Geoscience Reference
In-Depth Information
attributing all of the problems associated with a focus on marginalized groups
to one of attitude or disposition ignores structural and institutional issues,
which exert significant influence over individuals' abilities to take on new
ideas and to act in ways to improve health care.
Structures in post-Soviet health care
The primary aim of the Task Force was to fight the spread of communicable
diseases in the Baltic Sea region. Intuitively, a massive disease-focused cam-
paign might seem the logical way to proceed. However, a purely disease-based
approach would not have been sufficient. The structure of the health-care
system needed to be addressed as well. There were many structural impedi-
ments to project implementation that became evident during the lifetime of
the Task Force. Many of these countries are still transitioning from previous,
Soviet practices. The challenges posed by the old Soviet tradition are many,
both in terms of the prevailing culture and social structure. In this section,
we explore the challenges to reforming prison health care as a continuation of
some of the issues outlined above and discuss the challenges to public health
care in terms of communicable diseases, particularly the relationship between
general practitioners and specialists.
Civilian health care and the prison authorities
The strong, vertical segmentation of government was a characteristic trait of
Soviet public life. The different branches of the state lived their own lives, in
many ways isolated from the rest of society. The prison authorities were not
an exception to this rule, and this has become a problem when dealing with
issues associated with controlling the transmission of communicable diseases.
Overcrowded prisons, their ineffective ventilation systems and usually poor
hygiene are a breeding ground for tuberculosis (Stern 1999:13). The relatively
high prevalence of HIV caused by intravenous drug use and other high-risk
behaviour also increases the likelihood of further infections or the progression
of inert to active and contagious tuberculosis (Farmer 1999:72). Obviously,
the infected inmates are not only a danger to each other. Prison sentences last
only so long, and sooner or later infected prisoners are released into the gen-
eral population. It is vital that the civilian health services are kept informed
of prison conditions, as infected inmates will soon become their patients.
Effective communicable disease control requires well-developed surveillance
systems, which enable resources to be put in place where they do most good.
Reliable surveillance cannot, of course, be achieved if a major source of infec-
tion, namely the prison system, does not coordinate with the civilian health
authorities. The need to integrate prison-based health care with civilian health
care is also part of international standards on the treatment of prisoners:
 
Search WWH ::




Custom Search