Health provision and health professional roles under compromised circumstances: Lessons from Sierra Leone’s prisons
| Author | Ahmed S Jalloh,Andrew M Jefferson |
| Published date | 01 November 2019 |
| Date | 01 November 2019 |
| DOI | http://doi.org/10.1177/1748895818787016 |
| Subject Matter | Articles |
https://doi.org/10.1177/1748895818787016
Criminology & Criminal Justice
2019, Vol. 19(5) 572 –590
© The Author(s) 2018
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DOI: 10.1177/1748895818787016
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Health provision and health
professional roles under
compromised circumstances:
Lessons from Sierra Leone’s
prisons
Andrew M Jefferson
DIGNITY – Danish Institute Against Torture, Denmark
Ahmed S Jalloh
Prison Watch – Sierra Leone
Abstract
This article adds to a growing body of empirical work on prisons in the global south. It
reports on a survey into prison health provision in Sierra Leone, West Africa conducted
by a local non-governmental organization (Prison Watch – Sierra Leone). Taking the survey
results as the point of departure and engaging with the limited literature on prison health
provision in the South we discuss the role of health professionals in preventing violence
in prisons, suggesting that, under compromised circumstances where a punitive penal
ethos often subverts good intentions and appeals to professionalism, advocacy for prisoner
health and torture prevention initiatives must be broad-based and include a more radical
questioning of the foundations of the penal apparatus. Such circumstances call for a more
critical interrogation of dominant forms of penality and generic modes of intervention than
has hitherto been the case.
Keywords
Compromised circumstances, letting die, prison health, Sierra Leone, torture prevention
Corresponding author:
Andrew M Jefferson, DIGNITY – Danish Institute Against Torture, Bryggervangen 55, Copenhagen, DK
2100, Denmark.
Email: amj@dignityinstitute.dk
787016CRJ0010.1177/1748895818787016Criminology & Criminal JusticeJefferson and Jalloh
research-article2018
Article
Jefferson and Jalloh 573
Introduction
Where the autonomy of the self is systematically violated […] health may become just another
battleground for power over the lives of inmates. (Ross, 2013: 79)
Over the last decade or so prisons in the global South have received more attention from
scholars than ever before. There is a growing body of empirical, theoretical and meth-
odological work that strives to illuminate and learn from penal institutions and justice
delivery practices in the South, particularly Africa and Latin America but also Asia. This
development is perhaps most clearly illustrated by the inclusion in the recent new edition
of the Handbook of Prisons of a whole new section on international perspectives (Jewkes
et al., 2016).1 This work has been produced by criminologists and others often working
across disciplinary boundaries and often having dual commitments to knowledge gen-
eration and changing practice. Some of the work is co-produced through alliances
between academics and activists. This article has such roots.
Prison studies are important to illuminate sites where the state’s power to punish is so
clearly evidenced (though ironically often rather opaquely). But within social science we
find multiple examples of prison studies that cast light on much larger themes related, for
example, to the relationships between confinement and subjectivity and state and society
(e.g. Foucault, 1979 [1975]; Garland, 1990, 2001; Goffman, 1961a, 1961b). In their articu-
lation of the concept of prison climate, informed by empirical work in Africa and Asia,
Martin et al. (2014) identify three universal themes of significance to understanding prisons,
namely survival, governance and transition. These themes are illustrative of the way the
prison as a compressed, occupied site exemplifies issues that have fundamental significance
for the way we understand the relationship between persons and worlds. Survival – how do
people cope, manage, deal with or handle circumstances over which they have limited con-
trol? Governance – how is authority distributed and exercised? And transition – how do
institutional practices persist and mutate? This article, is about prison health provision in one
of the world’s poorest countries. We consider the role of the health professional in prison and
the limits of that role under severely compromised and compromising circumstances.
There is a scarcity of scientific literature on health provision in prisons in Africa. As
Ross (2013: 101) correctly puts it, ‘[m]ost research on health in prisons refers to institu-
tions in the developed world’. This article thus contributes to filling an empirical gap
with point of departure in a survey conducted by a grass-roots human rights non-govern-
mental organization (NGO) in Sierra Leone. In addition, and regarding the prevailing
wisdom that makes a case for health workers as potential preventers of torture and other
forms of violence, the inherent ambiguity of the position of health workers in prisons in
places like Sierra Leone is discussed. In a setting where it seems no one really cares what
difference can a health worker make?
Despite the principle of equity in medical care, prisons globally are notoriously sub-
standard when it comes to health care. This article aims to: (a) illuminate the state of prison
health provision in Sierra Leone; and (b) to discuss the role of the health professional in
torture prevention work. Discussion of the health professional’s role includes consideration
of the way the punitive ethos of prisons might hinder even the most well-intentioned and
principled professionals. The article illustrates that under circumstances compromised by
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