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Fragmented careIncarcerated women are the sickest demographic in the U.S. This is because prison conditions are unhealthy and healthcare is inadequate in prison, and because women coming in to prison are already sicker. In fact, being ill and poor is a risk factor for going to prison. At the 2008 National Women's Studies Association conference in Cincinnati, Ohio (see June-July 2008 N&L), "Disrupted Lives, Fragmented Care: Illness Experiences of Criminalized Women" was a paper presented by Susan Sered of Suffolk University. She looked at women in a Massachusetts prison. Most women prisoners in Massachusetts have not committed serious crimes but are there because they violated probation for very minor infractions: prostitution or petty theft. In California, where I work with women prisoners and edit The Fire Inside, women are incarcerated in huge numbers (over 11,000). In Massachusetts, there are around 600 women state-prisoners. If California incarcerated women at that rate, they would only lock up around 3,000. California prisoners fought the systematic medical abuse, which even the federal court found criminal, with prisoners dying needlessly every day. Sered's study took an extensive health history of the women prisoners. It was not the case that the women had no access to care; in fact the number of facilities they received care from was overwhelming. Dealing with that many providers resulted in a very fragmented, disrupted care. These are women whose lives, in general, have already been fragmented. While Massachusetts apparently has a large number of clinics and other care providers, they are oriented around conditions they treat, like dental, reproductive or emergency care. They don't coordinate care for the women. Their "object" is the condition they are set up to address, not the whole person. Most of the women have been sexually abused, many as children; many have been in foster care, juvenile facilities, homeless shelters, rehab programs, etc. Prison is just one more stop for them. Almost all have both chronic and acute medical problems such as diabetes and/or high blood pressure. Many also have dental and mental health problems. None have health insurance. They all have had some access to Medicaid, but it is on-again-off-again access, which contributes to disruption of care. They might see a therapist once and never get scheduled for a follow-up visit. Most of the women have been married. None of their relationships last. Some have been pregnant and lost all pregnancies due to severe beatings by boyfriends or other causes. A large number have learning disabilities, which make it impossible for them to coordinate their own care. Their housing, too, has been disrupted as they sometimes qualify for Section 8 housing but then lose it as a friend or a relative begs to stay with them. Their lives are spirals of disruption, they have no stability, no one who cares about them. The medical system only reinforces the parade of strangers, for whom the women are expected to disrobe physically, mentally and emotionally. This study was remarkable as it concludes that merely more services do not solve the problem. The humanity of the women prisoners, their total life, is not reducible to being a recipient of services. The conclusions I draw are that prison shows what is wrong with society at large: that healthcare focused on disease, not the patient, is not adequate. The lives of these women illustrate how this society failed them, how it is not a society for the people it creates. It shows why we need a fundamentally different conception of the "we" that is necessary to create the best possible individual "I"s. |
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