5 ZADHR News Prison Health in Zimbabwe: The Case for Reform There have been widespread reports of deplorable conditions of detention in Zimbabwe’s prisons. Food shortages, poor sanitation and inadequate supply of safe water, shortages of drugs and health workers and overcrowding are impacting on the health of prisoners across the country. Food shortages, however, are the main challenge for prisoners. Inmates generally receive one meal a day, comprising sadza served with vegetables and at times served without any relish. Vegetables or other available relish is usually prepared without cooking oil and sometimes without salt. Most prisons are unable to give prisoners any protein rich food such as meat or beans. Prisons that have not been able to get any meat or vegetables have resorted to serving sadza with salted water. Inadequate nutrition is closely tied to deterioration in the health of many inmates. Food shortages have resulted in poor drug compliance by patients that are chronically ill as some drugs need to be taken with or after food. Ill inmates tend to skip doses when meals are few. Cases of pellagra have been reported in several prisons. Diseases such as pellagra, manifesting in the form of diarrhoea, dermatitis and dementia, are caused by lack of nutritious food and a balanced diet, and can simply not be reversed without improved diet. Diets based on maize predominantly predispose to the development of pellagra as some vital elements, particularly protein, are not present in such a diet. All the prisons have an inadequate supply of drugs. Logistical problems such a delayed processing of requisitions, transport problems as well as central stock-outs are some of the reasons cited for the shortages. Standard treatment protocols for common conditions such as asthma, hypertension and diabetes are difficult to implement. Inmates who enter prison with these illnesses may not continue treatment in a timely manner. If emergency events occur e.g. asthma attack, most prisons do not have an emergency trolley with the standard emergency drugs and equipment. The shortage of some antibiotics means that conditions such as sexually transmitted and urinary tract infections are treated using available (but not necessarily correct) antibiotics thereby encouraging microbial drug resistance. Inmates – who eventually are released back into society – may then be carriers of infective organisms which require special expensive drugs to treat. Brain drain in the health sector has also affected prisons and most prisons have insufficient numbers of health workers. In some provinces prisons go for years without ever having been visited by a doctor. In addition to the shortage of prison doctors who can conduct on site visits, there is shortage of transport to ferry patients requiring hospitalisation to hospital. People who are in prison have the same right to health care as everyone else. The right of everyone to the “enjoyment of the highest attainable standard of physical and mental health” applies just as much to prisoners as it does to the entire population. A prisoner’s right to health care does not diminish because they are in detention. Regardless of the circumstances or status in society, all human beings, by virtue of being human beings have fundamental human rights. Apart from being deprived of their liberty for offences in society, prisoners retain all their human rights. It is in the interest of Zimbabwean society for the Ministry of Health and Child Welfare and the Ministry of Justice to work together to prevent disease in prisons as treating diseases in prisons costs more than preventing them. Furthermore prisoners return to the communities from which they come therefore the prison health system should be integrated into the public health system. It may be a challenge to ensure that public health services reach the people who need them the most, however prisoners are easy to reach and it should not be difficult to ensure that they can access adequate curative and preventive health services. “One of the strongest lessons from the end of the last century is that public health can no longer afford to ignore prison health. The rise and rapid spread of HIV infection and AIDS, the resurgence of other serious communicable diseases such as tuberculosis and hepatitis and the increasing recognition that prisons are inappropriate receptacles for people with dependence and mental health problems have thrust prison health high on the public health agenda. As all societies try to cope with these serious health problems, it has become clear that any national strategy for controlling them requires developing and including prison policies, as prisons contain, at any one time, a disproportionate number of those requiring health assistance.” (Source: Health in Prisons, A WHO Guide to the Essentials in Prison Health, 2007)