Dr Amanda Brown
By the end of January 1981, she completed the final part of her training and was registered with the GMC, On finishing her junior house jobs, she then spent the next 6 months as a senior house officer in Psychiatry at Wexham Park Hospital, in Slough. She secured back then, a place on a three-year GP training scheme, based in Heatherwood Hospital in Ascot. In 1984, she was offered a job in a GP practice comprising of six men.
Two years after leaving her GP practice, she was involved in a project that aimed to try and improve end of life care- it was set up by Buckinghamshire Hospitals Trust. The project’s aim was to try and improve end of life care, avoiding hospital admissions if possible by developing a safe and a suitable alternative patient pathways, particularly for the elderly and vulnerable. A major part of the project was trying to enable people to be able to plan for their end of life care.
If that is a conversation you think you never wanted to have, she assures you that the alternative can be much worse. Her time was split between the community, care homes and hospitals and, frequently, once it came to the latter, the fight grew ever more difficult. It was no the fault of the staff, this includes the doctors and the nurses who did their very best to keep the oversubscribed hospitals functioning. It was hard for them to meet the demands; there was never enough beds, there were crazy targets to achieve. There were frail, elderly, vulnerable and often confused people at the end of the journey, waiting to be assessed by an overstretched A&E team.
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THE EVENTS TAKE PLACE AROUND DECEMBER 2013 TO FEBRUARY 2014
Huntercombe was where her life as a prison doctor started nine years ago. She arrived from GP Surgery, working as a prison doctor to treat young male offenders and then moving to Wormwood Scrubs which was one of the oldest and largest prisons in the country, working three days a week.
It was an exciting and challenging life; everyday brings new difficulties, new aces and new purpose. Her life as a locum was never certain- I mean, so much of her work was temporary, she’d cover annual holidays, sick leave, and sometimes working in prison for one or two days. Her reality was this: her work could dry up anytime or she might become ill and unable to work so she was determined to work as hard as she could while she was able to! Even though her boys were all grown up, she wanted to be able to financially help them as much as she can.
Offender Health-A partnership between the UK Prison Service and Department of Health to improve the standard of healthcare in prisons. The aim is to provide prisoners with access to the same quality and range of healthcare services as the general public receives from the NHS. The Offender Health Division is responsible for leading on development and delivery of a cross-government Health and Criminal Justice Programme, with the aim of improving health and social care outcomes for adults and children in contact with the criminal justice system, focusing on early intervention, liaison and diversion. This is also a key component of the Reducing Re-offending and Health Inequalities Agenda, as many offenders have mental health and/or substance misuse problems and social care needs.
Certified Normal Accommodation (CNA) is the prison service’s own measure of how many prisoners can be held in decent and safe accommodation. Any occupancy above CNA means that the prison in question is overcrowded. Prisons in England and Wales fall into four separate security categories. Some prisons can operate under more than one category.
Category A: Category A prisons are high security prisons, holding those individuals considered the most threatening to the public should they escape. Category A prisons should not be overcrowded, given the high levels of security required.
Category B: Category B prisons, or local prisons, are the largest category of prison. They tend to hold un-sentenced prisoners, prisoners on remand awaiting trial, short-sentenced prisoners or those newly sentenced and awaiting transfer to another prison category. Category B prisons tend to be the most overcrowded, with a constantly churning population.
Category C: Category C prisons are sometimes called ‘training prisons’. They are meant to offer education and training to prisoners and the vast majority of prisoners on longer sentences will spend time in Category C accommodation. Historically not overcrowded, we now see more and more Category C prisons running overcrowded regimes.
Category D: Category D prisons offer open conditions and house those who can be reasonably trusted not to try to escape. Prisoners in Category D prisons will be given Release On Temporary Licence (ROTL) to work in the community or go on home leave, usually returning to the prison in the early evening. The majority of Category D prisoners will be towards the end of their sentence, and their period in open conditions is preparing them for their eventual release. Category D prisons tend not to be overcrowded.
History
Huntercombe was built as an Internment Camp during World War II. After the war the site opened as a prison in 1946. The site has seen renovation over the years so that very few wartime buildings remain today. Previously the prison had held adult males and was a Borstal to up to 1983, but in 2000 Huntercombe became a cellular prison for male juveniles aged 15 to 18. Originally an internment camp during World War II, Huntercombe opened as a prison in 1946. Since 2010, Huntercombe has exclusively held category C male foreign nationals.
An October 2002 report by Her Majesty’s Chief Inspector of Prisons heavily criticised Huntercombe for being severely overcrowded. The report described the prison as unsafe and recommended a large reduction in prisoners being held there.
In April 2007 a report from the Independent Monitoring Board stated that Huntercombe was failing in its central purpose to rehabilitate inmates. The report also criticised the fact that prisoners with serious mental health conditions were being sent to Huntercombe despite the fact that the prison did not have the facilities to treat them. However the report praised staff at Huntercombe and the prison’s approach to race relations.
In June 2010, Huntercombe was decommissioned as a juvenile prison due to a national decrease in Juvenile offender numbers. The prison was reopened in October 2010 as a Category C jail for up to 400 adult males and now holds a solely foreign-national population mainly awaiting deportation.
Front-line clinicians are key to the reformation of improving the health of offenders.
Kofi Aboah
A man from Ghana over six foot-he had a very large swelling on the left side of his neck. His notes mentions that he has advanced tonsillar cancer, it was too advanced, clutching onto a photo-he remembers his beautiful wife Amba, his daughter Esi and his son Yooku. “They are perfect too. Two boys and a girl.” He was in a lot of pain, he remembers Kwame who was born with a deformed spine, he laments that he’s here to suffer as he does, he is in prison because he smuggled twenty kilograms of cocaine into the country. Our doctor could not stop thinking about Kofi.
Daniel Kobe
There was a knock on the door, a man in his late forties stood in front of her, “I’m here because I’ve sprained my wrists,” he said. He injured his arm a few days ago at the prison gym. His self-diagnosis of a sprain was correct.” A compression bandage and some anti-inflammatories will do the trick.”
Usama
He is a much younger man in his late twenties. Notes say that he was from Syria and that he had a history of self-harm. As he rolled up the sleeves of his tracksuit; to reveal both of his forearms to be raw. “I cut them on anything sharp I can find.” His story started when hey protested the regime of President Assad; there were tanks, soldiers, bullets and death. He went with Elias, he was a homosexual, his eyes were dead. Desperation made them agree to a business with drug smugglers who wanted more money than they were paid. His eyes turned pink, they had little choice, on his notes it read that he was seeking asylum, the last thing he wanted was death returning to his homeland. He was already on antidepressants and under the supervision of the mental health team for counselling. A nurse named Saroj was ready to clean and apply dressings to his cuts. He remembers later on for the medical help she provided him.
Habib Khan
He was one of her first patients, he was in need of a chair to take up his two hundred and thirty four kilos-on asked on how he’s so heavy he recounts of how he was slim, fit and beautiful and could climb mountains-of course, he came from Karachi. It had all the best restaurants, London had good restaurants. His biggest regrets were of selling cream tea and selling cocaine. His entries were from Rowena, a dietitian-she worked at Huntercombe two mornings a week. He finds her terrifying when she talks of arteries. He talks to her of a terrible rash that is sore and itchy, on top of his legs, an awful smell escaped the room, the areas were raw with a little blood, looked like it had been like that for a considerable amount of time. “It’s not cancer, it’s a very common rash called intertrigo that usually affects areas of the body where the skin rubs together and traps moisture.”
“See you in a few weeks.”
Bogdan Kolev
He was a young Bulgarian man of 26 years, she treated him on her first day at Huntercombe, when he needed help with a shoulder injury. He came to the UK working as a labourer, a fight-and-manslaughter conviction got him remanded into the Young Offender Institute HMP Isis. Then, he was transferred to HMP Belmarsh after he was sentenced, now he was in Huntercombe prior to his deportation with two years left to serve. He was diagnosed with latent TB while at Belmarsh, and was completing a three month course on Rifinah, isoniazid and pyridoxine. He was screened at Huntercombe, his hepatitis core B was found to be positive. The results for hepatitis A and C are negative. He turned anxious on being informed of so. ‘She tell me I’m dying!’ He was in a frenzied panic and had picked up a chair swinging it above his head, Luke pinned him to the floor, in all the commotion officers managed to restrain him and put him in handcuffs. These, were one of those rarer incidents our doctor discloses.
Sources;
The Prison Doctor: THE FINAL SENTENCE
https://medical-dictionary.thefreedictionary.com/Offender+Health
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