By Thiago Carvalho, MD
Posted on September 18, 2011 – Brazilians usually rely upon and follow medical guidelines developed in the United States and so when I came here, I had every reason to expect the same. I decided to travel twice to America to learn how patients are managed inside prisons and jails. Having observed correctional health services in both Brazil and the United States, I am now able to describe some of the similarities and differences between systems in these two countries.
To help you understand how I see correctional healthcare in the US, I have to describe what happens in Brazil.
In Brazil, correctional health care is not well-known. Different states have their own ways of providing their limited health care services. In some correctional settings, inmates have no access to professional health care providers. The Espírito Santo State, where I work, has approximately 12,000 inmates. Approximately half of them have the opportunity to speak directly with a physician, but most of them have the chance to consult a nurse technician who may refer them to a doctor or a dentist.
Although I searched, I did not find any opportunities in Brazil for medical training on working with prisoners. To me, this represents both a significant deficiency and an exciting opportunity for growth. Correctional physicians internationally share similar challenges and Brazil would benefit from a process providing them with resources which would assist them with addressing their patient care challenges.
The first time I traveled to the United States to study correctional health care, I attended the National Commission on Correctional Healthcare conference in Las Vegas where I learned for the first time about specific standards and guidelines for use in jails and prisons. After the meeting, I returned to Brazil where I reported on these findings to my colleagues.
In my second visit, I spent six weeks visiting various correctional health care systems in Colorado, Massachusetts, Connecticut and Florida. In Denver, I visited some jails, where I observed how health care was delivered in a large jail. In Massachusetts, I traveled to the state prisons where the University of Massachusetts managed health services delivery. I was impressed by the way the university could take charge and lead patient care within the prison settings.
In Connecticut, I met with Frederik Altice MD, Professor of Medicine at Yale University School of Medicine, who showed me how he both provides care and conducts research in prisons and jails. I was amazed; what Dr. Altice is doing in Connecticut is not, to my knowledge, even considered in Brazil.
My visit to Florida was short and I did not have a chance to see any jails or prisons, but I was privileged to have an opportunity to meet with John P. May, MD, who is actively working with correctional healthcare services both in the United States and in other countries.
To my surprise, despite the cultural differences both American and Brazilian inmates frequently share similar complaints:
Oh Doctor, the food is bad. I cannot sleep. And I got this pain on my back that does not get better no matter what you do. And I miss my family.
After learning that there are standards and protocols guiding the provision of healthcare services for the correctional population in the United States, I wondered what was available in my own country and learned apparently there is some discussion of developing a similar organization to create these in Brazil. From my observations, I concluded that guidelines should be followed because these help correctional healthcare professionals respond to the pressures placed upon them by different sectors of society. Additionally, they are useful to governments that need to organize their budgets and allocate funds for inmate care.
Finding and meeting doctors specializing in correctional health care was also new to me. There are some characteristics that make the correctional environmental unique, and specialized professionals are best equipped to meet the needs of this field. If the Brazilian system had a similar area of specialization, it would likely have better clinical outcomes in its correctional settings.
Finally, I was greatly impressed by the healthy and carefully planned environments in which the American inmates are housed. Some buildings had a surprisingly modern appearance whereas others had the appearance of old historical buildings. I felt that a government shows its concern for its prisoners when it carefully creates the conditions in which they live.
In conclusion, I believe that the American correctional health care is well organized and of high quality. It has been organized for a longer period than that in my home country. I appreciate the knowledge that I have gleaned during my visits to the United States; I can evaluate better what I find in Brazilian correctional settings and will be able to apply that knowledge to help address some urgent needs and to improve correctional health care in Brazil.
Acknowledgements:
Thanks to Drs. Rebecca Lubelczyk, Frederick Altice, John May, Marc Stern and Kelly O´Brien for helping me with the arrangements all I needed for this experience. Thanks to Lenita de Araújo for helping me to revise my text.
Dr. Carvalho completed medical school in Brazil in August 2009 and decided to work as a doctor in the prison system. He is now a medical director in one of the facilities in the Espírito Santo State, Brazil. Readers may contact him at thc2@uol.com.br.
