(published in People's Voice, May 1-15, 2004, Vol. 12, No. 5)
Inside Cuba's Prisons:
Health Care and Vocational Training
by Susan Hurlich, Havana, 31 March 2004
No one likes to be locked up. But in a rare visit to two of Cuba's prisons, several dozen foreign journalists saw a very different reality from the image usually presented in the North American media of dismal filthy gulags full of prisoners suffering sub-human conditions and inadequate health care.
The visit was limited to the hospital complexes of Combinado del Este Men's Prison, located 20 km east of Havana and Cuba's largest correctional facility, and the Western Prison for Women, some 40 km to the southwest. The tours were part of the First Cuban Congress on Penitentiary Medicine, organized by the Ministry of Interior from 29-30 March and also open to national and foreign media.
The only sign that one is entering Combinado del Este is the barrier fence, barbed wire and guards at the main entrance. Then comes a huge central field where hundreds of men are playing baseball, volleyball and running around an outside track under the watchful presence of guards and surrounded by sprawling concrete buildings with rectangular openings for circulation of air.
One of these buildings is the National Hospital for Prisoners, and it's here where 44 foreign journalists from 13 countries are ushered. It's been 14 years since the media was last allowed inside Cuba's prisons.
"This hospital provides 16 basic specialties, has three operating rooms and provides both emergency and therapeutic services," says Dr. Aurelio Gonzalez Saldivar, director of the hospital, in his introductory remarks to the press.
Journalists - who were allowed to film and photograph what they were shown as well as interview selected inmates - were led by Interior Ministry doctors and nurses through anaesthesiology and operating rooms, post-op wards, intensive care units, laboratories and emergency rooms. High-tech equipment and computers were in evidence everywhere and the few inmates who were being treated had clean uniforms. In wards and down long corridors, the odor of disinfectant and fresh paint, part of a recent remodelling and repair program, was noticeable, and the only thing to distinguish this hospital from a civilian hospital "on the outside" were the iron grates on all doors and windows.
"With true satisfaction, we can affirm that inmates and detainees in Cuba receive adequate and humane treatment," Col. Pablo Hernandez Cruz, Head of Logistics, told the Cuban Congress on Penitentiary Medicine - attended by some 270 Interior Ministry medical professionals and legal specialists from around the country - in his opening remarks.
And the 200-bed hospital, built in 1977 and equipped to provide everything from basic medical checkups and dental work to major surgery, seems to confirm this. Among its 222 personnel - 77% of whom are women - are 50 doctors (including twelve surgeons) and 86 nurses. The rest are technicians or work in services. Although the hospital treats mainly inmates from the capital, some infirm come from several other prisons in Cuba.
"Inmates are patients for us," insists Dr. Amarylis Hernandez, head of the Intensive Care Unit which is outfitted with air conditioners, freshly starched sheets and four state-of-the-art cardiovascular monitors, "and we use the same norms, criteria and treatment that we use in health care institutions outside the prison."
According to Hernandez, the most common problems dealt with in her unit are respiratory and cardiovascular, similar to what one finds in any of Cuba's general hospitals. This assertion was also made in the hospital's emergency unit, where it was explained to the media that the main problems are bronchial asthma, diabetes and hypertension, again, just as one finds among the population as a whole.
"Prisoners show the same health indices as exist throughout the country as a whole", asserts hospital director Gonzalez Saldivar.
This theme, that there are no statistical differences between health indices inside or outside of Cuba's prisons, was also strongly underscored during the Congress on Prison Medicine, which included parallel meetings on nursing, dentistry and natural and traditional medicine in Cuban prisons. In his presentation on the history of the Cuban penal system, Lt.-Col. Dr. Terencio Batista Sanchez, head of Interior Ministry Health Services in the province of Holguin, referred to recent Internet data showing that the incidence of HIV- AIDS is ten times higher in US prisons than in the general US population, hepatitis is nine times higher and TB is as much as fourteen times higher. In comparison, in Cuba - which just last month was ranked the first among six countries which received an award from the World Health Organization in recognition of its TB control program - the same indices for TB, HIV-AIDS and other diseases, as well as the same programs of vigilance, testing and epidemiology, exist among prisoners as among the population as a whole. As well, in 2002, a special Sanatorium was opened just outside Havana for inmates who test positive for HIV. Here, and at two other similar sanatoriums for prisoners located in Villa Clara and Holguin, specialized care - including a 3,000 calorie diet - is provided by qualified medical staff.
The National Hospital for Prisoners is one of five such hospitals in Cuba, the others located within prisons in Holguin, Villa Clara, Granma and Santiago de Cuba. A sixth, under construction in Camaguey, will be ready by the end of the year. There are also special rooms for prisoners in provincial hospitals. Data made available during the Congress indicate that there is one doctor for every 200 inmates, one nurse for every 100 and one dentist for every 900. Throughout the visit as well as during the Congress, Interior Ministry officials repeatedly refused to say how many prisoners there are in Cuba, insisting that the Congress and prison visits were to show tendencies and programs rather than numbers.
In chats with inmates receiving medical attention, none of the prisoners complained about conditions or food. When asked, most shrugged and said things were "adequate." Off limits to the media at Combinado del Este were the four-story cement housing blocks, libraries, and the conjugal visit rooms.
Perhaps most interesting was the glimpse offered of the Cuban penal system's job training programs, particularly for male nurses. This program, one of several intended to "convert prisons into schools", is part of what is known as "Task 500". Beginning in 2000, the aim is to provide educational opportunities and a vocation to inmates, with the long-term goal of social reintegration for prisoners who have served out their sentences. In addition to nursing, courses are also provided in physical education, basic hygiene and epidemiology, and in technical areas such as laboratory, ultrasound or X-ray technicians. The provision of libraries is also part of the program.
"Task 500 has changed the entire concept of Cuba's prison system," affirmed Batista Sanchez during the congress.
"When you're preparing yourself professionally, you see things differently," says Juan Carlos Romero, 35 years old and serving a 15 year prison term for battery. Enrolled in the prison's new two-year training course for nurses and snappily uniformed, Juan Carlos asserts that "(nursing) is a very human profession, and the prison has given me an opportunity to study and do something useful".
Along with fifteen other students, Juan Carlos studies five days a week, eight hours a day in a small neat classroom, in the prisons first nurses-training pilot program which began last February. As part of their studies, they have access to a lab with five IBM computers. Professors are nurses and doctors from the prison's hospital.
"As students, these inmates are very motivated", declares Dr. Nestor Azcamo Gonzalez, the hospital's Deputy Director for Education. "It's a second opportunity for them."
"Students in this program must have a 12th grade education," continues Azcamo Gonzalez, "although rapists and murderers are excluded." Graduates receive a nursing diploma, just as nursing students do elsewhere in Cuba, although for the inmates it won't disclose where they studied. Once they are paroled or complete their sentences, they can either get jobs in hospitals on the outside (although it's yet to be seen how the public will accept them) or study for a bachelor's degree in nursing. If they are still incarcerated, they can help staff the National Hospital for Prisoners or transfer to another prison. Inmates who work in prisons receive the same wages as for comparable work outside. A second nursing course is beginning this month at the Provincial Hospital for Prisoners in Holguin, where 20 student-inmates have already been selected.
At first glimpse, the Western Prison for Women appears like a three-star low- slung tourist installation surrounded by thick vegetation and an organic garden just inside the main entrance. Built in 1983, this is the largest of Cuba's nine women's prisons. Inside, it houses the showcase Maternity-Infant Block, created at the end of 2002 for pregnant women inmates and mothers with newborns.
Under the Cuban penal code, a female prisoner who gives birth is allowed to keep her baby until one year of age. After that, the child lives on the outside with relatives or is sent to a childcare facility, with weekly visits allowed.
Last year, the prison maternity wing attended to 48 pregnancies and 37 births, said medical director Orestes Gonzalez Torres. He also asserts that up to the present, no underweight babies have been born and both infant and maternal mortality are at zero. (All births take place in the Obrero maternity hospital in Havana.) Pregnant and nursing mothers also receive a more specialized diet with higher calories than other inmates, their babies get regular checkups and mothers are encouraged to nurse their newborns for the first six months.
"It's for these reasons that in August 2003, the Maternity-Infant Block received the 'Friend of the Mother and Child' award from Cuba's Health Ministry and UNICEF," explains Gonzalez.
At the Women's Prison, the Public Health Ministry's standard Program for Mother and Child Care is applied in full, as are all other standard health programs for women such as detection of uterine cancer, breast cancer, etc. Round-the-clock medical attention is provided in the Maternity-Infant Block, with a permanent health worker for every two women. Water is boiled for the babies, clothing of both mothers and babies is washed daily, and a family doctor tends to the babies and ensures that they receive their vaccinations.
"The food given to me and my baby is good," says Grisel Varela, sitting in a rocking chair while holding her sleeping infant. "My daughter, Melody, is seven months old. I've learned a lot in prison. Before, I didn't think. Now, I have to think about my child."
Having now served four years of a five year sentence for robbery, Grisel is up for release next month on conditional parole. Melody's father is an inmate in another prison in Havana, serving a 25-year sentence for forced robbery.
"We met in a prisoner letter-exchange program," explains Grisel, "and every two months we are able to meet for six hours in the conjugal visit rooms here at this prison. We earned this right through good behaviour and work. This is the first baby for each of us."
Grisel lives in the prison's maternity ward in a corridor of cells for mothers and babies, all windowless, sparse but clean. There is one narrow bed for her and a crib - draped with mosquito netting - for her baby. Larger rooms accommodate two mothers and their babies. White walls are decorated with colourful cartoon characters like Mickey Mouse and the metal bar doors are often left open. Family members send baby clothes.
To date, the women's prison in Matanzas has a smaller Maternity-Infant Block, and there's a plan to eventually have similar wards at Cuba's other women's prisons.
Some say that the highly supervised media access to the medical facilities of Havana's two main prisons was orchestrated by the government to deflect criticism about Cuba's prison conditions two weeks before the 53-member U.N. Commission on Human Rights votes on the island's rights record. But in any country, visits to prisons by press and others are controlled.
A week ago Foreign Minister Felipe Perez Roque asserted in a press conference that "Cuba meets the minimum requirements the United Nations requires for detainees." Perez Roque was referring to some ninety-five laws for the treatment of the penal population, approved by the United Nations and established at the First Conference about Crime Prevention and Delinquent Treatment held in 1955 in Geneva, Switzerland. Under these laws, no prisoner is subject to torture or physical abuse in jail.
The International Red Cross has not been allowed inside Cuba's prisons since 1988, and access has also been denied to the UN High Commissioner for Human Rights. This will only change once anti-Cuba ploys cease in such bodies as the rights commission.
In the meantime, Cuba's penal system will continue to search for new alternatives in prison health care, rehabilitation programs and social reintegration. In September of this year, study programs in Cuban medical faculties will include a new career of General Integral Medicine in penitentiaries.
Susan's article provides an insight not available to the public who read the U.S. media coverage of this prison visit in Cuba. For those interested in how U.S. and other nations' prisons may compare, further information can be found on these websites:
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