The Liberian Correctional Palace

Yesterday, I went with Dr. Kerry to the “Liberian Correctional Palace” just outside Zwedru – the Grand Gedeh County main prison. Not knowing what to expect in a Liberian prison, the road there gave a quick sense of its remoteness. A UN driver took Kerry, a nurse named Ernest, and me along the dirt mud road running through the bush outside town.

Kerry started doing a weekly clinic at the prison after she kept seeing a number of prisoners present at Martha Tubman Memorial Hospital in Zwedru where she predominantly works. Many had signs of malnourishment and with protracted courses of various health problems. She ended up writing a report that helped change feeding and other policies at the prisoner. The County Health Team should have been seeing the patients but they were not doing so with any regularity. Now, Kerry sees patients once a week at the “palace” (this is what the prison is called here) and refers those that need further care to the hospital within the next few days.

When we arrived, Kerry talked briefly with UN-POL and UN-MIL UN troops/officers who are helping teach how to run the prison. The India UN-MIL unit is now stationed here for that purpose. We checked in at the prison gate and signed the prison visitor book. Family members and pastors appeared to be the main visitors but not with much frequency. On a piece of paper sitting atop the desk, there were 4 crimes listed on the slip and nothing else: rape, murder, attempted kidnapping, and robbery. We headed into the prison, met some friendly guards, and stopped at the clinic, basically a set of 2 rooms with a desk in one and some benches in both. Outside the clinic window facing inside the prison, I saw the concrete compound where the prisoners could exercise all surrounded with the standard barbed wire rings.

The prison houses 115 persons, 111 of them being men. Of those 111, 35 presented to clinic yesterday with afflictions such as typhoid, dysentary, malaria, hernia, fungal skin infections (secondary to hygiene and the hot, humid weather here), constipation. Ernest employed top-notch efficiency in a crowded, hot room. Formerly from Sierra Leone, he worked with Doctors Without Borders there before coming to Liberia to work as a nurse. Kerry finds that he performs at a level higher than most physician assistants. With 35 patients in just under 2 hours, we all had to be efficient, though I was the weakest link. Ernest was both triage/intake staff and pharmacist. Kerry saw each patient in the interim. If she thought the patient had malaria, I did the Paracheck malaria test. A simple test, I used a lancet to prick the inmates’ fingers and then used a rapid diagnostic tool using some reagent drops to look for a certain strain of malaria endemic here. None of patients tested positive, but Kerry was concerned about the integrity of the particular kit box we had for the day. So she’ll keep tabs on their symptoms for next time.

The guys were pretty jovial the whole time. I didn’t know their crimes, but many were those listed on that little white slip of paper at the entrance I suspect. Some probably ask to come to clinic weekly just to see Kerry, and it was clear that they like what she is doing and the care she provides them. A 78-year old frail man was particularly memorable. As a term of respect Kerry and the other inmate who helped him called him “papa.” He had what appeared to be a Tinea fungal infection on the back of his neck. I couldn’t help but think what this man has seen in terms of Liberia’s history. The younger inmate’s affection towards him was endearing.

He wasn’t the oldest inmate. Of the 4 women here, 2 are 89 and 98 years old (the oldest people by far that I have heard of here). Why are they in? Up to 3 of the 4 were accused of witchcraft. Kerry didn’t have time to tell me the full story, but for all the anti-witchcraft accusation signs in the country, it seems some women are still getting jailed for it. Fighting on behalf of those women’s rights might be a good project for the nascent group Zwedru Women United for Change being run by Agatha Toure in TH, and we intend to pass that message on. Just the first day I was in Zwedru, Agatha said a few women had been jailed for witchcraft accusations.

Just after we packed up the remaining drugs, kits, and forms (let’s just say the lab work wasn’t the most hygienic of situations given the rapidity and lack of safe disposal equipment), I stood by the interior bars facing the exercise compound surrounded by cells. I had my camera, but I didn’t take what I thought was a powerful picture: a young man, Nubian in skin tone, hands clasped as in prayer intertwined with the fence, and alone, kneeling on the concrete. Bright sun in his face, barbed wire above and below him with the fading yellow-painted, decrepit walls around me. There wasn’t any particular “message” I saw in this image, but it captured some facet of prison life that only a photo might do.

As we left, Kerry showed me a set of gardens just outside the prison walls. Inmates now get some of their food from it. I didn’t know what to expect for the day, but the generally upbeat spirit of the prisoners was not something I would have expected. I tried to lighten up the finger jab by having them guess their malaria status first. Men are often the biggest babies when it comes to being a patient. I should know as one of them. So in a rural prison in Liberia or a hospital in Illinois, I know at least that transcends cultural boundaries and that honoring prisoner health rights is not only a professional ethical requirement but can be a meaningful one at that. Thanks to Kerry for taking me along and for standing up for her patients. I look forward to hearing if TH health accompanier supervisor Alphonso Mouwon’s idea to start TH health talks for the prisoners takes shape soon.

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