Violence and the threat of violence, physical and psychological, are thus almost constant features of the prison. This can extend to the prisoner’s families and friends on the outside and is a powerful tool in determining the behaviour of the prisoner. The medical staff usually sees only the tip of the iceberg, or total denial. It is amazing how many accidents happen in prisons – prisoners falling out of bed, slipping in the showers, bumping into steel doors and spilling boiling water on themselves. It is even more amazing that people who will run to the doctor with a minor cold can medicate themselves for very serious injuries which might otherwise require sutures, plaster casts or surgical intervention. Prisoner victims are often very loathe to report their victimisation by other prisoners.
This might limit the possible contribution to prevention and treatment of violent incidents by the medical staff, especially in a situation where the doctors are seen as part of the official establishment. There might be a temptation for medical staff to become complicit in ignoring the real causes of injuries by simply providing appropriate treatment when the patient presents and leaving things at that. But there is also an opportunity to take steps to protect the individual patient from further victimisation and perhaps to contribute to lessening the general incidence of violence in penal establishments.
Consider your response to the following scenario:
You are aware that a power struggle has been going on in your prison as a new group of prisoners connected with organised crime on the outside has attempted to take over dominant positions, including the best jobs, cells, clothing and food, in the prison. This has resulted in a number of prisoners presenting at your clinic with injuries including stab wounds, slashes, bruises to the face and genitalia, and with high levels of stress.
These prisoners provide "accident" explanations for their conditions, forensically inconsistent with their symptoms. You have also observed several other prisoners with obvious injuries, but only a few actually seek treatment from you. Some of those consulting you seek your support to have them moved - to the hospital wing, a psychiatric placement or to another prison.
Do you challenge individual prisoner's accounts of the cause of their injury?
Your answer