Even Dead Bodies Must Work - Office of the High Commissioner for ...

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people. You see, here we sleep in one room—sometimes 70 people, or 80. If you are sick, definitely you will infect others. If they are also sick, they will infect you.” 222 Testing We worry a lot when people are coughing that we might catch the disease. No one has ever checked us for TB here. Normally when the nurse comes and people complain about the cough, he says, “I don’t have the gadgets to test you.” He gives you some tablets and says, “Let’s see what will happen next.” — Owen, Kitalya Farm Prison, February 28, 2011 Regular TB screening is a well-established cornerstone of prison health. Since 1993 the WHO has explicitly recognized the need for “vigorous efforts” to detect TB cases through entry and regular screenings in prisons. 223 On Human Rights Watch’s visits to Ugandan prisons, screening for TB was taking place only at a few of the reception centers located near larger towns. 224 The prison medical authority reported that entry screening had recently been scaled up to 21 prisons from three original pilot sites, 225 and he has plans to scale up entry screening for TB further. 226 But he admitted: “We are wondering why we stayed too long to do that. The findings are shocking.” 227 Outside the major reception centers, TB screening for prisoners upon entry is not taking place. Twenty-eight percent of male prisoners and seven percent of female prisoners interviewed by Human Rights Watch said that they had been tested for TB during the period of their incarceration. Twenty-two percent overall, the percentage of prisoners tested for TB varied between categories of prison and fell to only 11 percent at former LAPs. Just over one-third (36 percent) of prisoners interviewed said that they had coughed for longer than two weeks since incarceration, but nearly three quarters of these prisoners had 222 Human Rights Watch interview with Johnson, Bubukwanga Prison, November 16, 2010. 223 Joint United Nations Programme on HIV/AIDS (UNAIDS), “WHO Guidelines on HIV Infection and AIDS in Prisons,” UNAIDS Best Practice Collection, 1993, http://data.unaids.org/Publications/IRC-pub01/JC277-WHO-Guidel-Prisons_en.pdf (accessed March 3, 2010), pp. 7-8. 224 TB screening was reported by officers at Fort Portal Women’s and Men’s Prisons, Masaka Ssaza and Masaka Main Prisons, Murchison Bay and Luzira Upper Prisons. 225 Human Rights Watch interview with prison medical authority, UPS, March 11, 2011. 226 UPS, “Work Plan and Budget,” p. 12. 227 Human Rights Watch interview with prison medical authority, UPS, November 18, 2010. 39 Human Rights Watch | July 2011
not been tested for TB (28 percent had been tested). Some of those prisoners who had been tested had never received the result. 228 Table 3: Prisoners Interviewed Reporting Cough Longer than Two Weeks Tested for TB % of Prisoners Reporting Cough Lasting Longer than Two Weeks (n) n=124 % with Cough Over Two Weeks Who Were Tested for TB (n) n=44 Overall 36% (44) 27% (12) Farm Prisons 48% (10) 20% (2) Former LAPs 39% (16) 25% (4) Regional Reception Centers 29% (18) 33% (6) Case detection rates for TB in the UPS are unknown, 229 but it is widely acknowledged that infectious TB patients are not being identified. The director of the national TB program speculated: “TB missed? It must be big. Transmission in prisons may be 10 times higher than in the general population. When you miss one, it is catastrophic.” 230 Preliminary results from a recent national drug resistance survey suggest that between one and two percent of TB cases are multi-drug resistant (MDR-TB). 231 In the prisons, testing for drug resistance exists only at Murchison Bay Hospital; the prison medical authority acknowledged that drug-resistant cases undoubtedly exist but are not detected. 232 Treatment Uganda has been making progress in treating TB in the general population, though significant gaps exist. 233 Among the prison medical facilities, only Murchison Bay Hospital is accredited to manage TB. 234 Elsewhere, the prison medical authority envisions that TB 228 Human Rights Watch interview with Jonathan, Masaka Ssaza Prison, November 22, 2010; Pius, Muinaina Farm Prison, March 3, 2011; William, Muinaina Farm Prison, March 4, 2011. 229 UPS, “Work Plan and Budget,” p. 12. 230 Human Rights Watch interview with director, National TB and Leprosy Programme, March 10, 2011. 231 Ibid. 232 Human Rights Watch interview with prison medical authority, UPS, March 11, 2011. National TB guidelines in Uganda note that prisoners are a risk group for drug-resistant tuberculosis. Republic of Uganda Ministry of Health, “Manual of the National Tuberculosis and Leprosy Program,” p. 47. 233 Between 1996 and 2006, the coverage of directly observed treatment, short-course (DOTS) expanded from 0 to 100 percent. The DOTS treatment success rate among new sputum smear positive cases was 73 percent. World Health Organization, “Country Profile: Uganda,” 2008, http://www.who.int/tb/publications/global_report/2008/pdf/uga.pdf (accessed August 10, 2010). DOTS coverage is defined as the percentage of the national population living in areas where health services have adopted DOTS. DOTS treatment success rate is defined as the percentage of new smear-positive patients that are cured (negative on sputum smear examination), plus the percentage that complete a course of treatment, without bacteriological confirmation of a cure. 234 Human Rights Watch interview with prison medical authority, UPS, March 11, 2011. “Even Dead Bodies Must Work” 40
Page 1 and 2: Uganda “Even Dead Bodies Must Wor
Page 3 and 4: Copyright © 2011 Human Rights Watc
Page 5 and 6: Prisons Service Failures of Managem
Page 7 and 8: Definitions and Acronyms ART or ARV
Page 10 and 11: Summary If you say you’re sick, t
Page 12 and 13: available in the prison medical sys
Page 14 and 15: Key Recommendations For Immediate I
Page 16 and 17: Methodology This report is based on
Page 18 and 19: Caution should be taken in generali
Page 20 and 21: center prisons. Individual officers
Page 22 and 23: The Ugandan Healthcare System While
Page 24 and 25: wards routinely sleeping twice or t
Page 26 and 27: confiscated all or a portion of the
Page 28 and 29: less quantities of food items,” l
Page 30 and 31: when issued, kept in good order and
Page 32 and 33: Many prisoners said they had to wor
Page 34 and 35: Despite the prohibition in Ugandan
Page 36 and 37: to Kampala for distribution to pris
Page 38 and 39: cultivated but also processed the m
Page 40 and 41: they knew corporal punishment was b
Page 42 and 43: these people [with mental disabilit
Page 44 and 45: few hours to two weeks, as specifie
Page 46 and 47: equivalent to that available to the
Page 50 and 51: suspects will be transferred to reg
Page 52 and 53: will receive visitors and be able t
Page 54 and 55: testing at health centers when allo
Page 56 and 57: We, the sick ones, remain in the wa
Page 58 and 59: When I arrived here, on that very d
Page 60 and 61: Hygiene- and Sanitation-Related Ill
Page 62 and 63: facility.” 323 The WHO protocol f
Page 64 and 65: incarceration. 339 The president of
Page 66 and 67: Table 6: Months in Detention for Re
Page 68 and 69: crimes—in itself a violation of i
Page 70 and 71: Numerous prisoners told Human Right
Page 72 and 73: Unnecessary and extended pretrial d
Page 74 and 75: of two prisoners remanded at Bubukw
Page 76 and 77: The prison death register confirmed
Page 78 and 79: supervisory duties over lower units
Page 80 and 81: Uganda for AIDS relief, 457 with di
Page 82 and 83: IV. Recommendations We need resourc
Page 84 and 85: • Establishing guidelines for ref
Page 86 and 87: To the Uganda Ministry of Health
Page 88 and 89: HUMAN RIGHTS WATCH 350 Fifth Avenue
Page 90: H UMAN R I G H TS WATCH 350 Fifth A

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