Health and human security - Environmental and Human Security in the Arctic - page 177

Dealing with prisoners with active TB cannot be done in isolation. The
imperatives of treatment, the minimum six-month course, the permea-
bility of the prison walls, all require the prison treatment to be enmeshed
in a wider system. Rule 22(1) of the UN Standard Minimum Rules for
the Treatment of Prisoners requires that 'the medical services (in prisons)
should be organized in close relationship to the general health adminis-
tration of the community or nation'.
(Stern 1999:30)
Until recently, it has been difficult for the civilian health system and the
prison authorities to work together. The Task Force has been credited for its
substantial efforts to establish cooperation between civilian health and prison
authorities. Once again, though, we need to remember that the Task Force is
by no means the only initiative that has emphasized the necessity of coopera-
tion among civilian health and prison authorities. 18
In Russia, progress has been slower than in the Baltics, though there is
movement. One aspect of public-prison cooperation, which Western partners
need to be aware of, is that prison and civilian health services belong to two
different hierarchies. The penal system in Russia is under the Ministry of
Justice of the Russian Federation, and is thus a federal agency. It has a higher
status than the civilian health service, which is a regional or a municipal
agency, depending on the type of services provided. For example, the tubercu-
losis dispensaries are usually part of the oblast or provincial administration. In
Russia, the psychological and legal barriers to cooperation between regional
and federal structures are significant, and inter-agency and inter-governmen-
tal cooperation during Soviet times was unheard of.
We observed these legal barriers in action in Arkhangelsk Oblast, where
the need to improve laboratory services has been urgent for some time both
in the civilian sector and penal system. To a Westerner, the obvious, most
efficient and cheapest solution would be to establish a dedicated laboratory
to serve both systems, but according to a Russian interviewee, a combined
solution would in fact be in conflict with Russian law. She said it was very
difficult to get Western partners to comprehend the situation. Another inter-
viewee said that 'in the prisons there are too many rules and regulations,
which they have to follow. It is difficult for them to be flexible. They have
their own difficulties, and live by their own laws.' As one Western inter-
viewee put it, 'they lose synergies and competence by retaining the dual
system. The two systems “steal” competent medical workers from each other,
and, besides, neither of them are sufficiently busy to need a whole laboratory
for themselves', articulating a view that rejects the resignation of the Russian
explanation. An example from St Petersburg shows that innovative solutions
can be found. There, the city authorities provide medical help for the federal
prison, the Kresty. This assistance is not formalized, but it shows that cross-
sector cooperation is possible.