| Between Hospital and Prison | ||||
| Text and photos by Wei Wei-ting Translated by Tang Yau-yang | ||||
His groans of pain were accompanied by occasional clanks from his chain. The elaborate tattoo on his body indicated a checkered past. The long, dangling chain and a guard sitting near the foot of his bed showed that he was not just a regular patient in a hospital in Hualien, eastern Taiwan. A-shui, 73, was a cancer patient at Hualien Tzu Chi Hospital, but he was also an inmate at Hualien Prison for drug offenses. He had been in and out of prison many times. This time, he was serving a 13-year sentence. Prison medicine Taiwan’s national health insurance was extended to prison inmates in 2013. That was when Hualien Tzu Chi Hospital began its involvement in the first phase of a national insurance project to provide medical services to inmates in Hualien Prison. Hospital staff members from 18 specialties have taken turns going to the prison each day to offer outpatient services. A-shui started feeling unwell early in 2015. He felt as if food was getting stuck in and blocking his digestive tract after each meal. He put up with the discomfort for a few months, but then the condition grew worse. When the pain got really bad, he could not even walk. In early June, he made an appointment to be seen at the prison clinic. Dr. Hung Jui-sheng (洪睿勝), a gastroenterologist, examined him and found that something was very wrong with him. The doctor immediately arranged to have him sent to the Tzu Chi hospital for CT scans and other tests. They confirmed that A-shui had prostate cancer and that it had spread to his bones. A-shui was immediately admitted to the hospital, and specialists from the oncology, urology, and other departments joined forces to care for him. His condition was sometimes up and sometimes down. He was in and out of the hospital a couple of times. When he returned to the prison, Dr. Huang Liang-kai (黃亮凱) of family medicine was in charge of his care. One day in early September, Dr. Huang was notified that A-shui was rapidly going downhill, so he went to the prison to check on him. After his examination, he recommended that A-shui be moved to the palliative care ward at Hualien Tzu Chi Hospital so he could receive better care. The cancer in A-shui’s bones caused extreme pains in his waist and back, and he moaned all day long. He could not get out of bed or walk, let alone tend to his own daily needs. Pain management and symptom treatment became the primary objectives of the care team. Due to his feeble condition, the nursing staff had to feed and sponge-bathe him. After he had survived the first couple of weeks in critical condition, he gradually stabilized. He began to be able to eat on his own, albeit slowly. He could even take a shower with some help from the nursing staff. “The doctors and nurses in the palliative ward took really good care of me,” he said. Since A-shui had regained strength in the hospital, he was sent back to the prison in mid-September. Though the palliative team had discharged him from the hospital, it had not taken him off its list of patients. In fact, before discharging him, Dr. Wang Ying-wei (王英偉), director of the palliative ward, conferred with the care team on how best to continue caring for A-shui. They decided to apply to the prison to take their palliative care into his jail cell. Wang’s team routinely goes to patients’ homes after they are discharged to provide palliative care, but they had never gone to a jail cell. Wang’s insistence on doing what was best for the patient impelled the team to navigate the uncharted waters of providing palliative care in prison.
A patient is a patient To the medical team a patient is a patient, wherever they are or whoever they may be. It does not matter to them that A-shui is a prison inmate. “True, they’re inmates, but they’re paying for their past wrongs,” said Dr. Hsieh Jyh-gang (謝至鎠), a family medicine doctor at the Tzu Chi hospital who conducted the first “home visit” for A-shui. “Being inmates doesn’t mean that they are less entitled to medical care,” the physician said. He added that though convicts are deprived of certain rights, such as the right to move about freely in society, they should not be denied the right to medical care. It is a fact that in a prison, where medical service is highly restricted, inmates already have less access to it than the general population. Therefore, additional restrictions to such access should be reduced as much as possible in a humanitarian spirit. If Tzu Chi doctors can visit discharged palliative care patients at their homes, perhaps they can also visit such patients in their jail cells. “To me, when an inmate is sick, he is just a patient,” Dr. Hsieh stressed. Thus the hospital decided to apply for permission to visit A-shui. Prison administration officials—including Liu Shi-tian (劉世添), the warden, and Chen Wen-yin (陳文銀), the director of health— concurred with that line of reasoning and wholeheartedly supported the Tzu Chi hospital in their endeavor. With their help, the project began. A palliative care team from Hualien Tzu Chi Hospital made its initial visit to A-shui in prison on September 24, 2015. Dr. Hsieh and home care nurse Liu Jia-zhen (劉嘉臻) went through a series of metal doors to reach the infirmary, where A-shui was locked up with about 20 others. Unlike regular cells where inmates slept on mats on the floor, this unit had a bed for each inmate. At the end of the room was a partitioned space for toilets, washing, and clotheslines. A-shui was curled up in pain when the doctor and nurse reached his bed. Dr. Hsieh gingerly examined him, but even the slightest movement pained the patient to tears. His tattoos of dragons and phoenixes gave a glimpse into his past, which seemed totally remote. Now thin and gaunt, he was just another terminally ill patient needing care and empathy. “A-shui, may I massage you? Maybe it’ll make you a little more comfortable,” Liu asked. She sat by him and began to work on the painful spots on his back and waist. “Inhale deeply. Exhale. Relax. Right, just like that,” Liu instructed him. “A-shui, you’re doing great.” The nurse could feel A-shui beginning to relax. Other infirmary inmates were curious about what was going on. They looked at the medical professionals from the Tzu Chi hospital working on A-shui, and some of them began to volunteer bits of information about him. That gave Hsieh and Liu a better idea of what A-shui’s life had been like after his discharge from the hospital. Actually, A-shui was eligible for medical parole. The prison administration and hospital staff had tried to contact A-shui’s family for that purpose, but no family member was willing to come forward and help him set the proceedings in motion. He therefore had to remain in prison. The “home visit” was soon over, but the care was not. Every week after that, A-shui made appointments with doctors on duty at the outpatient clinic, who would make adjustments to his medications or help with other needs.
Going way back Liu has regularly visited A-shui every week since that first visit, providing him with therapies for pain relief and mental relaxation, including essential oil massages, abdomen massages, and painting therapy. After a few sessions, A-shui no longer wore a constant frown. He began to open up to Liu, and to talk more about his past. He seemed more at peace now that he was under the good care of the palliative team. Tzu Chi’s connection with the prison was formed long before the National Health Insurance project kicked off in 2013. The Tzu Chi International Medical Association began offering free clinics at the prison many years ago, and volunteer Yan Hui-mei (顏惠美) has also visited inmates regularly for a long time. Then, starting in 2009, hospital personnel went into the prison four times a week to staff clinics for inmates. When A-shui was hospitalized in the palliative ward, Yan Hui-mei visited him often. She promised him that she would visit him after his discharge. On the eve of the Mid-Autumn Festival in 2015, Yan did just that. A team of volunteers went with her. “I knew all along that you would come,” A-shui said when he saw Yan. Though he would have very much liked to sample the moon cakes that Yan had brought in, he was too weak to sit up in his bed to have a taste. Yan bent forward and delivered a small bite of the cake into his mouth, then another. Judging from the satisfied smile that lingered on his face, it must have been scrumptious. In early November, A-shui was admitted back to the palliative ward to manage his pain. The collaboration between the prison and the hospital continues to unfold. |
|
