(b) The training of prison officers, supervisory staff and prison management, and the payment of adequate wages to prison personnel; (c) The adoption of measures to promote access by civil society and representatives of the media as a means of ensuring external monitoring; (d) Immediate adoption of the following measures: (i) Monitoring the assignment of cells and beds to ensure that all inmates have a decent place to sleep without being obliged to pay for it; (ii) Banning the carrying of money by staff within the institution, and overseeing the enforcement of this ban; (iii) Recording in the inmates ’ personal files the wings to which they are assigned and the reasons for that assignment. 166.According to repeated and concordant allegations, drugs are widespread in Tacumbú National Prison, particularly cannabis and cocaine and its derivatives (crack). Medical staff estimate that approximately 30 per cent of inmates regularly use these substances. The wide availability of drugs along with the high number of knives in the prison points to the need to step up security. 167. The SPT recommends that the prison authorities should not only step up security and combat corruption but also make a concerted effort to prevent drugs being brought into the prison, to identify access routes and to establish campaigns to dissuade inmates from using these substances. At the same time, they should introduce detoxification programmes for individuals and family reintegration therapy. 168.According to information obtained by the SPT from medical records, 20 detainees died at Tacumbú National Prison in 2008. Nine of them were the victims of stab wounds, two of them having been in the solitary confinement wing. It is estimated by medical staff that approximately one in four detainees dies from wounds, caused mainly by fights between rival groups of detainees. According to information provided by the prison director, during a search carried out in 2008 approximately 2,000 knives were confiscated. 169. The SPT recommends that the number of prison guards at Tacumbú National Prison should be increased to an appropriate level in order to ensure security and respect for the integrity of all persons deprived of their liberty. 4.Health 170.The SPT found that the prisons visited did not guarantee detainees the right to the highest attainable standard of physical and mental health. 171.The medical examination carried out upon admission to prison is extremely important. In the first place, it helps to prevent torture and ill-treatment in the case of people coming from police stations, by making it possible to establish whether there are any signs of previous ill-treatment and assess when it might have taken place. The examination also provides a good opportunity to assess the state of health and medical needs of prisoners, to carry out voluntary tests and to offer advice on sexually transmitted diseases as well as information on the prevention of such diseases and other infectious diseases or drug addiction. 172.According to government sources, medical examinations upon admission to prison are conducted as a matter of routine, subject to the availability of medical staff. Otherwise, the medical examination takes place as soon as medical staff become available in the institution concerned. Staff at the Tacumbú National Prison clinic informed the SPT that upon arrival at prison three inmates who help out in the clinic take note of the name and other personal details of the prisoner as well as any indicated health problems. Where there is no health problem, the prison doctor sees them the following day. The prisoners interviewed, however, denied that a medical examination is carried out upon arrival at the facility. The SPT is concerned that access to medical care is at the discretion of the inmates who help at the clinic. It considers that all prisoners must be examined by a doctor on or as soon as possible after admission. 173.The SPT recommends that medical practitioners should examine all inmates upon admission to the prison. The examination must be carried out on the basis of a general questionnaire that, in addition to general health questions, must cover any acts of violence suffered recently. Medical practitioners must also conduct a complete medical examination, including a full body examination. If patients show signs of having suffered acts of violence, medical practitioners must assess whether the account of the acts is consistent with results of the medical examination. When medical practitioners have reasons to believe that torture or ill-treatment have taken place they must include such information in the register prescribed in paragraph 97. 174.As mentioned above, in addition to medical staff, Tacumbú National Prison clinic employs three prisoners who help to distribute prescribed medicines and to organize patients’ medical records. The SPT recognizes that entrusting such tasks to prisoners may be useful for their subsequent reintegration into society; however it is concerned that it is detrimental to medical confidentiality. Confidentiality is extremely important for gaining the trust of patients and is closely related to the right to privacy. The current system whereby a prisoner who is not a medical practitioner carries out the initial interview may give rise to a lack of confidence in the clinic and may result in patients providing less accurate information. Furthermore, opportunities may be lost to collect information on current illnesses (e.g. tuberculosis) and exposure to acts of violence prior to arrival at the institution. It may also place inmates in a difficult situation if they need to deny their fellow-inmates medicine owing to shortages. The SPT recommends that prisoners ’ medical records should be kept strictly confidential and that only medical staff should have access to them. 175.After comparing requests for medical equipment against the audited receipts, the SPT noticed that the equipment received did not satisfy the demand. Nevertheless there were enough basic medicines. The SPT recommends that the