THE PENITENTIARY HEALTHCARE SYSTEM AND TORTURE PREVENTION MECHANISMS Management and prevention of very dangerous contagious diseases According to information provided by the Ministry of Corrections, screening on tuberculosis was conducted in 65,130 cases in 2013. A total of 294 prisoners infected with tuberculosis have been registered. In 2013, 107 bacteria-emissive prisoners underwent treatment. 57 prisoners are ill with multi-drug-resistant tuberculosis (MDR TB). 20 cases of terminated treatment were registered in 2013. Pursuant to information received from the Ministry of Corrections, a sensitive form of tuberculosis grew into a resistant form in 44 cases. 4 TB-infected prisoners died. In 2013, prisoners were transferred to various civilian medical establishments for testing on or treatment of accompanying diseases in 202 cases. A monitoring visit paid to the Center for the Treatment of Tuberculosis and Rehabilitation on 21 December 2013 showed that the conditions of living at the Center are satisfactory in general. However, infection control is a matter of concern. There is a ventilation system working with negative pressure installed in the cells but the prisoners say most times the system is switched off. The inmates are disturbed also by the noise caused by operation of the ventilation system. Prisoners move around inside the premises of the institution without wearing protective surgical masks. In their cells, they do not have containers/vessels for sputum. The division of extensive and multi-drug-resistant tuberculosis is located in another building. Prisoners suffering from tuberculosis are complaining of poor management of side effects of anti-TB medications and poor treatment of accompanying diseases. Pursuant to information received from the Ministry of Corrections, in 2013, anti-TB treatment was terminated in 20 cases. It should be noted that this figure does not accurately represent prisoner obedience in accomplishing treatment courses because, formally, under the TB Management Guidelines, an anti-TB treatment is considered terminated only if a patient refuses to follow the indicated treatment for two months or more in a row;87 in reality, however, prisoners stop taking medications several times, for different time periods. Prisoners may stop taking drugs for various reasons such as side effects of the drug treatment or protest against inadequate medical assistance in handling the accompanying diseases. Be it this or other reasons, stopping treatment is dangerous as resistant form of tuberculosis may develop as a result. Unfortunately, of the 294 prisoners who became infected with tuberculosis in 2013, 57 prisoners have developed the multi-drug-resistant form (MDR TB). Sadly, moreover, in 44 cases a sensitive form of tuberculosis grew into a multi-drug resistant form, according to the information provided by the Ministry of Corrections. The monitoring revealed that, by 21 December 2013, the Center for the Treatment of Tuberculosis and Rehabilitation was housing 187 prisoners, while it is designed to accommodate as many as 698 patients. TB-infected prisoners involved in the DOTS programme are accommodated also at the Penitentiary Institutions nos. 8, 6 and 17; women prisoners are undergoing their treatment in the Institution No. 5. For these reasons, it is advisable to accommodate all the prisoners involved in the anti-tuberculosis treatment programme at the Center for the Treatment of Tuberculosis and Rehabilitation, which has a sufficient number of beds and appropriate infrastructure. Recommendation to the Minister of Corrections: QQ To take all the infection-control measures according to the TB Management Guidelines at the Center for the Treatment of Tuberculosis and Rehabilitation; 87 Guidelines for the Management of Tuberculosis approved by the Order of the Minister of Labor, Health and Social Protection No. 22 June 2013, available at http://www.moh.gov.ge/index.php?lang_id=GEO&sec_id=68&info_id=1486 [last accessed 15.03.2014]. 2013 During its monitoring activities at the Penitentiary Institution No. 8 through 24 – 25 December 2013, the monitoring group found out that prisoners infected with TB are accommodated on the second floor of the “E” wing in the 1st Regime Building. Untried prisoners are accommodated in the same building. By 24-25 December, there were 3 smear positive, 18 smear negative, 4 extensive and 10 multi-drug-resistant TB-infected prisoners; 35 in total. Having talked to the healthcare staff of the Institution, we found out that the DOTS programme objectives were not being implemented properly since it was virtually impossible for the healthcare staff to observe whether and how the TB-infected prisoners were administering their drug treatment. The cells where TB patients were accommodated had no separate ventilation system to ensure negative pressure – something that is a violation of infection control requirements endangering other untried prisoners accommodated in the same building. NPM Report 43