Katete Prison Blues

From time to time we have a prisoner from Katete state prison on the ward. They are easy to spot in their flimsy white uniforms of shorts and t-shirt usually with a prison guard by their bed. I have had a couple of issues with the prison staff regarding their care. At one point I discovered one of my patients who was confused handcuffed to the bed. The police officer said he was a suspect for cattle stealing and as they felt he was a flight risk and they were unable to provide a guard to watch him they decided to handcuff him. Understandably I was less than impressed that a patient already confused from sepsis was chained to the bed. This led to a heated dispute with the officer responsible until he rescinded.

Come to think of it my only real disputes since here have been regarding prisoners. Recently we had an inmate from the prison admitted quite unwell suffering from HIV and a TB pleural effusion whereby the space where one of his lungs should be was completely filled with serous fluid. After about a week’s treatment including draining the fluid and giving TB meds he was improving, was less short of breath and able to mobilise about the ward. I felt at this stage he was fit for discharge home.

However I didn’t feel prison was the appropriate place for him right now and it would be best for him to spend a few months recuperating at home with the care of his family before returning to serve the remainder of his sentence. Now bear in mind this man is a taxi driver imprisoned for eight months for non payment of motor related fines and has two months left to serve. Surely my suggestion that the remainder of his sentence be deferred sounds reasonable. I tell the prison guard I will be supplying a medical letter recommending this to the officer in charge and as soon as he Okays it I will discharge Misheck. I think this should be a straight forward procedure, but this is Zambia. Whilst not meaning to be over critical of this country which is populated by amazing friendly people with a vast depth of culture, the bureaucracy here can be infuriating.

The following day the officer in charge arrives saying it is not in his power to defer the sentence that the request must go through ‘channels’, that it would take many months, that only the President himself his excellency could grant such a request and so on. Cue another heated debate eventually leading me to desist from further conversation on the matter as it was futile. So my options now remain to leave the patient on the ward for a number of weeks with a guard 24 hours at the Zambian exchequers expense or discharge him to the prison.

What is a prison in Zambia like? The hospital is fairly basic compared to home so how will a prison compare? I don’t like the look of the food the patients get in hospital but Misheck tells me it’s far better than prison food. The guards inform me they have a sick bay for prisoners who are ill and that they bring patients regularly for review to the clinic or St Francis. I grant they do regularly bring inmates for medical attention but Misheck was really sick when admitted a couple of weeks ago.

I arrange a visit to the prison with Chisala one of the guards for Saturday morning. Some of the medical students come along for the trip. When we arrive I ring Chisala who tells me to knock and go ahead in. We are greeted by another guard Kelvin who recognises one of the students having been admitted to the surgical ward a few weeks back. Here at the outer gate one of the prisoners is working as a tailor mending uniforms. After a couple of minutes Chisala arrives in the gate with two cows trotters, which he proudly boosts will make a good meal. We have to leave our cameras and phones behind before proceeding through the inner gate.

Inside is a barren open space with five or six buildings and a toilet block scattered about. The prisoners are mostly sitting down on the ground, it’s hot this morning and there is little shade here. Kelvin explains that this is a medium security prison housing prisoners with sentence of five years or less. There are currently 152 convicts or people on remand (people awaiting trial) here. Some are currently in the prison farm in Msoro camping and sowing crops.

Our first stop on the tour is the ‘sick bay’. We are shown into a tiny room with no windows about 7*6 foot. There is a single mattress on the floor with a net above. Nobody is in sick bay right now but we are told sometimes there are three or four prisoners here. Must be fairly cramped. I enquire about medical care for people from sick bay and informed that someone form Katete urban health clinic attends weekly. In addition sick patients are allowed daily visitors.

Beside this there is a door behind which is the ‘women’s wing’. We are brought here next. It looks like a scene from a Dickens dramatisation, some kind of back alley that Oliver Twist might run down. There is a building facing the perimeter wall some six feet away. There are three wooden doors on the outside to three separate rooms. There are just three female prisoners right now sharing one of these rooms. I later learn the other rooms are used for solitary confinement.

One of the female prisoners is awaiting trial for murder. I briefly get to talk to her, she doesn’t enjoy the prison and tells me that the death of her friend was an accident. With her in prison is her 17 month old daughter Anna. If convicted Anna’s mother faces a sentence of up to 12 years. The death sentence still exists in Zambian law but for men only. The last execution was in 1997. When I ask what the method was I am told it’s a government secret.

We go back through the wooden door into the main compound, the men are sitting about mostly. One is listening to music on headphones, Chilasa informs me he is one of the captains appointed to oversee the other prisoners. We enter cell one, a building where we are told 25-30 prisoners sleep. However there is only cell one and two which would leave quite a shortfall out of the 127 men here. We are told each prisoner has a mattress. In the corner of the cell behind a screening wall is a single toilet. It’s a proper toilet and clean.

We go next to cell two the same size, except kitted out better. On one wall is a big blackboard being used as a sort of count down calendar. The days of December are being rubbed off as they pass, below this reads ‘coming soon: January’ and then ‘next attraction: February’. Elsewhere on the board is a list of activities including ‘Bible day’, ‘quizz day’, ‘complaint day’ and ‘yoyoyo day’ which I’m told means stories. Hen there is a bible quote from one of Peter’s letters ‘one day freedom’. I ask about the spiritual needs of the prisoners and am told that the various churches do come. ‘The churches they do assist us a lot, they provide soap and other commodities, they are helping a lot’ Kelvin explains.

In another corner of cell two is a small TV belonging to one of the prisoners. It along with the single light bulb in each cell are the only twentieth century items here otherwise the prison could be literally be from the eighteenth or nineteenth centuries.

The kitchen is in another building. There is no electricity, water is carried from a burr hole outside. Behind the building some prisoners are lighting fires under where the pots are inside. There is a bowl of Kapenta (small dried salted fish) outside as well as the trotters resting on a lump of wood, flies swarm all about. Chisala tells me there is just nshima and kapenta to eat right now. Normally there is beans and rice but these are currently out of stock, sounds like the pharmacy report in St Francis. The prison does have some ducks here and goats and these are occasionally on the menu.

At the end of our visit we sign the book back at the gate. I am surprised to see the name of one of the hospital staff in the book and am told he came to bring a few prisoners with a guard to do some work around his house. I am told I can do the same at any time if I wish, my own chain gang. The prison is basic but not as bad as I thought it would be. There is a laid back atmosphere no hint of violence, the prisoners even have their own football team. The accommodation is simple but probably not a whole lot worse than the hospital. How will they feed over 100 on two cows trotters? Am I comfortable to discharge Misheck there or not?