Board of Regents.

While discussing his campus’ challenges with nearly-maxed out inpatient beds — reporting many days above 90 percent occupancy — Haws in a November 2018 presentation noted his team’s work to “make sure that we’re not keeping patients longer than they need to be there.”

He noted they were exploring options to provide less costly care, free up beds and also better serve certain patients, such as by placing them at skilled nursing facilities or inpatient rehabilitation facilities.

And then Haws noted for the board “a sideline” involving a pair of patients from Africa who had been in a serious auto crash.

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“Both of them have been in our hospital now for more than two months, because there’s no place for us to discharge these patients,” Haws said then, noting the patients weren’t well enough to go home but not “sick enough that they need to be in the hospital.”

“And so we are actually considering strategies where we might pay another skilled nursing facility or other home to take these patients to free up those beds,” he said. “But they’re essentially existing in our hospital for months on end in an observation status, which is not the ideal use of the capacity that we have.”

‘There for too long”

Citing privacy laws, UIHC officials then and now declined to answer questions about the Congolese patients — including why the officials hadn’t subsidized a move to a lower-cost skilled nursing facility, how much the patients have cost the hospital, how those accruing expenses are being covered and if the hospital expects to ever be reimbursed.

In fiscal 2018, UIHC provided free charity care for 14,548 patients, absorbing costs for services valued at $14.2 million, according to Iowa Hospital Association figures. Statewide, Iowa hospitals provide $253.1 million in charity care, which the association describes as “free or discounted health services provided to people who cannot afford to pay and who meet the organization’s financial assistance policy criteria.”

The quandary has everyone frustrated — from the hospitals to Nkumu to Shako.

“Occasionally he gets really upset,” Nkumu said of Shako. “He realizes he’s been there for too long. He can tell. He’s been there for too long.”

Nkumu has been scrambling for other options — including asking lawmakers to consider waiving a wait rule for legal immigrants wanting access to Medicaid.

Many “qualified noncitizens” have to wait five years after receiving their “qualified” status before accessing the state and federal program meant to help low-income residents with medical costs.

State Sen. Joe Bolkcom, D-Iowa City, said he believes the state should step up with support in these unusual circumstances that — in this case — have UIHC, Iowa’s only public academic medical center, providing charity care “at great expense.”

“UIHC is one of the most expensive places to be taken care of,” Bolkcom said. “We could be saving money by making it possible for this person to have Medicaid coverage and get care in a more appropriate setting, which they are now having to wait for.”

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Medicaid funds, if Shako had access, could support his transfer to a lower-cost facility where he could receive more appropriate brain trauma-specific rehabilitation services.

After learning of Shako’s situation from The Gazette, state Sen. Mariannette Miller-Meeks, R-Ottumwa, said she plans to inquire about his case and believes lawmakers might have an appetite for considering a change to allow for exceptions to the five-year wait rule in extreme circumstances.

But Miller-Meeks, who previously has been involved with Medicaid legislation, said she wants to make sure other avenues and options are considered — like mandating more stringent insurance requirements for legal immigrants.

“Is there work-related health insurance — if not, why not?” she said. “I think there are other questions that would have to be asked and answered to make sure we’re not unfairly penalizing one group over another group.”

When asked about possible solutions for Shako, Kelly Garcia, director of the Iowa Department of Human Services, which oversees Medicaid in Iowa, said she, too, was learning of the case from The Gazette but viewed her agency as a key player in the conversation.

“Obviously, ensuring that we as a state have a structure that supports individuals is incredibly important,” she said. “How we do that, I would imagine that our agency would be a key player in that conversation, so I look forward to diving deep into the specific circumstances.”

No close relatives

Shako spent months in intensive care before recovering enough to be placed in a general inpatient unit, where he slowly is regaining skills with help of staff through activity therapy. But, at well over 6 feet, he has difficulty standing upright and challenges communicating.

In the hospital, Shako — with his trimmed hair and mustache — enjoys apple juice and fruit, but misses native dishes like rice and cassava.

He has in his wallet pictures of his wife and five children, who remain in Congo. He proudly carries his employee badge from Iowa Premium, where he had been working trimming fat from beef to support his family and kids’ education. Asked whether he wants to return to Congo or stay in Iowa, Shako is clear: Stay here.

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Members of the Congolese community here have rallied to support him even though many knew him only a little or not at all before the crash. They visit as often as they can, bringing food, praying with him and keeping him company, and have continued the financial support to his family.

But they have limits.

Shako’s closest family members include a nephew in North Carolina and a niece in Canada. The court appointed Nkumu co-guardian, along with the nephew, to have someone nearby to help make decisions. But Nkumu said he’s not equipped to be a full-time caretaker.

“I am his guardian but I cannot take care of him in my home,” he said.

Pursuing solutions

UIHC nurses like Laura Deininger have developed a rapport with Shako — reminding him, when questioned by reporters, about all the progress he’s made.

“We really didn’t think he would live, and this hospital really did enormous work,” said Omer Mfuamba of Iowa City, a fellow migrant from Democratic Republic of Congo, who is among his regular visitors.

Mfuamba, Nkumu and others discourage sending him back to Congo where they fear he could die because of poor conditions there.

Nkumu said they’ve explored trying to bring someone from Congo to support him, but getting a visa is difficult. Shako received one of 2,664 permanent visas issued to the Democratic Republic of Congo in 2017, according to the U.S. State Department.

Associate Pastor Patrick Munyakazi of Asbury United Methodist Church in Cedar Rapids, where Shako went weekly to pray, got to know him before the crash and said he has noticeably changed. Shako’s cognitive and mental abilities are diminished, but he believes he can recover.

“The way I knew him before the accident, he had a will,” Munyakazi said. “He was determined. He had a strong spirit. I know the strong spirt and determination are still inside.”

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Munyakazi said he believes if Shako had transitioned to a rehabilitation center, he would be further along in his healing — similar to Hyundai driver Guetty Otshumbe, then 18, of Cedar Rapids, who also was severely injured but was discharged to his family months after the collision.

“I think if Jean-Claude had enough resources and support outside, he would have been home a long time ago,” he said.

Geoffrey Lauer, executive director of the Iowa Brain Injury Alliance based in Iowa City, has been considering potential paths forward since connecting with Nkumu after being contacted by The Gazette. The newspaper contacted him to see if the alliance was involved in the case.

One option, although it requires resources, involves potential admission into a neurobehavioral center. Lauer has spoken with two of those centers about what he sees as the first step — arranging a formal assessment of Shako’s neurological status and whether he’d be a good fit for their facilities.

“They can assess him for a next level of support and care — to determine if he would be eligible or appropriate for their services, if a payer could be found,” Lauer said.

Nkumu — with the help of his local Congolese community — has launched a “Go Fund Me” page to raise money for Shako’s care, and Lauer noted that doesn’t have to cover an indefinite term.

“If the fundraising can be done to maintain Jean-Claude in the United States long enough to qualify for Medicaid…,” Lauer said, that could help the situation.

It also could save taxpayers a lot of money.

“The cost for charity care, that’s going to be borne by taxpayers,” he said. “If that cost is higher than the cost of providing the appropriate available accessible and more affordable services for someone with a brain injury and/or chronic injury and illness, it seems logical the taxpayers would want to do with right thing.”

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Getting Shako into a more appropriate setting — an actual home — not only would save state resources, it could accelerate his rehabilitation — potentially curbing future social expenses, as many with brain injuries end up in shelters or jail.

That, Lauer said, gets to the broader issue of how this country and state cares for its indigents — beyond this unusual case.

And, Lauer said, Shako now is an Iowan, making him “part of our mission.”

Comments: (319) 398-8310; brian.morelli@thegazette.com or (319) 339-3158; vanessa.miller@thegazette.com

Michaela Ramm of The Gazette contributed.

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