House officers are going to prison in a new programme being tested out in Auckland
Doctors fresh out of medical school are testing their mettle in a totally new environment thanks to a partnership between the Department of Corrections and Waitematā District Health Board.
Dr William Hung started work as a house officer in Auckland Prison (commonly known as Paremoremo) in February, the first in what Northern Regional Commissioner Lynette Cave hopes will soon be seen across other Corrections facilities.
“This is a ground-breaking initiative and our hope is that we’d be able to extend this across other prisons within the Northern Region and our other three regions to continue enhancing healthcare delivery for people in prison,” she said.
The programme will see junior doctors completing a 13-week placement at Auckland Prison. While the prison already provides training for nurses, up until now only experienced doctors have provided care for the people living inside.
Hung has been going to the prison for almost two months, and he said the experience has been an interesting culture shock, naming daily routines like entering work through a metal detector and the heavy security protocols as points of difference.
“It's been a really good learning experience,” he said. “I think specifically surrounding communication skills, because as you can imagine you might be dealing with people who are more challenging or difficult to liaise with.”
Providing medical care within the prison walls poses unique challenges that change the role of the healthcare provider. Hung said the high levels of security needed within the prison is one of the biggest differences.
"I've had the opportunity to work in an outside GP clinic as well and I guess that the main difference is that in the prison, if you do want to assess someone, there is quite a high level of security," he said.
He hasn't felt unsafe working in the prison, largely due to a supportive and informative group of staff.
"I read a patient's notes and I feel like it would be an unsafe environment for me, we do have the option of reviewing a patient in a non-contact room," he said. That's two rooms separated by a glass window, meaning only a verbal review is possible, which Hung has used when members of Corrections staff have warned him that a patient is in an agitated state.
Another challenge is the 600 prisoners living within the walls of the maximum-security Auckland Prison needing both urgent and chronic care for a wide range of issues.
Department of Corrections chief medical officer Damian Tomic said working within a prison is very different to community or hospital-based healthcare.
“In prisons, we are focused on delivering the full range of primary care health services and mental health and addiction services, with referral to secondary care if needed,” he said.
At Auckland Prison, this means a medical infrastructure that can provide a wide range of services, with triage open bays, observation rooms, a dental area with x-ray facilities and a full nursing staff.
Four are contracted GPs who work part-time in the prison, providing a GP-to-patient ratio of around 1:600.
On top of that, the health profile of the prison population is different to that of the general population - especially when compared to people living in the DHB’s in-hospital population.
“Research shows that people in prison have much higher rates of mental health and substance use disorders than the general population," said Tomic.
An estimated 62 percent of prisoners would have met the diagnostic criteria for either a mental health or substance abuse disorder within the 12 months before going to prison, while 91 percent of them would have met these diagnostic criteria at some point over their entire lives.
A large segment of the prison population also live with long-term medical conditions that require ongoing treatment, care and support.
Tomic shared the hope that the success of the first placement would mean the expansion of the programme into other sites and allow Corrections to keep bolstering healthcare delivery to prisoners.
“The programme is designed to allow House Officers to gain exposure to working in a unique environment outside the hospital setting, whilst providing peer and senior support within existing DHB frameworks,” he said. "It will provide House Officers with an improved understanding of difficult to reach patients and the importance of the integration between primary and secondary care to improve patient journeys.”
The programme was the brainchild of Dr Laura Chapman, director of clinical training at Waitematā DHB.
As the convenor for junior doctors who are required by the Medical Council to do a community-based attachment in their first two years, she said she was on the look-out for a way to get young doctors interfacing with the community outside of the hospital.
Limited time and space at GP clinics meant looking for another solution, and sending them into prisons proved not only to fulfil the Council’s requirements, but also give the doctors a chance to experience a non-traditional healthcare environment and put prison healthcare on the map.
“I thought sending a junior doctor there would hopefully be an eye-opening experience while also perhaps being a little more useful to Corrections and the prisoners in general,” Chapman said. “Working in a different environment with people with different needs will make them better doctors, short-term and long-term.”
By showing new doctors that work in the prison system is an option, she hopes it becomes normalised as a career choice.
“Traditionally you see relatively conventional healthcare at medical school as a junior doctor,” she said. “It's about exposing them to other things, so they are aware - every few years one of them may say I am going to be a GP and do two days a week in the prison, and suddenly we are going to be serving society in a much more effective way.”
Prisons represent a slice of the population among whom mental health issues are keenly felt. Research has found mental health disorders and illnesses are up to five times more prevalent among prisoners than in the general population.
Prisons do mental health screening on any new entries over the age of 18, and can be referred to prison doctors or counselling or cognitive behavioural therapy for those eligible.
The pandemic has also produced new challenges for medical staff within prisons, as reducing the spread of Covid while treating prisoners who test positive has become a necessary task for almost every facility in the country.
Auckland Prison currently has nine active cases.
