WHO HEALTH IN PRISONS PROJECT(WHO HIPP) BEST PRACTICE AWARDS SCHEME 2009 APPLICATION FORM

Transcription

1 WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR EUROPE ORGANISATION MONDIALE DE LA SANTÉ BUREAU RÉGIONAL DE L'EUROPE WELTGESUNDHEITSORGANISATION REGIONALBÜRO FÜR EUROPA WHO HEALTH IN PRISONS PROJECT(WHO HIPP) BEST PRACTICE AWARDS SCHEME 2009 APPLICATION FORM Before filling in the form please visit the web site of the Collaborating Centre of the Health in Prisons Project (which is hosted by the University of Central Lancashire) at the following web address, where you will find useful background information on the award: When completed please return the form electronically to your WHO Health in Prisons Project National Counterpart for consideration. The decision to forward applications to the International Judging Panel rests with your National Counterpart. Please indicate the category (you may choose only one) for your application, by typing an X in the box against the correct category x Category 1: an example of best practice regarding health care services provided to prisoners. This category includes any aspect of the clinical care provided to prisoners by doctors, nurses or other healthcare professionals. Category 2: an example of best practice regarding any of the following, or a combination of the following: prevention, health education or health promotion services provided to prisoners. For example, members of staff (not necessarily medically trained staff) working within the prison might provide the service, or it may involve peer education i.e. using specially trained prisoners. Category 3: an example of best practice, which demonstrates effective co-operation between a prison and the outside community, in the area of health improvement. This category includes any aspect of improving the health and well being of prisoners. Contact details of the person in the prison managing the application: Name: Gerardo Ramón López Palacio Job Title: Medical Deputy Director Address: Carretera de Berria s/n. Santoña (Cantabria). gerardo-lopala@hotmail.es Tel No: Fax No:

2 BACKGROUND INFORMATION Title of your piece of work: Visual impact on the history of HIV in prisons: reporting and raising awareness on the disease Name of country: Spain. Name of prison: Centro Penitenciario El Dueso. Dirección General de Instituciones Penitenciarias. Ministerio del Interior. Brief description of the prison and prisoners (not more than 200 words): El Dueso, which was conceived in 1907 as a modern prison because it incorporated elements to improve social rehabilitation by means of inmates working in large open spaces, is located in Cantabria, in the centre of Santoña and Noja marshes Natural Park. It has 330,000 sq m and is surrounded by a 3000m long wall. El Dueso is divided into three Departments which share a large open courtyard which enables inmates to have an extraordinary freedom of movement and free access to all services (health, treatment, kitchen, laundry, store, school, workshops, gym, educators, soccer field, tennis and basketball courts). El Dueso looks more like a town centre, something which makes it different from other facilities. It also has a high potential for productive work and cultural and sport activities. El Dueso has approximately 600 inmates (throughout 2007 and 2008, about 400), convicted males who have been classified as 2nd treatment degree because they suffer serious health problems. 60% of them have a history of drug addiction, 30% are HCV- positive, 10% HIV-positive (98%of whom present HCV too), 63% are infected by Mycobacterium tuberculosis and about 40% suffer some psychiatric disease. PURPOSE OF THE WORK 1. What is the aim or general objective of your initiative or piece of work (in just one sentence please)? We intend to represent by means of a table-panel health treatment supplied to an HIV patient through their stay in prison. We can therefore show the number of medicines he took and equivalently show the development of health programs implemented in Prison Health between 1992 and

3 2. What are the main characteristics of the target group(s)? Is it targeted at all prisoners, or a particular group or groups? e.g a particular age group. Are others being targeted e.g. such as staff involvement or involvement of families. What is the coverage of the work e.g. how many persons are being reached? The project targets different populations, especially all inmates in the facility. They are convicted men (15% are foreigners) with an average age of 39 years, an average stay of 1 year and 8 months and a poor health status as it has been previously stated. The Project targets all the inmates who usually live in the facility, regardless of their health status. It also reaches all the staff working in the facility, who were offered information and education regarding the prevention of the disease and outside students (Secondary Education, High school in Santoña), health professionals, inmates relatives and in general citizens as part of a prevention strategy. The Project started with the participation of 24 Penitentiary Department professionals (most of them from the facility s staff). They took part directly in the 3

4 design, assembly and transport of the table-panel. We have also counted with the special participation of 12 inmates who were part of the Health Agent Group trained in this facility (Domino Effect Program). It can be estimated that the project has reached a relevant number of people (5034 visitors). 3. Why this initiative is important? What is the health need you are addressing? Has there been any form of needs assessment undertaken? Were you drawing upon any evidence or research to inform the piece of work? If yes please briefly refer to it here. HIV is the most important public health issue in prisons since the end of 1980s. In Spain, the epidemic quickly developed, specially amongst young intravenous drug users, therefore constituting an infectious source for their sexual partners and their offspring. Prisons, which mirror their contemporary times, housed in 1980s and 1990s a large number of HIV-positive inmates (30%), triggering a health emergency. The lack of effective treatments at first only enabled a preventive and palliative approach, where a large number of patients deceased. Prison Administration had to significantly increase health resources and programs to meet and face the new assistance needs. The eventual appearance of new effective retroviral treatments has increased therapeutic possibilities and they are turning HIV more and more into a chronic disease. On the other hand, a lot of damage reduction programs have been implemented, which have therefore decreased the illness s prevalence This table represents graphically and equivalently the different stages of the treatment which an HIV patient follows while in prison, as well as prevention and health promotion programs within Prison Health: Tuberculosis prevention and control program (TBC), flu, tetanus, HB, and pneumococcal vaccination, damage reduction programs: methadone, syringe exchange program, supply of hygiene products with bleach, condoms supply, with the cooperation of different national and autonomous organizations. We have also noticed an extraordinarily important reason regarding the disease s incidence, the high number of patients who were infected with both HIV and HCV, were also intravenous and not intravenous drug users, Mantoux positive, contacts, which imply risk factors associated to developing HIV. We also think that our initiative is important because we intend to improve the commitment towards our patients and the services that we provide. Furthermore, we have presented a new idea to reflect in a descriptive and visual way HIV s impact on patients and its treatment, although we carry out a complete education program with both the Domino Effect and Nacar programs and we innovate with new treatments. The criteria established by the Centres for Disease Control, the HIV Prevention Program within prisons as well as those by the National Plan on AIDS have been adopted. Checking out how effective visual impact on other exhibitions regarding health was, and how using original and creative techniques helped assimilate the objective, encouraged us to create the table-panel as a strategy for health education. 4. What did you set out to achieve, and how successful were you? Please list your specific objectives in order of importance, and any indicators used to help you measure progress. (NOTE any evaluation should refer back to these objectives and indicators, indicating progress towards meeting them.) 4

5 The objectives which were proposed were the following: 1.- Presenting graphically both to inmates and to the general population the evaluation of the treatment of an HIV patient as well as its means of transmission in prison and identifying associated diseases. The quantity indicator used has been the number of visitors. 2.- Exposing different health programs for patients in El Dueso. Quantity indicator used: number of visitors and inmates. Quality indicator: statements by inmates who have showed their interest or have requested further information on programs. 3.- Evaluating the importance of undergoing the treatment. Quality indicator: Register of subjective comments. 4.- Acknowledging patients their fight against the disease and Hospital, NGO, and National Plan on Aids staff their help. Quality Indicator: Appreciation and congratulation statements made by people responsible of those organizations. 5.- Involving all health staff members in a education program that can be easily understood by people in general. Quantity Indicator: Staff members involved: 100%. 6.- Cooperating with a new health education tool in preventing the incidence of HIV amongst the population. Quality Indicator: requests by different organizations to exhibit the table. Once the table is finished we can point out the following results regarding the proposed objectives: 1.- The estimated number of visitors to the exhibition has exceeded our expectations reaching 5034 visitors. The exhibition in Santoña in May 2007 was a great success, and numerous authorities and Prison Department staff members attended (327 visitors), as well as people in general and relatives (871). Although the exhibition was expected to last for 10 days it actually lasted for one month because health staff members explained the meaning of the exhibition and HIV prevention strategies to students in the High School Marqués Manzanedo (180 students) during several weeks according to teachers demand. The exhibition was also presented to health mediators from the penitentiary facility during a health education event on the 24th and 24th of May 2007 (29 people). Furthermore, the Head of Service of the Regional Plan on AIDS and the Vice- Chancellor of the International University Menéndez Pelayo, requested the exhibition to be moved to Palacio el Kursaal (Kursaal Palace) in San Sebastian in the National Congress on AIDS in June 2007 (850 visitors). It was also moved to the Magdalena Palace, the University s Headquarters (812 visitors) during a Penitentiary meeting for a week in August The exhibition was then part of the World AIDS Day 2007, by demand of the Citizen Anti-AIDS Committee in Teatro Romea in Burgos for 15 days (294 visitors) and by demand of the Nursing School for 2 months in the University Hospital Marques de Vadecilla (486 visitors). Finally the table was also exhibited in the Conference on Health in Prisons in Murcia in November 2008 (811 visitors). In El Dueso as well as being used as part of a workshop on HIV in 2007, 5

6 where 26 inmates attended, it was exhibited in 2008 as part of the activities of World AIDS Day 2008 (347 inmates) % of 5,034 visitors are estimated to have asked for further information on programs, pathologies or treatments. The great success entails a greater interest towards health programs, because of the increasing information requested to health professionals and health agents. 3.- The table has strengthened treated patients because they have been able to see how with new treatments AIDS, which was initially mortal, becomes more and more a chronic disease and their quality of life and life expectancy increase. This has been noticed because of their comments and statements. 4.- The amount of pills exhibited on the table reflects the courage and effort of patients in their fight against the disease. Members of the organizations involved have shown their gratitude to such acknowledgment. 5.- The team work carried out by 100% of the staff provides a table which entails a new tool in health education and HIV prevention. 6.- Our Project contributes to promote the prevention of HIV in a different way, therefore favouring the objectives from the National Plan on AIDS and the Penitentiary Facility. The table has been requested to be exhibited in different organizations but many requests have not been satisfied yet because of a lack of time and resources to move it. WHO WAS INVOLVED / WHAT WAS THE TIME FRAME? 5. Please describe: Those involved in delivery of the initiative? Give names, job titles and the employer of key people involved. Any prisoner involvement in the planning or delivery of the work. The time frame: When did the work commence? What did you do and when? Is there a finish date known yet? Gerardo López Palacio: Medical Deputy Director, coordinator of the Project. PHYSICIANS Pedro Álvarez Cimiano Carmen Benito Ruiz. María Nieves Fontecilla Herrera Carlos López Urcelay Elena Pujol Padró Gema Sánchez Real José Ramón Pallás Alvarez Javier Otero Piñal PHARMACIST Rosario Fernández Pérez NURSES José Ramón Borraz Fernández Pilar Fernández Prieto José María González Sáenz de Buruaga Inmaculada Juárez García 6

7 Angel López Sánchez Lurdes Nargánes Hospital Marta Reyero Marisol Wood Ubilla NURSING ASSISTANTS María José Barruetabeña Silva Jorge Bengoechea Ibaceta María Angeles Cuenllas Rodríguez Soraya Miramón Azcona. Lucila Monje Barragán Reyes Sánchez Blanco ADMINISTRATION Juan José Escagedo Calleja REGIME DEPUTY DIRECTOR Pedro Hernando Ranero HEALTH AGENTS 12 inmates have taken part and have been trained as health Agents, they have listened and understood the explanations of mediators, helped in moving the table, showed the table to other inmates in an Interactive or two-way way both in 2007 and during the events of World AIDS Day, handing out brochures, ribbons and condoms. TIME SCHEME OF THE PROJECT In 2007, on the occasion of El Dueso s hundredth anniversary, (it is the oldest prison in Spain), an exhibition on prison topics was held in Palacio Manzanedo in Santoña. The health Department decided to make a practical and visual panel table for inmates and people in general to see what the treatment of an HIV and other associated diseases patient implies during 16 years, using as an approximate guide an inmate s medical history. A longitudinal study on the medical history ( ) is jointly carried out by all health staff members and according to the Spanish Constitution sections 25.2 and 43.1 as well as to section in Prison Regulations: The person sentenced to prison shall be entitled to the appropriate Social Security benefits. Pharmaceutical assistance is recognized, the table depicts a typical inmate s profile from the end of 1980s and the beginning of 1990s. Therefore, 60% of inmates were or had been drug users, most usually of heroin, used intravenous drugs, were infected because of sharing syringes, lacked hygienic habits, had a low education level, low working activities, subtle family stability but frequent social uprooting, didn t use condoms in sexual intercourse, and suffered from associated diseases such as HIV/AIDS, HCV, HBV, TBC and psychiatric disease. Physicians considered the medical history of the patient and calculated the total amount of pills and other undergone treatments. We then outlined a sketch so that it could be moved to a panel table and wrote different health messages in explanatory cards. Other cards were later added which explained health programs which patients could follow during their stay in prison. The pharmacist then provided expired medicines and capsules with no drug inside so that its appearance was as real as possible. Nurses and Assistants prepared a wood table as a display case and stuck the medicines individually. It all resulted in a 15 x 1.30 m panel table with 46,775 pills, which describes the clinical monitoring of an HIV patient during his stay in prison, the means of 7

8 transmission of the disease and the treatments which he underwent. The treatment s evolution is noticed from the first drug against HIV (AZT), through the combined treatment (AZT and DDI) and the later appearance of TARGA with three antiretroviral elements which improve the disease s prognosis. In the course of time, pharmaceutical laboratories decreased the number of pills that have to be taken, reaching a daily pill which combines three different medicines (Atripla). Treatments for other pathologies are identified (herpes, seborrheic dermatitis, thrush, malnutrition, respiratory diseases, psychiatric disorders, HCV infection, etc.). The oral prosthesis and glasses financed by prison administration are depicted as well as prevention treatments such as tetanus and pneumococcal vaccination. Reports are carried out on the prevention of suicide, famine strike, health education campaigns, safe sex promotion, blood testing and hospital reports. Different treatments for damage reduction are exposed: health education, bleach distribution, safe sex promotion and condom distribution, maintenance program with methadone, sterile syringe access with the Syringe Exchange Program, health agents or pair influence as well as counselling and psychological interventions, therefore if our patient can not withdraw we can offer other solutions. There are moments which are especially critical such as personal, social, family or prison adverse situations which can trigger several events: opiate overdose, selfinjury, anxiety, reactive depression and famine strike. The great importance of following the treatment and the varieties regarding its nonfulfilment are exposed. Diseases such as tuberculosis and HCV are described as well as their treatment and WHO recommendations to eradicate tuberculosis, directly observed treatment. In our facility we provide directly observed treatment to tuberculosis patients, methadone treated patients, psychiatric patients and inmates with HIV who do not undergo completely the antiretroviral treatment. Finally, this table establishes two clearly different parts. The first one intends a visual impact because of its amount of pills depicted, which are chronologically ordered. The other one equivalently describes, by means of graphics, information brochures, reports, testing, programs (HIV, HCV, TBC, etc.), health assistance (glasses, prosthesis) and other prevention items such as condoms, lubricant, syringes. In short, as well as counting the amount of pills that a patient like this has to take, the table intends to serve as a health education tool for all those people who have the opportunity of seeing it. Its final objective is the WHO events that will take place in Madrid. EVALUATION 6. Was there an evaluation? If yes please detail findings (not more than 300 words). You may want to consider: Formative or process evaluation, concerning the quality and acceptability of your programme s implementation with the target group. Summative evaluation: what were the outcomes and impacts in relation to your Specific Objectives and indicators as listed above. 8

9 Both an objective evaluation, by means of counting the number of attendants, and a subjective evaluation have been done. The later has been especially satisfactory and it has evaluated the impact amongst different groups, exceeding our initial expectations by exhibiting our project in Centres and Conferences. Subjective statements made by visitors to the exhibitions show the acceptability of the project for both inmates and the general population. Furthermore, the panel table has had a large impact in the media, in all the towns were it was exhibited, confirming the importance of the project. In short, the number of visitors has exceeded our expectations, arousing interest amongst inmates towards different health programs. Many inmates have stated that the simplification of the treatments has greatly improved the undergoing of the antiretroviral treatment, something which has been largely confirmed by scientific reports. 100% of the members of the Health department participated and worked in a Project in which patients, relatives and several professionals have felt identified in the fight against HIV, showing their satisfaction and acknowledgement. This later triggered numerous requests for the table to be exhibited in different contexts. ABSTRACT 7. Now tell us in your own words about your piece of work or initiative and why it is important (not more than 500 words): Although our main objective was to transmit the evolution of the treatment and the difficulty of undergoing such treatments for an HIV patient in Spanish prisons between 1992 and 2008, because of the amount of pills, we were encouraged to take a step further and we decided to identify associated diseases and their relationship with HIV as well as to expose the different programs which have been offered to patients in El Dueso between 1992 and We have been able to prove that implementing the proper programs to reduce damages has improved the health status of drug users in general. Methadone programs have enabled thousands of inmates to stabilize their behaviour and in Spanish prisons a significant decrease of the prevalence of certain diseases such as HIV and HCV has been noticed. Vaccination programs have also determined HBV s control. On the other hand, offering efficient and pioneering antiretroviral treatments to our inmates has entailed a step forward for Prison Health patients, many of whom have succeeded to survive because of their imprisonment, even if it may seem paradoxical. Our Project is important because our objective was to identify the improvement that advance in new treatments means to our patients and the need of properly undergoing such treatments. Our formula for this health education was not very well known and had not been proved in our context, but it reached for the visual impact amongst attendants. We want to point out that we also find interesting that our Project targets not only seriously ill patients but all the imprisoned population, offering a different and new vision on preventing HIV. 9

10 On the other hand, we also wanted to offer relatives, public in general and young people in particular, a tool to know the problems associated to the transmission of HIV in order to decrease its incidence and contribute to its prevention amongst society. To conclude, if punishments entailing imprisonment shall be aimed at re-education and social rehabilitation, the improvement of their health status will undoubtedly help to improve the health of the society in which they must be rehabilitated. LEARNING POINTS 8. Finally, what are the most important specific learning points from your piece of work that you would like to share with others working with prisoners? (not more than 500 words) It is a very graphical and documented exhibition on the evolution of the treatment of an HIV infected patient as well as of the assistance programs and health promotion programs within a penitentiary facility. It offers very comprehensive information for all types of audience and it is very attractive because of its visual impact. It can be used as a tool for health education both as a one-way method and as a two-way tool. THE TABLE SPEAKS FOR ITSELF This is so that many patients (both inmates and citizens) have felt totally reflected in it. They have remembered the fight and concerns at the beginning of 1990s and the hope they felt in the HAART era. Some of them even cried while they remembered their experiences. We want to share that health assistance has to be closely related to education, so that patients assimilate the knowledge of the disease, the means of its transmission, its treatment, its prevention and becomes responsible of it. In order to do so, we need a broad and continuous program on health education. We need to use all the possible strategies so that we improve health habits and values. This table is so expressive that it can be used as an education tool, both by professionals and health agents. In El Dueso, awareness campaigns take place continuously, we use several education strategies and we intend to spread that both information and education lead to prevention. A good means to do so is with the table which depicts the consequences of not preventing the disease and how this entails taking such a big amount of pills during so many years. We want to underline that we can also innovate in our context and that with enthusiasm and team work we can develop different strategies for health education. The high awareness and motivation degree of all the people who have participated has entailed a very positive experience. Organizations that have exhibited the table and visitors have stated their satisfaction and we therefore think that it should be continuously exhibited in the future. We also want to state that this panel table also acknowledges all patients for their courage, will and effort in fighting the disease. We also want to underline the acknowledgement and respect that surveillance officers showed during the difficult health situation which took place during 1990s and during the progressive implementation of damage reduction programs. It also intends to acknowledge professionals from University Hospital Marqués de Vadecilla, for their invaluable assistance to our patients, NGOs for their support and members from the National 10

11 and Regional Plan on AIDS and the Regional Plan on Drugs for their help and cooperation. Note: please attach supporting photographs electronically to this application if you wish. They may be used in any subsequent publication of the awards. Thank you for filling in the application. Please send it electronically to your WHO Health in Prisons Project National Counterpart for consideration. The decision to forward applications to the International Judging Panel rests with your National Counterpart. Good luck! 11