One of the most serious and hidden threats in the Guyana Prison Service (GPS) is the spread of contagious diseases within the overcrowded jails, according to Director of Prisons, Dale Erskine.

He expressed this view yesterday while addressing the opening of the two-day workshop on the Direct Observation Therapy Strategy (DOTS) Programme in the chronic care of tuberculosis (TB), provided through the Tuberculosis Control Programme in the Ministry of Health.

The TB workshop, which is being convened at the Hotel Tower, targets prison officers and staff of the Palms as well as homes for the elderly.

Yesterday's workshop was considered to be very important since according to Minister of Health, Dr Leslie Ramsammy, "TB is raging in Guyana at this time."

According to the minister, with the growing rate of HIV and AIDS cases, TB continues to increase in prevalence rate in Guyana. He disclosed that the hospital wards were now overwhelmed by TB cases. Unfortunately, he said, it was an infection that could be contracted with persons being involved in "risky" behaviour. He noted that the prisons and homes settings, with large numbers of persons together in close quarters, were at risk if someone there contracted TB.

The ministry explained that the workshop was meant to teach the participants about TB and how to effectively implement a DOTS programme in their institutions. In doing so they would have considerably enhanced Guyana's capacity to respond to the disease.

Erskine said that currently, prison officials as well as related policymakers and practitioners were acutely aware of the responsibility to make the prison environment safer for both staff and inmates.

According to him, the prison systems throughout the world have evolved from simple institutions whose main interests were security and detention of their populations to become complex multi-activity institutions, which magnify and reflect society's social problems.

He noted that today, the prison environment manifested populations where many were poor, lacked employment skills, had dysfunctional family lives, came from communities which lacked up-to-date medical facilities and/or might have indulged in behaviours that led to disease or a compromised health status, (substance abusers, mentally ill, infected with HIV/AIDS and/or tuberculosis, among other contagious diseases).

The prison director pointed out that due to this complexity of the modern prison system, one could not therefore conceptualise the prison system as a warehouse for criminal offenders. "As prison officers we understand the rights of inmates to be supervised and cared for in a safe and humane environment," Erskine said. He added that since invariably over 90% of them returned to the society from which they came, no doubt this obligation was becoming more demanding, dangerous and dynamic, considering the limited resources/facilities available within the prison system, which generally was considered a negative institution.

According to Erskine, it is said that the fastest emerging threat is the spread of tuberculosis in the prison system. He disclosed that in the International Centre for Prison Studies Annual Report 1999, the dilemma of the dreaded disease was highlighted when the report stated, "one of the greatest problems facing prison systems in the countries of the former Soviet Union is the spread of tuberculosis," referring to ill health as an extra-judicial sentence.

"Overcrowded and under-resourced prisons are places of disease and infection and the incidence of tuberculosis in particular has reached epidemic proportions."

Fortunately, Guyana's prison service, according to Erskine, has not reached this drastic situation and might never reach there. But what was important to note, he said, was a general view that the spread tuberculosis was rising in society and since the prison reflected society's problems, it was necessary that steps be put in place immediately to control or prevent this.

Erskine opined that the exposure provided by the workshop for his staff members was a necessary intervention in the prison setting.

"It must be clearly noted that the GPS is cognizant of the responsibility not only to treat medical complaints of offenders, but also to advocate and encourage healthy lifestyle changes and reduction of health risk behaviours as a method of health promotion of the TB disease," the prison director said.

Ramsammy, in declaring the workshop open, said that his ministry was "painfully" cognizant of the problems of re-emerging diseases. He noted that TB was not simply a re-emerging disease but in fact had already re-established itself in Guyana.

The minister admonished the participants that as employees they must protect themselves and protect the people for whom they had responsibility. And in order to provide health care to those they have responsibility for, they must be trained.

Dr Ramsammy pointed out that a person with TB would be less able to transmit the disease if he or she received treatment, which was available in Guyana. However, unfortunately many persons who were infected did not comply with instructions to take their medication. It was for this reason that the World Health Organisation put together the DOTS programme; to ensure 100% compliance. In this strategy, someone always ensured that the infected person took his or her medication, thereby improving the cure rate and reducing risk of infection to others.