Where We Work: HAITI
Health through Walls' initiatives and work inside Haiti's national prisons include:
Capacity building. Working together with Haiti's prison authority, and various stakeholders, to develop greater capacity on the part of the prison system and its staff to deliver effective health care to all its prisoners.
Identification and treatment of contagious and infectious disease through comprehensive medical screenings including HIV, tuberculosis, syphilis, cholera and other diseases. An electronic medical file is established for each prisoner. Our portable digital x-ray machine allows us to perform chest x-rays as part of routine tuberculosis screenings for quicker identify of disease. Laboratory capacity has increased in the prison to include detection of drug-resistant tuberculosis through a GeneXpert machine in cooperation with the Haitian National TB Program. In 2013, HtW began annual cervical cancer screening at the women's prison.
In 2009, together with our volunteer medical delegations, and prison medical staff, we performed medical screening of 2,000 prisoners in the National Penitentiary until the January 12, 2010 earthquake. While working to rebuild the health unit in prison following the earthquake, we also conducted medical screenings in 2010-2011 of all prisoners in Cap Haitian, in the Central Plateau region and in Les Cayes.
By the end of 2013 HtW had dedicated, trained medical teams in place to work full-time with the prison authority medical staff in six of the national prisons including in the women's prison and in the juvenile prison.
In 2014, a grant from the Elton John AIDS Foundation makes it possible for HtW to conduct medical screenings in ten additional national prisons throughout Haiti.
Identifying and implementing preventive measures in order to reduce transmission of disease and mortality rates; training, equipping, and overseeing prisoner sanitation teams is an important part of this effort.
Discharge planning and continuity of care upon release from prison for those with HIV, AIDS or tuberculosis.
Health Promoter/Peer Educator training for a team of prisoners who then educate other prisoners on HIV, AIDS, tuberculosis, Sexually Transmitted Diseases and cholera.
Health through Walls first introduced Peer Education at Haiti's National Penitentiary in 2009 thanks to a grant from UNAIDS. The program comprehensively addressed knowledge, attitudes, and practices related to HIV infection and prevention through trainings by current and former prisoners. The process focused on erasing stigma associated with the disease in order to encourage prevention, testing and treatment. Once trained, the peer educators conducted educational programs, one-on-one sessions, and other activities to impart important disease prevention and health information using methods readily received and appreciated by their fellow prisoners. Following an evaluation, the program demonstrated that prisoners were twice as likely to volunteer for HIV testing after exposure to peer education programming.
Providing Reading Glasses to Prisoners. For the last few years HtW has been partnered with the Reading Glass Project, an innovative program that encourages the distribution of reading glasses, particularly to workers, artists, and families internationally. Their reading glasses have been distributed in 43 countries. Reading glasses are particularly important for prisoners in Haiti, the Dominican Republic and Jamaica where prisoners often spend long hours without sufficient lighting, and most have never had their eyes examined for glasses. HtW is provided with instructions and eye-charts to fit glasses with the people who need them. Where we can, we work with a visiting, volunteer optometrist to dispense these reading glasses. Once the prisoners receive their glasses they are finally able to see details up close and read letters from family, legal documents, their medication instructions, or health information flyers, books, etc. HtW's Haiti Coordinator, Karine Duverger, wrote the Reading Glass Project: "The medical parade went very well at the Women's Prison in Petion-Ville, Haiti. We completed the entire prison, 247 women, in 3 days. Each prisoner now has a medical record. Adding to our physicians and nurses, we had a dental team and an optometrist on one day. You can not imagine how we were happy to have the reading glasses available to distribute as the optometrist was doing his screening. Health through Walls wants to say thank you and on behalf of all the inmates that have benefited from those glasses."
Health training for prison staff. Educate and train prison officers and staff about HIV, AIDS, tuberculosis, Sexually Transmitted Diseases and cholera. HtW also hosts prison administrators and medical staff to attend key conferences in the United States or elsewhere and also tours them throughout prisons in the United States including visiting their medical units.
Legal component. A critical aspect to our work is a partnership with a prisoner's rights organization, such as the Vermont-based Rural Justice Center, who provides a legal component to our medical screenings. Their attorneys and law students interview and assist prisoners and in some instances were successful at getting people released. This is extremely important when, for example, a prisoner is seriously ill, has already been imprisoned for longer than a prison sentence would be if ever convicted and sentenced, and their release is critical to their health. (More than 80% of Haiti's prisoners have not been sentenced or had their cases heard in the courts, yet they languish in prison for years on sub-standard diets, exposed to contagious disease, and often suffering from circulation problems from standing for long periods of time in overcrowded cells.)
Telemedicine, through the use of computer, Internet, camera and sound, enables doctors with particular expertise -- based in Haiti, or abroad -- to consult on difficult cases or in making diagnoses. The patient is presented onscreen for a medical interview and viewing of their condition. Prison medical staff can engage in discussion with the consulting doctor via the screen as well.
Donations of medical supplies, equipment, prison and medical unit furnishings, medicines, etc. In the immediate aftermath of Haiti's catastrophic earthquake on January 12, 2010, HtW played an important role in gathering medical supplies, equipment, medicines and furnishings for Haiti's National Penitentiary.
The Haitian Prison Authority suffered major setbacks from the earthquake, which ruined much of Port-au-Prince and nearly all federal buildings. Interior structures of the prison collapsed, killing four prisoners. Fires started in different areas, completely destroying the administrative and record areas. All surviving prisoners fled. The prison headquarters sustained damage. The Supreme Court and Ministry of Justice buildings completely collapsed killing officials, judges, lawyers, and correctional officers. Files and records were destroyed. Other partners of Health through Walls also sustained losses. The United Nations peacekeeping operations in Haiti, MINUSTAH, suffered collapse of their headquarters and multiple deaths including Mission Chief Hedi Annabi and his deputy Luiz Carlos da Costa. All of the UN's corrections unit advisors survived. GHESKIO also had serious damage, and Maryse Thimothee, their head of the bacteriology lab who tracked tuberculosis specimens for HtW, died.
During the next several days and weeks, HtW organized support for the prison authority with multiple agencies including the American Correctional Association, International Corrections and Prison Association, and Iota Phi Theta Fraternity. The response joined the other international organizations already in Haiti such as the United Nations and International Committee of the Red Cross to provide short-term relief and long-term strategic planning. Monies raised by HtW were immediately dispatched and directed to the urgent needs of the prisoners and staff in the broken prison system. During the next several months, HtW collected materials and equipment, enough for three 40-feet commercial containers. These were packed, shipped, and delivered to Haiti's National Penitentiary.
By mid-February, 2010, a portion of the prison reopened. Provisions and space were sparse, yet the prisoner population grew quickly from a few dozen to more than 1,000. HtW worked closely with prison authorities to restore medical services and programs at the prison. The medical unit reopened, new medical files created, care and treatment resumed.
HtW also gave medical support to the prisons of Cap Haitian, Grand Riviere du Nord, and Les Cayes, some of which were also affected by the earthquake.
In July 2008, Health through Walls implemented a plan of care and treatment for prisoners with HIV infection in Haiti's National Penitentiary. Prior to this time, no formal mechanism existed for prisoners to receive HIV specialty care. HtW partnered with Les Centres GHESKIO, the preeminent provider of HIV care and treatment in Port-au-Prince, in order to provide specialty training, laboratory support, access to antiretroviral medications, and treatment linkages for released prisoners.
The plan spearheaded by HtW and GHESKIO involved a formal Memorandum of Agreement under the leadership of Haiti's Prime Minister at the time, Madame Michele Duvivier Pierre-Louis, and established a framework for HIV-related prisoner health services, defining the roles of multiple organizations who were invited to participate including the United Nations Mission for the Stabilization of Haiti (MINUSTAH), and Haiti's Ministries of Health, Justice, and Social Affairs, as well as the International Committee of the Red Cross. This critical initiative established the groundwork for a sustainable mechanism of on-going care, treatment and prevention.
On July 15, 2009, HtW received a USAID grant entitled "Control and Prevention of the Spread of Contagious Disease at the National Penitentiary," that engaged HtW to coordinate and conduct large scale voluntary medical screenings and examinations for each of the more than 4,000 prisoners at the National Penitentiary at the time. HtW also created a medical record for each prisoner, established systems of intake screening, chronic care clinics, and discharge planning. Plans began for a transition to an electronic health record and development of telemedicine. This was the first award from USAID for a prison health program anywhere in the world.
Starting in 2010, HtW traveled to various prisons throughout Haiti to conduct medical exams, set up medical files for each prisoner, and identify and treat infectious disease, as well as to train local medical staff and prison staff.