One month ago, we returned from Zambia, where we initiated our work with Ubumi Prisons Initiative (www.ubumi.dk) and In But Free (www.inbutfree.org). It was an inspiring and productive journey, and we believe that we now have a foundation for our future work regarding mental health mapping and health workshops for prison officers and inmates in Zambian prisons.
The week started with a two-day meeting with mental health specialist Mweene Nseluke and the director of In But Free, Nawa Sanjobo. We discussed how to conduct a research study on mapping of mental health in Zambian prisons. Amongst others, the discussions gave a unique insight into the prison system and mental health system in Zambia. The meeting resulted in a proposal for the study design and a detailed schedule for future work tasks related to the study. Interestingly, seven Zambian mental health experts will meet in August to discuss particular cultural aspects, that are important in the presentation of mental disorders in Zambia. It is believed, that mental problems often are expressed through physical symptoms and local idioms, which may vary between Zambia ìs many ethnic groups. Furthermore a literature review will be conducted on mental health studies in prisons in Sub-Saharan Africa. As part of the study, it is planned to create a brief screening tool for mental health, that hopefully will be useful in screening of inmates at prison entry.
After the two-day meeting, we visited Mukobeko Maximum Security Prison. We had a welcome by the head of the prison, that was followed by a round trip, guided by prison officers and inmates working voluntarily for the Ubumi Prison Initiative. Amongst others, we saw the prison gardens, and the facilities for learning craftsmanship; sewing, mechanics, upholstery and a lot of other trades. We also visited the sick bay, where there were eight beds, housing inmates suffering from various infectious diseases. The responsible clinical officer told us, that it was mainly upper respiratory diseases that were admitted. Our impression was that they had access to a range of specific drugs, but only relatively few diagnostic tools. During our visit, we talked with various prison officers and inmates who seemed very motivated to work for improvement of the prison health, and they shared many interesting ideas with us.
The following day we visited the country´s only mental hospital, Chainama Hills College Hospital, where they also have a section associated with the correctional services. Our impression of Chainama Hills College Hospital was, that it had a relatively low capacity, but a dedicated staff. Amongst others, we talked with an inspiring clinical officer, that was working with group therapy with the patients, in the correctional service section of the hospital.
That same day, we also visited Lusaka Central Prison, where we saw both the female and male ward. In the female ward we had the opportunity to talk with some of the inmates, and listen to their personal health related stories. Above all, it was sadening to see the many young children that accompanied their mothers in the prison.
In the male ward, we observed extreme overcrowding (600%). The cells, where the inmates sleep at night, each built for twenty persons, were now housing 100-200 inmates. The inmates are packed so close together, that they barely can move. Furthermore, there were only ten toilets and ten showers for 2000 inmates. In addition, the food is cooked in a small kitchen, that did not seem to follow common hygienic measures. Overall, because of the poor hygienic conditions, the prison population seem to be very vulnerable to various infectious diseases. We also visited the medical ward, where they screen inmates for HIV and tuberculosis (funded by Pepfar).
We have learnt a lot from the journey, and we feel very motivated to move on with the work of improving the health education in the prison, both for the prison officers and the inmates. On our journey we got in contact with relevant local NGO’s and experienced that many local people are very dedicated to work for a positive change in the prison context. We strongly believe, that Global Doctors will have the possibility of establishing a health education project, and that we will be able to assist in the research study regarding mapping of mental health.
Mark Werner and Sophie Lauridsen