precarious residency: All the good you can

There's been some nice developments at the prison in the last few months, some small but others carrying a greater import.

One is that a donor came forward to fund the renovation of a room within the prison so it can be used to quarantine actively-infectious patients. As I described earlier, the prison is designed for about 250 inmates, but holds up to 500 (or more) at any given time. The population typically hovers around 400 male inmates, plus a handful of female inmates with their children. (Mostly as a temporary holding cell, as the permanent women's prison is in Thyolo, near a famous tea estate.)

I've walked through the prison a few times and the layout is simple. There is a reception area, then a big metal locked door leading into the prisoner area, which is a medium-sized dirt courtyard, flanked by about six rooms, three on each side, which is where the prisoners sleep. Those rooms are not large, maybe 30 x 20 feet (don't quote me, this is a guess from memory). They're clearly overcrowded at night. There are no beds, just a handful of reed mats for a few lucky inmates. The rest lay directly on the concrete floor, stuffed in like sardines. This is why infectious diseases are rampant there, particularly scabies and fungal infections.

Also TB.* A few months ago, we had three patients test positive in one day for TB, but when the nurse followed up in the following weeks, they still hadn't been taken to the district hospital to start treatment. That delay is a chronic problem at the prison, because the local police - who are responsible for transporting prisoners over to the district hospital (the Janky Chair hospital) - don't want to take the risk of someone escaping on their watch. It's very hard to get them to do their job. But any kind of delay is no good in a setting like this, a place with too many prisoners in one area, poor sanitation, no hygiene supplies, and bad nutrition.

I had found an old proposal from a few years ago to create an isolation space for such prisoners, but there wasn't enough money to do it at the time. Thanks to this new donor, now there is. Their $2300 will completely renovate a room which is being used to store firewood and make it into a space for people who really need to keep separate from the general prison population, at least until their medical treatment starts.

Wouldn't you like to recover from a pulmonary disease in here?

It was terribly encouraging to know we could do something, finally. Nobody wants to witness human suffering, and there's a term for the phenomenon of seeing suffering without the ability to do anything about it: moral injury. (It's discussed in this Plough article, but I first learned about it from Minnesota author Rachel Pieh Jones.) We Americans tend to think throwing money at things will solve almost all problems and I will tell you, without hesitation, that it does not. Often it creates new ones. The Kingdom of God does not depend upon capitalist economics.

BUT - when rich people give up the things they have for poor people, it can help. In this situation, some cold hard cash solved a simple problem: the need for a small separate room in a yucky prison, where sick people can keep their germs to themselves until medicine does it for them. I think we'd all want that for ourselves, so naturally they want it for themselves, too. Moral injury not completely averted, but lessened a bit. It's a long slog, this battle between darkness and light; all the more reason to:

"Do all the good you can,
By all the means you can,
In all the ways you can,
In all the places you can,
At all the times you can,
To all the people you can,
As long as ever you can."

(John Wesley, OG Methodist)

So that was the first encouragment.

I also was able to have a long sit-down meeting with the hospital administration and together really think through what and how and why we're working at the prison, and how we can do it better. A follow up meeting is scheduled in October, and there's a chance that we may be able to tie the prison program to one of our existing mobile clinic programs, which will give it better oversight, access to supplies, some fresh blood in terms of staffing, and (maybe?) more consistent program funding. It's complex to think through, with a lot of moving parts, but that such changes are even up for conversation is good news. So you can pray for that, hey?

One of the ongoing issues at the prison has been the reluctance of local nurses to work there. The prison carries a lot of stigma, here as in America. But mostly, I think people don't want to catch scabies or fleas or TB, because the working conditions at the prison are really bad. I get it, I am often flicking bugs away when I'm there.

Here is our "clinic":

And this is where the pharmacist works. All the prisoners sit lined up on the bench, with guards lingering around, so you have to shuffle past them all to talk to her. And that's it. That's the prison health clinic.

The prison asked if we could, pretty please, just build a nice, shiny new freestanding clinic for inmates out in the front yard of the prison, but the contractor quotes for that were much more expensive. During the process of getting those quotes, though, I got a closer look at the prison classrooms. These were funded by some nuns a few years ago and are used by ex-teacher inmates to teach fellow inmates primary or secondary-level classes (those who qualify). The nuns still play an active role in their use, too. "Couldn't we use one of these for the health clinic?" I asked in a loud stage whisper, but the question was quickly batted down. They were holding out for a dedicated clinic space. I can't blame them.

Now that is officially off the table, though. So I got the name of the nun (I think she's European, but we haven't met yet), Sister Anna, and texted her, asking for permission to use one of the classrooms each week. She was immediately like, gurrrrrrrrrrrrrllllll, no problem! (I knew she'd come through!) Last Friday I asked the prison chaplain to please ask the prison wardon for the final go-ahead, and I think (hope) they're going to let us. It seems promising. That would be amazing, because those classrooms are five times bigger than our current space, cleanish, and newish. We'll just move our scant supplies back and forth each time. It will be an easier sell to attract better nursing staff if they don't feel their personal safety is at risk.

Prison classroom.

Another encouragement!

And just a quick story, to end things: my friend, let's call her L, is herself working in a developing country, but out of the blue a couple of weeks ago, she texted and said she wanted to give $100 toward buying soap at the prison. I was surprised but glad for this - because you know, widow and last mite, all that business, it seemed to bode well for her. Not long after, I got handed the task of developing a budget for a mass scabies screening/treatment at the prison, something that should have been done almost a year ago, but kept getting put off. "What's our budget?" I asked hopefully. The answer was 350,000 kwacha. Which seems like a lot, no? That order of magnitude is big, in the hundred thousands, right?

WRONG. What that buys is exactly not enough soap for each inmate to get one bar - and not just one bar, the same bar to wash both their clothes and their body. That entire budget buys one bar of soap for almost but not all of the prisoners. Which leaves nothing to pay the medical staff, nothing for disinfectants for the sleeping quarters, nothing for extra medicine. (Thankfully, the ivermectin is supplied by the Ministry of Health - but only one dose and what we need is two. We're petitioning for a second one.)

It seems a very small thing, but adding in L's $100, we now have enough soap for all the prisoners (or maybe even two bars each?) and money to pay staff. It gives the campaign at least a fighting chance of success, rather than being a foretold failure and not really worth doing.

It's gratifying. These actions are tiny, probably hardly even noticed by the inmates themselves. But they're the right thing to do. It means a lot to be able to do them.

Prisoners get one meal per day, so lucky inmates have family who bring them extra food. This guard sits at the front of the prison, on the outside, and cuts through the food as a security measure. (Taken with permission.)

Then the family member has to eat some to "prove it isn't poisoned". "Does that sometimes happen?" I asked, my eyes big. The guard started laughing. "No."