«Working in prison is like starting a game of Monopoly: you sit at the table knowing the rules (the written ones) and slowly learn even the unwritten ones. The players are many: some play for their explicit decision (civilian operators, the police) others are forced to do so (prisoners). Everyone plays to win. For prisoners, paradoxically, it means getting out of the game (read: get out of prison; read: freedom) ».
It was February 2, 2007 when Michelangelo Poccobelli, medical director of the Milan Opera prison, published this intervention on the website of the Italian Society of Penitentiary Medicine. In those years, the organization of health care for prisoners was entrusted to the prison administration. Controls were few. Access to visits and medication was often not guaranteed. Those in prison, among common prisoners or in high security (excluding those in 41 bis), lived in pitiful conditions. Doctors complained of an ineffective system. When the reform of prison medicine arrived in 2008, the rules of the game changed: the health of the prisoners was entrusted to the National Health Service. Many spoke of a revolution. But after ten years the criticalities remain: controls are few, access to visits and drugs is often not guaranteed, those in prison live in pitiful conditions, doctors complain of an ineffective system.
Elisabetta Dalmonte has been working in the Forlì prison for five years. He is deputy director and doctor on call. “I take care of organizing shifts and coordinating visits,” he says. He admits that working in a prison is not easy. You need to have a particular attitude. «I fell in love with this job by chance. I entered the competition while I was following a master’s degree in geriatrics and, when I was selected, I decided to accept ». There are no specialization or training courses that prepare recent graduates to become prison doctors. You learn in the field. Elisabetta loves her job, but she knows very well that the difficulties are not few. Today, with the spread of the new coronavirus and with increasingly dilapidated structures, prisons are time bombs.
“When the bill was drawn up in 2008 I was sitting at that table. I vindicate the principle underlying the intervention ”, explains Stefano Anastasia, spokesperson for the regional guarantors. The objective of the reform was to guarantee the right to health also in prisons, not places where the individual tends to cancel himself out. Prisons were no longer to be containers of physical and mental suffering, “factories of disease”, as the sociologist Giuseppe Mosconi calls them. From that moment on, health care would have been a prerogative of the National Health Service and not of the individual penitentiary administrations. The path, however, is still long. “The situation differs from region to region and from institution to institution. Each one is managed by a different local health company », explains Sandro Libianchi, doctor in Rebibbia and head of the“ Know ”association (National coordination of health workers in Italian prisons). The problems are of a different nature.
There is a lack of doctors and nurses in the first place. In 2019 there were 1000 prison doctors in Italy. Too few to be able to guarantee adequate health care for both the over 65,000 prisoners of the time and the current 55,000. In Casal del Marmo (Rome) the general practitioner is available six hours a day, nurses 12. The prisoners are 88. “All these figures should be present 24 hours a day”, stresses Franco Corleone, former Tuscan guarantor. When his term was about to expire, he decided to embark on a demonstration fast to denounce the promises not kept by the prison administrations. “There are no hires, this is the reality,” he explains.
Not only. “Many times the tools are lacking to carry out the exams”, adds doctor Elisabetta Dalmonte. They have recently been able to buy an ultrasound machine at the Forlì institute. First they had to make do. “So working is not easy.” The risk is that of having to request travel to facilities, hospitals or clinics, where examinations can be guaranteed. Waiting times are long. The Translation Unit, which deals with the transfer of prisoners, is not sufficiently equipped: even in this case, there is a lack of staff. There are regions where the wait is shorter. Others where times expand. In Campania, in the Poggioreale prison, it can take up to six months to perform a CT scan. Four for a gastroscopy at the Arienzo institute. Guaranteeing preferential ways to book specialist exams in all ASLs could be an effective solution.
“It is important to keep in mind that, Regardless of the type of health care, the public must ensure basic care. In these contexts, private access is not possible. Either we are treated through the ASL or we are not treated»Clarifies the spokesman of the guarantors, Stefano Anastasia. Precisely for this reason, as well as for logistical conditions, the prison health system continues to be severely tested by the Covid-19 epidemic. According to the latest available data, almost 1000 inmates and about 700 agents are infected. Since the second half of December the numbers are gradually decreasing. There is no common strategy. Isolating the positives in dedicated areas was the only solution adopted to avoid the spread of the virus. But the spaces are not enough; despite the house arrest granted in March and with the refreshment decree, the facilities are overcrowded.
Since the first lockdown, the inmates have never stopped being afraid. It is estimated that 70 percent have a chronic disease. The possibility of easy access to medicines is therefore essential. In 2015, there was an agreement between the regions in which it was established that class C drugs were provided free of charge in all prisons. “The goal was to integrate the 2008 law and standardize the system,” recalls Sandro Libianchi, head of the “Know” association. The measures taken were only partially implemented. The complaints about the lack of medicines come from all territories.
“Controlling is not so easy”, highlights Libianchi. It seems that any kind of complaint goes unheeded. Even those 119 that the inmates formally presented last year. According to Stefano Anastasia, in order to truly preserve the right to health, “human and economic” resources are needed. Since 2008, funding for health care management in prisons has been around 160 million. Looking at the conditions in which the structures are, apart from some virtuous cases, it is legitimate to ask where the money invested ends up. More than 3 out of 10 institutions do not guarantee access to hot water and the heaters do not work in 7 percent of cases. The data is provided by the latest report drawn up by the Antigone association, which in 2018 visited 85 prison and prison houses (out of 189). In 46 structures, access to showers is guaranteed only in areas outside the cells. “The premises – the observers write – are often moldy and unhealthy.” It remains rooted in the dominant culture, “the idea that detention must consist in the affliction of suffering (physical and psychological)”.
In the last year the situation has not changed, quite the contrary. The volunteers of the Antigone association are concluding their visits to the penitentiaries before drawing up the usual annual report, which will be published in 2021. «There has been no improvement. The deterioration continued, ”says Antigone’s Hassan Bassi. Before Christmas he inspected the Frosinone prison. “Many showers don’t work, the structure seems abandoned. I was shocked, ”he adds. One cell was completely flooded and inside there, sitting on his mattress, was a man with his feet immersed in water. “It was cold, the heating didn’t work. He had a scared look, ”recalls Hassan.
That man was there, in solitary confinement, but he didn’t know why. “He was a black boy, I think of North African origins. He did not speak Italian and was unable to understand why he was arrested ». It often happens: cultural mediators are lacking in prisons. They are considered ancillary figures. “How is this possible?” Asks Hassan. In the Frosinone prison, people stay in their cells practically all day. “The football field has had to be renovated for two years, the greenhouse has been out of use for some time and, since there was an escape in 2017, all external activities have been suspended. Then now with Covid, professional courses and laboratories have also been interrupted “.
It is these living conditions, in addition to the punishment itself, that have a devastating psychological effect. “Psychic distress is one of the major problems», Underlines Franco Corleone. Cases of self-harm are very common. In 2016, almost 9 thousand were registered. With Covid it is possible to assume that they are on the rise. “In Frosinone in the last year there have been eight suicide attempts and 178 cases of self-harm,” specifies Hassan Bassi. Throughout Italy, however, psychologists and psychiatrists are scarce in the structures. The administration of psychotropic drugs is often used, medicalising disorders that could be solved in different ways. According to Dr. Elisabetta Dalmonte, doctors in prisons must also learn to be a bit of a psychologist. You have to do two, three, four jobs in one. Franco Corleone explains it well: «Making equal parts among unequal is not the goal. A person in prison must have more, because he does not have freedom: his body is in the hands of the state ». Or rather: it should have more.
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