“There are only two groups of people on this earth who know when and where they will die,” Steve disclosed to me, peering carefully over the rims of his glasses. “They’re the people in hospitals and people with life in prison.” The discomfort of his words slowly settled in the silence between us. Before me was a man serving two consecutive life sentences in prison, each eye an amphitheater of grief as he lay bare the moral injury inflicted upon him by the carceral state.
I carried the heaviness of Steve’s words into my medical training. I had previously misunderstood that hospitals and the criminal justice system were separate arms of our society, functioning independently and distinctly of one another and interpolating only when necessary. This is not the case. In reality, they exist in continuous movement within one another, perpetuating one another and upholding institutional racism, violence, and trauma. The same structures that uphold mass incarceration also uphold health care inequality in the United States.
Once Steve began to unravel this idea, I began to follow the various threads of injustices in our society. I realized that these threads all led me back to one place: pain. This type of pain is embodied pain. It is the type of pain untouchable by interventions or the therapies we perfect in medical education and health care delivery. This is the pain that we have systematically chosen to ignore in our communities, and it disproportionately affects women, Black and Indegiounous people, and transgender and gender non-conforming individuals. As such, how we approach the delivery of health care to incarcerated individuals is a direct reflection of our political priorities: we neglect to serve our most vulnerable populations.
Right now, we are seeing the most obvious failure between the health and criminal justice systems in the way our carceral system has dealt with the outbreak of COVID-19. COVID-19 poses a particular threat to prisons and incarcerated populations that is unimaginable from the outside. Our understanding of the virus, and our subsequent reactionary policies, hinge upon the fact that the virus itself is highly transmissible– our strategy for ameliorating the transmission is the concept of “social distancing.” However, rules of social distancing cannot be practiced within the prison itself. The physical manifestation of incarceration implies and necessitates enclosed quarters, poor sanitation, and lack of access to personal protective equipment. In fact, it is built into the DNA of our carceral system to encourage overcrowding. Regulations set forth by the government do not consider the built environment of prisons, nor the unattainable task of providing clean surfaces, adequate ventilation, and safe shared areas. In no other population are we seeing such an egregious form of negligence during the COVID-19 pandemic. Incarcerated individuals are four times more likely to test positive and two times more likely to die from COVID-19. In the Central Michigan Correctional Facility, almost two-thirds of inmates have tested positive for COVID. In Oregon, inmates have sued the state government because their Eighth Amendment rights are being violated. How our carceral state functions is evidently incompatible with health in the face of COVID-19. That which follows is an immeasurable loss to our community and a violation of one of our most fundamental tenets of health, justice, and healing.
To regard these deaths as negligible or unimportant is to ignore a humanitarian crisis occurring in our nation. The answer is decarceration. We must advocate for the release of medically vulnerable individuals, including individuals over 55, pregnant women, those with comorbidities, and those who are being held in jail without charges. Governments should also consider restorative justice principles when commuting sentences of those who have committed person-to-person crime. Other countries, like Iran, have released 70,000 individuals to limit the spread of COVID-19. Yet, in the US, state governments have only just begun to release individuals under strict restrictions. In many cases, release is contingent upon a variety of immutable factors by the individuals themselves. It is irresponsible and negligent to uphold these restrictions, particularly without accounting for the possibility of individuals’ rehabilitation and transformation while they serve their sentences. Our responsibility is to lend our voices to this issue — anything else would permit harm in our communities, allowing our health care system to fail our most vulnerable community members once again.
Many of us consider the walls of prisons to be impermeable, but they are not. They are porous and between them move mothers, fathers, sisters, brothers, children– humans. They deserve to live without fear of death and dying.
Yet, where there is conflict, there is also contact. It is at these places of conflict where we have the power to intervene. This, in the medical field, is something we know intimately. We have the power to either allow for violent structures to endure or make decisions to begin the process of reckoning with our past for a more just future.
In health care, we have the unique position to enter our patients’ lives when they experience pain: to hold their hurt and treat their symptoms. We do everything in our power to problem solve and oppose threats to our patients to ensure that they will no longer need interventions. We must understand that this same obligation and these same principles can be applied to our communities. We have the ability to observe the pain, the injustice, and to demand that the wounds that have been inflicted upon our communities be healed.
Anna Ayala is a medical student.
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