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Prison Medical Service
230 Ritual buffoonery or no ritual buffoonery, in Africa as elsewhere, it is women who are punished, by social strictures and by disease, for men’s promiscuity. Faculty of Medicine, Eduardo Mondlane University, CP 257, Maputo, Mozambique 1.
W. G. POVEY
Fassin D, Badji I. Ritual buffoonery: a social preventive measure against childhood mortality in Senegal. Lancet 1986; ii: 142-43.
FOOD INCENTIVES TO IMPROVE CLINIC ATTENDANCE
SIR,-Dr Benjamin and Dr Michael Loevinsohn (June 7, p 1314) describe the use of food incentives to improve the uptake of rural health services in Nicaragua. We consider the view that "some of the large amounts of non-emergency food aid available could be offered as incentives to increase the use of basic health services in developing countries" is misguided in a Papua New Guinean setting and, we suspect, elsewhere. We work in the Southern Highlands Province of Papua New Guinea and much of our time is spent in trying to improve uptake of basic health services and attendance at maternal and child health clinics. Experience has shown us that there are many ways of improving clinic attendance. Some of the best attendances are achieved by clinics which, far from rewarding mothers for
The House of Commons Social Services Committee has expressed its views on the work of the Prison Medical Servicel in England and Wales (and to a lesser extent in Northern Ireland).Its repor&bgr; and the 58 recommendations it contains await the Government’s response.
Many witnesses before the committee had advocated the total abolition of the PMS and the transfer of responsibility for the medical care of prisoners from the Home Office to the NHS. One solution was the bringing together of all forensic psychiatric services-the special hospitals, regional secure units and the prison medical service-under the auspices of the DHSS. The committee did not find this a convincing argument. Prisoners’ health needs were not limited to psychiatry. It had also been suggested that the PMS should become a special health authority, in much the same way as is planned for the special hospitals, under the auspices of the DHSS or the Home Office. Such an authority might include not only Home Office and DHSS representatives but outsiders, from, for example, the universities, and it could allow specialist input, in, say, general medicine, community medicine, and forensic psychiatry, into the planning of prison health care. The committee found that more plausible, although it acknowledged the difficulties in establishing such an authority. There was no intrinsic advantage at this stage in a change in the administration arrangements. The proposals the report makes for improvements in the PMS and for closer liaison with the NHS would resolve most of the current problems. The committee therefore simply recommended that Ministers monitor closely progress towards integration of prison medical services with the NHS. Some of the other recommendations are: The Home Office should consider alternatives to the routine medical examination of all prisoners on reception into custody, including screening by a qualified nurse. Doctors should be given discretion to allow prisoners to keep in their cells limited quantities of simple drugs or medicaments. Any prisoner asking to see a doctor should be able to do so, and such requests should be facilitated by prison officers. The Home Office should take immediate steps access to
to ensure
proper
then be seen as relevant and beneficial. In the short term the use of incentives to improve attendance and compliance in health care can doubtless be beneficial provided that the instigators are clear as to their objectives and the likely limitations of such a project. In the long term, however, we feel that bribing mothers to come to clinics is liable to be counterproductive, promoting the idea that health is something to be dispensed. Ialibu Health Centre, Southern Highlands Province
ALEC BUCHANAN
Mendi Hospital, Southern Highlands Province, Papua New Guinea
ALISON MOTT
washing facilities at all times.
Prison Medical Service
patients in prison hospitals have
attending, fme them if they do not. Other centres achieve good attendance figures through the reputation of individual members of staff or through a reputation for not treating people as outpatients if they fail to bring their children to clinics. As one nurse has pointed out to us, many mothers consider that they are doing the staff a favour by turning up for these clinics. Providers of health care can always improve their statistics by staffmg health clinics with enthusiastic personnel whom local people like to do favours for or by offering incentives. The problem with this is that it encourages the belief, widespread here, that the responsibility for health care lies with government and other agencies, not the village. In the long term, improvement of health in rural areas must come through the involvement of village people in health issues, when support from government and aid agencies can
that
lavatory and
1. Editorial. The future of the Prison Medical Service. Lancet 1985; ii: 755-56. 2. House of Commons paper 72-I. Third report from the Social Services Committee, session 1985-86. Prison Medical Service, vol I. HM Stationery Office. £6.
Immediate steps should be taken to devise a single form of medical record, capable of holding all case papers, for all prisoners. Medical records on prisoners should be kept in the prison hospital under the auspices of medical staff, not in the main prison record. Urgent steps should be taken to centralise, possibly on computer, prisoners’ medical records, and to devise a system whereby records can speedily be transferred from prison to prison and be retrieved when a person is reconvicted and enters prison again. Prison doctors should make greater effort to communicate to a prisoner’s GP details of treatment given in prison and respond helpfully to any request from a GP for such information. The Home Office should establish better domestic environments for women offenders with young children; and the Parole Board should treat pregnant women and women with young children more sympathetically when considering applications for parole. The Government should remove responsibility for hygiene in prisons from prison medical officers and crown immunity from prison kitchens and hospitals. The role of regional and district medical officers should be extended to enable them, as specialists in community medicine, to play a part in the maintenance of environmental health in prisons. Immediate steps are recommended to find hospital places for those prisoners whose mental illness or severe mental impairment fall within the terms of the Mental Health Act. Pilot units are proposed for violently disruptive prisoners; and a study should be undertaken into the characteristics of these inmates and the effect of different forms of management and treatment. The Home Office should take steps to improve liaison at a lod level between prisons and drug and alcohol rehabilitation projects; extend the use of parole for drug and alcohol abusers on condition of attendance at a specialist facility; consider establishing pre-release hostels at selected prisons; and initiate a national study into the prevalence of drug and alcohol addiction within the prison , population and its relationship to crime. Doctors working in the PMS should be encouraged to undertake "medical audit"; and the Home Office should sponsor a natioa survey into the general health needs of prison inmates. Eventually every prison doctor should work at least one daya week outside the prison setting. Provision should be made in prisons for training grades, probably on a part-time basis, as well as consultant appointments. Some prison appointments, either in general practice or in psychiatry should be linked to appropriate university departments.
W. G. POVEY
Fassin D, Badji I. Ritual buffoonery: a social preventive measure against childhood mortality in Senegal. Lancet 1986; ii: 142-43.
FOOD INCENTIVES TO IMPROVE CLINIC ATTENDANCE
SIR,-Dr Benjamin and Dr Michael Loevinsohn (June 7, p 1314) describe the use of food incentives to improve the uptake of rural health services in Nicaragua. We consider the view that "some of the large amounts of non-emergency food aid available could be offered as incentives to increase the use of basic health services in developing countries" is misguided in a Papua New Guinean setting and, we suspect, elsewhere. We work in the Southern Highlands Province of Papua New Guinea and much of our time is spent in trying to improve uptake of basic health services and attendance at maternal and child health clinics. Experience has shown us that there are many ways of improving clinic attendance. Some of the best attendances are achieved by clinics which, far from rewarding mothers for
The House of Commons Social Services Committee has expressed its views on the work of the Prison Medical Servicel in England and Wales (and to a lesser extent in Northern Ireland).Its repor&bgr; and the 58 recommendations it contains await the Government’s response.
Many witnesses before the committee had advocated the total abolition of the PMS and the transfer of responsibility for the medical care of prisoners from the Home Office to the NHS. One solution was the bringing together of all forensic psychiatric services-the special hospitals, regional secure units and the prison medical service-under the auspices of the DHSS. The committee did not find this a convincing argument. Prisoners’ health needs were not limited to psychiatry. It had also been suggested that the PMS should become a special health authority, in much the same way as is planned for the special hospitals, under the auspices of the DHSS or the Home Office. Such an authority might include not only Home Office and DHSS representatives but outsiders, from, for example, the universities, and it could allow specialist input, in, say, general medicine, community medicine, and forensic psychiatry, into the planning of prison health care. The committee found that more plausible, although it acknowledged the difficulties in establishing such an authority. There was no intrinsic advantage at this stage in a change in the administration arrangements. The proposals the report makes for improvements in the PMS and for closer liaison with the NHS would resolve most of the current problems. The committee therefore simply recommended that Ministers monitor closely progress towards integration of prison medical services with the NHS. Some of the other recommendations are: The Home Office should consider alternatives to the routine medical examination of all prisoners on reception into custody, including screening by a qualified nurse. Doctors should be given discretion to allow prisoners to keep in their cells limited quantities of simple drugs or medicaments. Any prisoner asking to see a doctor should be able to do so, and such requests should be facilitated by prison officers. The Home Office should take immediate steps access to
to ensure
proper
then be seen as relevant and beneficial. In the short term the use of incentives to improve attendance and compliance in health care can doubtless be beneficial provided that the instigators are clear as to their objectives and the likely limitations of such a project. In the long term, however, we feel that bribing mothers to come to clinics is liable to be counterproductive, promoting the idea that health is something to be dispensed. Ialibu Health Centre, Southern Highlands Province
ALEC BUCHANAN
Mendi Hospital, Southern Highlands Province, Papua New Guinea
ALISON MOTT
washing facilities at all times.
Prison Medical Service
patients in prison hospitals have
attending, fme them if they do not. Other centres achieve good attendance figures through the reputation of individual members of staff or through a reputation for not treating people as outpatients if they fail to bring their children to clinics. As one nurse has pointed out to us, many mothers consider that they are doing the staff a favour by turning up for these clinics. Providers of health care can always improve their statistics by staffmg health clinics with enthusiastic personnel whom local people like to do favours for or by offering incentives. The problem with this is that it encourages the belief, widespread here, that the responsibility for health care lies with government and other agencies, not the village. In the long term, improvement of health in rural areas must come through the involvement of village people in health issues, when support from government and aid agencies can
that
lavatory and
1. Editorial. The future of the Prison Medical Service. Lancet 1985; ii: 755-56. 2. House of Commons paper 72-I. Third report from the Social Services Committee, session 1985-86. Prison Medical Service, vol I. HM Stationery Office. £6.
Immediate steps should be taken to devise a single form of medical record, capable of holding all case papers, for all prisoners. Medical records on prisoners should be kept in the prison hospital under the auspices of medical staff, not in the main prison record. Urgent steps should be taken to centralise, possibly on computer, prisoners’ medical records, and to devise a system whereby records can speedily be transferred from prison to prison and be retrieved when a person is reconvicted and enters prison again. Prison doctors should make greater effort to communicate to a prisoner’s GP details of treatment given in prison and respond helpfully to any request from a GP for such information. The Home Office should establish better domestic environments for women offenders with young children; and the Parole Board should treat pregnant women and women with young children more sympathetically when considering applications for parole. The Government should remove responsibility for hygiene in prisons from prison medical officers and crown immunity from prison kitchens and hospitals. The role of regional and district medical officers should be extended to enable them, as specialists in community medicine, to play a part in the maintenance of environmental health in prisons. Immediate steps are recommended to find hospital places for those prisoners whose mental illness or severe mental impairment fall within the terms of the Mental Health Act. Pilot units are proposed for violently disruptive prisoners; and a study should be undertaken into the characteristics of these inmates and the effect of different forms of management and treatment. The Home Office should take steps to improve liaison at a lod level between prisons and drug and alcohol rehabilitation projects; extend the use of parole for drug and alcohol abusers on condition of attendance at a specialist facility; consider establishing pre-release hostels at selected prisons; and initiate a national study into the prevalence of drug and alcohol addiction within the prison , population and its relationship to crime. Doctors working in the PMS should be encouraged to undertake "medical audit"; and the Home Office should sponsor a natioa survey into the general health needs of prison inmates. Eventually every prison doctor should work at least one daya week outside the prison setting. Provision should be made in prisons for training grades, probably on a part-time basis, as well as consultant appointments. Some prison appointments, either in general practice or in psychiatry should be linked to appropriate university departments.