Sima’s Death: A case of poor prison health system?

The death of the Chief Executive Officer (CEO) of EXOPA Modelling Agency, Ibrahim Sima, who was serving a 15-year prison sentence, raises questions about health care for prisoners in Ghana.

Access to proper and adequate medical care is a basic right of every human being, including prisoners.

The health of prisoners is generally poorer than those in free society. They are a disadvantaged group in the sense that they have very little or no control over their environment.

This is particularly true where the prison faces the spectre of overcrowding.

The health of prisoners has implications for public health. Prisoners may come to prison with infections, or they may contract various diseases while in prison.

If their health problems are not properly addressed, they may transmit their infections to people in the community to which they will return after serving their terms. International instruments define the quality of care that should be provided to prisoners regardless of their legal status.

The Body of Principles for the Protection of all Persons under any Form of Detention or Imprisonment, Principle 24 provides that: “A proper medical examination shall be offered to a detained or imprisoned person as promptly as possible after his admission to the place of detention or imprisonment, and thereafter medical care and treatment shall be provided whenever necessary. This care and treatment shall be provided free of charge.”

Health screening for new inmates is of utmost importance and must be adhered to by prison authorities.

The Prison Standing Orders (1960) No. 53 stipulates that every prisoner shall, as soon as possible after his admission, be separately examined by the medical officer, who shall enter on the prisoner' record the state of health of the prisoner, and the class of diet, clothing and bedding which should be issued to the prisoner and shall also give any necessary direction with regard to him.

New inmates must receive a thorough medical examination so that any disease condition can receive immediate medical attention.

Before their incarceration, some might have led poor lifestyles which exposed them to various infections such as HIV/AIDS, hepatitis, mental illness, substance abuse and alcoholism.

The early detection and treatment of such infections will prevent the newly admitted prisoner from infecting other prisoners, prison staff and visitors to the prison.

Although a medical officer has a vital role to play in prison health, the Ghana Prisons Service has no hospital and no qualified medical doctors.

Most correctional facilities have infirmaries that are manned by qualified nurses, and in some cases physician assistants.

The majority of these infirmaries are poorly equipped and also lack basic essential drugs and other medical supplies.

Some infirmaries do not have a treatment room to ensure confidentiality; others have no ward where patients can be admitted for long-term management of their health conditions.

Minor ailments, wounds and other injuries are treated at the prison infirmary but serious medical conditions are referred to civil hospitals for management.

When newly admitted prisoners have been screened, those found to have contagious diseases must be segregated and given treatment in a confidential manner.

Segregation units have been created in some prisons to take care of this.

The screening should also consider prisoners at risk of self-harm or those who by virtue of their health condition may pose a threat to the well-being of other members of the prison community. For instance, prisoners with mental illness or suicidal tendencies will need constant observation and regular treatment.

They will need to be removed from prison to mental hospital for management.

Those with contagious diseases should be transferred to the only Contagious Disease Prison at Ankaful in the Central Region.

Even though medical screening for each inmate should be comprehensive, UN and WHO guidelines prohibit the compulsory testing of prisoners for HIV/AIDS and Hepatitis B and C. The prisoner must consent before such tests can be done and certainly not without the needed counselling which should precede the testing.

If after Voluntary Counselling and Testing a prisoner is diagnosed positive, he must be told of the fact and receive confidential counselling and also placed on anti-retroviral medication.

Prisoners with alcohol and drug addiction problems will obviously need either individual or group psychotherapy. This job can be carried out by the prisons chaplain or psychologist.

Pregnant female prisoners should have access to pre-natal and post-natal care and treatment and adequate arrangements made for the pregnant woman to give birth at a hospital outside prison.

If a child is born in prison, this fact shall not be mentioned in the birth certificate. A medic may prescribe medication to control the psychosomatic problems of prisoners.

As we have seen, at no time do prisoners lose their basic rights to health because of their incarceration.

What happened to Sima Ibrahim can happen to anybody who finds him or herself in prison for various reasons.

The state has abandoned the Prison Service to the extent that professionals such as psychologists, health professionals, as well as other professionals reject job appointments because of poor conditions of service.

Politicians who were incarcerated made promises to lead a crusade to transform our prisons when released.

However, these promises become white elephants when these politicians gain freedom.

Prisoners need proper medical care and their living conditions should promote their good health.

Good prison health is good public health. Prison health needs the collective effort of all, and not just prison authorities.