Fighting tuberculosis in prisons is a smart choice

Fighting tuberculosis (TB) in prisons is a smarter choice for governments from economic, social justice and public health criteria. In India, the government was asked to cough up INR 300,000 (>USD 6000) as compensation to be paid to the wife of the TB prison inmate who died inside Howrah Jail (source: The Times of India, 22 February 2011). Getting TB disease and dieing of it was not part of prison sentence. Although government tried to shun responsibility in the beginning, the inquiry conducted by the National Human Rights Commission (NHRC) brought forth the truth: there was clear negligence on part of the government to not provide TB treatment and care to this prison inmate. He died later of chronic obstructive pulmonary tuberculosis on 27 February 2007. His family had complained that he was not given proper medicine and was not allowed to consult an expert.

If governments are made to pay compensation to every person who dies of avoidable diseases like TB, one can imagine the financial crisis governments might soon be in. Add to this the cost of TB that spreads due to suboptimal infection control measures particularly in prison settings. From social justice point of view, people who are sentenced to prison terms, are not sentenced to get TB and other diseases and at times death due to these avoidable causes! Fighting TB clearly is a smart choice for governments!

There is no doubt that standard TB treatment and care should be made available to prison inmates who need it. But more important from public health point of view is infection control in congregated settings like those of prison in this case. The media coverage of this news from India doesn’t even mention infection control measures if at all they were in place. Standard infection control measures should be in place in prison settings, and every other congregated setting.

Why is health not a priority in prison settings? Some public health advocates believe that right to health is not recognized in prisons by governments. "Prison inmates are considered to be condemned people in the society, so the right to health is not considered in many countries. In few countries like South Africa, people have fought for the right to health and are able to push the government at all cost to access medication in prisons" said Fred Mwansa. "When you have right to health you can be able to sue the government when this right is violated. If leaders can show good will and consider right to health then we can say we are on the right track in achieving democracy. There should be a way by which the prison inmates should be protected by forming coalitions in prisons in order to fight this and reduce deaths. Universal Access to medication won't be achieved if the clause of right to health will not be implemented in all countries" said Fred Mwansa.

Not just TB, prison environment is usually considered to exacerbate the risk to myriad conditions. "There is a lot if negligence on the part of government on issues concerning prison inmates. Prisons are the most horrific places to ever be in, many have issues like overcrowding, which amplifies the risk of spread of communicable diseases like TB, there is poor medical services for jail inmates, very poor nutrition, horrific conditions of living, such as bedding, etc" said Kennedy Kassaza from Uganda. "There are hundreds, even thousands of death of prison inmates which are directly related to negligence on the part of governments, people whose relatives die in prisons due to negligence lack the legal means to hold governments accountable. If only people can get to know how and where to start from, to follow the legal procedures, in holding prison authorities and governments accountable, there would be many reforms in many government prisons" said Kennedy Kassaza.

"We call upon the Government of every state in India and all the agencies and related departments in this region to take priority measures and compensate the families of prison inmates who died of HIV, TB or from other opportunistic infections while languishing in prisons or during judicial custody in the jails while serving a term or even otherwise" said Ashok Sharma and Rajni Bhatt from Preserve' Society in Uttrakhand, India.

According to the World Health Organization (WHO), TB is not an unavoidable consequence of incarceration and can be controlled through the application of Stop TB Strategy based programmes and improvements in prison conditions. Effective TB control in prison protects prisoners, staff, visitors and the community at large. One can just wish if authorities are listening and implement the WHO guidelines in letter and spirit.

Bobby Ramakant - CNS 

Published in:
Citizen News Service (CNS), India/Thailand 
The Asian Tribune, Sri Lanka/Thailand 
Pakistan Christian Post, Karachi, Pakistan 
Modern Ghana News, Accra, Ghana 
News Blaze News, California, USA 
The Brunei Times, Brunei 
Mangalorean.com, Mangalore, India 
Now Public News, India   
The Scoop News, New Zealand 
HealthDev.net     
CNS Stop-TB Initiative 
Silobreaker.com
MSG.com    
Iplextra.indiatimes.com 
HDLNS.com                                                                                                                                                                                                                      

5 comments:

  1. Prison inmates are considered to be condemned people in the society, so the right to health is not considered in many countries. Few countries like South Africa where people have fought for the right to Health and are able to push the government at all cost to access medication in prisons.

    When you have right to health you can be able to sue the government when this right is violated. If leaders can show good will and consider right to health then we can say we are on the right track in achieving democracy. They should be a way by which the inmates should be protected by forming coalitions in prisons in order to fight this and reduce deaths. Universal Access to medication won't be achieved if the clause of right to Health will not implemented in all countries.

    Fred Mwansa
    Email: fredmwansa@yahoo.ca

    ReplyDelete
  2. Ashok Sharma and Rajni Bhatt28 February, 2011

    We call upon the Government of every state in India and all the agencies and related departments in this region to take priority measures and compensate the families of people who have died of HIV or TB or from other opportunistic infections while languishing in prisons or during custody in the jails while serving a term or even otherwise. Neglect is on the part of government which must be paid with market rate interests to the survivors immediately.

    Thanks

    Ashok Sharma and Rajni Bhatt
    Preserve' Society (Regd) Uttrakhand, India
    and NTAT Projects -southwest Asia
    Email: ntatsouthwestasia@yahoo.co.in

    ReplyDelete
  3. It is rather bizarre the way hierarchy, both government and correctional,view prisoners as condemned human beings with no rights at all. This article awakens in me the rotten environments in which most of Cameroonians prisoners rot and die under the pitiless eyes of their very custodians.Can you imagine that in one of its central prisons housing more than 3000 inmates, a prison that was originally built for 700,was in 2006, for instance allocated $550 for medicines. That leaves every inmate with a ridiculous $0.18 per year or $0.015 per month, worse still $.0000411 per day, that is almost nothing! The legislative and judicial remain deaf to the outcries of journalists and human rights activists about the appalling conditions of incarceration. As this article says, Government should sit up and treat prisoners as human beings and not let them die from situations or illness that were not part of their sentence. One would be tempted to regard this as a kind of government masterminded euthanasia if people are willfully allowed to rot and die in prisons as if they were perishable agricultural commodities.

    ReplyDelete
  4. Dr Shanta Ghatak, India04 March, 2011

    TB programme officers in the states and districts change after every few years. And it becomes a very big responsibility to carry out activities as per the previous persons' work plans especially if the outgoing person has really done and achieved something substantial and credible. At times some politically swayed officers come and go and do great damage to the programme in terms of services already in place.

    Sustainability at the grassroots for TB control stems from judicious monitoring, interpretation of
    the relevant data, providing constructive feedbacks and acting upon them and moving activities forward. Not paying the DOT providers' honorariums on time, taking out people irrationally and placing them in distant areas which is difficult to work in for contractual who never had really a
    decent salary or paid timely for their travels, district officers acting on impulse and trying to change overnight every piece of the jigsaw called the DISTRICT TB Control Programme might have damaged the services rendered in the said area beyond feasible and timely repair. There might have been other reasons for the death.

    But if I may humbly put forward a question to the world at large for TB control in prisons in a district like Howrah (total population nearing 47 lakhs, having a very large migrant population, catering to the needs of the second largest slum in the entire country, having ten TB control units and its proximity to Calcutta), the nature of the inmates that are taken in there, the term that they (in this case the under-trial mentioned) were serving (and usually the nature of sentence that are dealt with in that specific prison conditions) and the existing DOT providers' network that must have been already in place (as the district had started service delivery in 1998), the roles of the medical officer TB control , the additional supervising second medical officer at the District TB centre, the district tuberculosis officer and the Supervisory staff as well as the local existing well meaning NGO network in place, where really the patient's care did not happen? What had been the circumstances and how has it been pinned down with tuberculosis?

    Leave aside tuberculosis - this prison doesn't serve long term prisoners (patients also) and that's where my question is. I am not questioning human rights or TB control in prisons but may be critically re looking at this episode in Howrah prison will help in our future perspectives for an
    unbiased share of information for better planned TB control efforts in future for these prisons in the districts all over India.

    Shanta Ghatak
    Email: drshantaghatak@gmail.com

    ReplyDelete
  5. Rusli Ismail, Malaysia07 March, 2011

    I am happy to report that in Malaysia, methadone is now available in many prisons throughout the country and antiretroviral therapy (ART) is being provided into some prison now under Adeeba.

    Rusli Ismail, Malaysia
    Email: isrusli@kb.usm.my

    ReplyDelete