PRACTICAL RECOMMENDATIONS ■ The conditions in which prisoners live should be inspected regularly by a doctor. ■ The doctor should have regular access to the director of the prison and should be encouraged to bring any matter to his or her attention. ■ If the doctor feels that his or her recommendations are being ignored, he or she should have the right of access to a higher authority within the prison system. ■ All prison staff should receive training in health matters, including first aid, suicide prevention and issues relating to HIV/AIDS and other transmissible diseases. ■ Special attention should be given to the health needs of women prisoners, particularly in respect of antenatal and post-natal care and for nursing mothers and their babies (see chapter 30 of this Manual). ■ Staff and prisoners involved in food preparation should receive special training in food hygiene. ■ Staff responsible for safety issues should be specially trained. ■ Prisoners should receive health information and education when they arrive in prison, particularly in respect of concerns they may have about matters such as HIV/AIDS infection. ■ The European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment has stressed the importance of preventive health care in prisons. Thus the task of prison health-care services should not be limited to treating sick patients, but should extend to social and preventive medicine, including supervising proper hygiene in prisons, preventing transmissible disease, suicide and violence, and limiting the disruption of social and family ties. TOPICS FOR DISCUSSION In an overcrowded room holding pre-trial prisoners, the doctor discovers that one prisoner is suffering from AIDS. What should be done? What is the role of the medical officer in circumstances where very poor physical conditions in a prison present a serious and continuing threat to the health of prisoners? CASE STUDY There is a dormitory in the prison which holds all prisoners known to have tuberculosis. There is severe overcrowding in the prison. A new batch of prisoners is admitted. The director of the prison says that two of them should be accommodated in the dormitory with the prisoners who have tuberculosis as there is no room for them anywhere else in the prison. What should the doctor do? 68