Prisons are a commonly known and used term, whether we're playing monopoly and you find yourself unable to pay your taxes or through a glut of movies and TV shows that have them as the central theme.

But Orange is the new black or Sallu do very little to convey just how bad conditions in Indian prisons can be. Think of a cross between the Tihar and Alcatraz documentaries you see and a bit of the prison system corruption vividly described in Indian movies., that's closer to reality.

While basic living conditions, hygiene are pretty deplorable even in the more progressive states states that have invested heavily in transforming prisons to prevent crowding and repeat offenders, the conditions can be worse in prisons located in remote areas or states that have large financial deficits and poor resource allocation.

While an overhaul and innovative solutions is the need of the day we're talking about a small yet very significant part of daily life for inmates, namely their health care. This aspect can have far reaching consequences for both prisons and the authorities managing them. While the constitution of India guarantees access to Healthcare as a fundamental right it is very rarely extended to prisoners as a whole.

This is usually due to a societal attitude that criminals deserve to pay for their crimes and murderers or rapists deserve to have health care withheld from them especially when the general population itself has such sketchy coverage.

So unless you're well connected within the prison (there's just as much corruption and bribery, contraband in the system as your viewing experiences would lead you to believe) or a celebrity prisoner, politician doing a routine stint for something or the other you can expect healthcare to be a distant dream for you in jail.

Multiple studies have shown that prison populations are more susceptible to a variety of stress induced, nutrition based diseases as well as a greater risk of STI's and traumatic injuries. There are according to the latest statistics nearly twice the number of diabetics and hypertensive patients in the prison system compared to the average population of India. There are many inmates who have psychiatric issues, anger management problems etc who can benefit from regular counselling services.

UNDERSTANDING THE SHORTFALL

• Prison inmates can't access healthcare like the rest of us do. There are a long list of forms, procedures, scheduling concerns before a prisoner can even visit the hospital.
• There are always security concerns regarding escape or the threat to other patients.
• Police guards and escorts are expensive and time consuming.
• Private hospitals nearby don't take in prisoners for treatment due to security and public opinion concerns.
• Government hospitals can be far away and under staffed to deal with prisoners.
• Social stigma and indifference shown when treating prisoners can be a big concern.
• Incidents where prisoners fake illnesses to go out and receive contraband or attempt escape are well documented.
• Female prisoners require specific health care that may be hard to access including basic reproductive health.
• The medical costs of treating prisoners have to be borne by the state or city concerned, local authorities can be very late in financial deliberation.
• Complex surgeries such as those for complex trauma, heart problems etc may involve traveling long distances or involving a private hospital.

These and other logistical problems make it hard for prisoners to get the equal access to health care.

APPLYING TELEMEDICINE SOLUTIONS TO THE PROBLEM

"But as they say every problem is but a misunderstood opportunity". Where conventional medical access is hard we can always turn to remote healthcare. Our current technology and the widespread internet access has provided us many new avenues to explore.

Telemedicine and Telehealth are by definition remote monitoring of a patient's health and that suits the specific needs and challenges of the prison system perfectly. Prisons have an abundance of space, the ability to establish connectivity, guards and pretty much everything needed to keep the inmates in.

Just using a small amount of space to set up a Telemedicine cart, audio/video consults is more than enough to start the process of creating a remote consulting room inside the jail. There are many commercially available communication apps, web applications that enable secure teleconsultation. Many telemedicine companies, start ups have created incredibly flexible software to enable teleconsultation while also complying with Indian medical association rules /guidelines.

PROS:

1. Telemedicine software can be built in with forms for doctors to use either in assessment, diagnosis or treatment.
2. Doctors will be from the government employ and the nearest location.
3. Connectivity is easy to establish in such facilities.
4. Video consults and online prescriptions are easy to dispense and take less time than conventional visits.
5. No need for waiting in long lines, expensive escorts etc.
6. Variety of specialties such as eye, dental, general medical complaints, assessment of pain, long term illnesses like diabetes can be done quite well online.
7. Telemedicine software can be built in with forms for doctors to use either in assessment, diagnosis or treatment.
8. A larger number of patients can be seen in less time in over Teleconsult.
9. Any number of specialists, other doctors etc can be added onto each consult with just the click of a button.
10. Telemedicine software can keep track of the medical records, details of prescriptions, past consults etc to identify chronically ill prisoners.
11. Such valuable data and metrics can help with decisions such as parole, commuting sentences, transfer to different prison, conditional bail.
12. Remote triage and initial consult can reduce the number of fake consults, contraband, Escape attempts etc.

STUMBLING BLOCKS FACED

There are quite a few hurdles that doctors and aid workers have faced in implementing such schemes in prisons. Beyond the initial PR and media furore that companies and the government are after the plans for implementation are usually abandoned halfway or enforced in a lackluster manner.

• Prison wardens and police are suspicious of and against initiating contact for prisoners with others. Some initiatives by the national aids control mission were met with hostility from the police in charge.
• When it comes to sexually transmitted diseases the stigma is high among both prisoners and guards.
• Finding sympathetic ears among politicians and local authorities can be a challenge.
• There is a rigid hierarchy within the prisoners and they can be obstacles to accessing healthcare.
• Misconceptions about the costs, training required to implement telemedicine programs can make people hesitant.
• Prison authorities are hesitant to allow third parties to have contact with inmates due to fear of consequences.
• Most teleconsultation software don't come with security compliance or recording features that authorities demand.
• Potential for misuse of such a software for more nefarious purposes by inmates with political or financial connections.

THE LIGHT AT THE END OF THE TUNNEL!

There are many NGO's that have taken an active interest in having good medical care established in prisons. Unlike attitudes in the past the advancements in technology, increasing incentives from state and central governments have spurred the enthusiasm of both private sector hospitals and private telemedicine software companies.

This partnership has the potential to get the process setup in good time by using the best of boththe corporate and government worlds.

FIELDS THAT CAN BEST BE SERVED BY THIS

1. Tele Radiology for remote opinions on x-rays and other imaging with the use of DICOM viewer and SNOMED CT.
2. Psychiatric counselling and treatment for women, male inmates.
3. Remote audiometry technologies can be employed for ENT consults.
4. Dental health has been shown to be poor in prison populations, basic diagnosis & treatment planning can be done remotely to schedule patients.
5. Long term and palliative care for older prisoners can be simplified by using remote health monitoring devices and Teleconsultation.
6. Women's health care, reproductive care can be given to female prisoners with prescriptions being dispensed online.
7. In the case of trauma, violence, stabbings etc telemedicine can be a hand holding tool before the patients reach the hospital.

THE WAY FORWARD :

There are many areas where telemedicine has seen a significant rise in use. Pre and post COVID numbers of teleconsultations across various fields has shown a 200% increase in various specialties.

The same COVID pandemic has shown that prisons had the rapidest spread and greatest numbers compared to the general population. Multiple reports from the USA, India and other countries have shown the risk to prison inmates in any pandemic situation.

The poor general hygiene, closed spaces, lack of access to healthcare can lead to fatal and long term complications from any disease scenario.

Telemedicine software and start-up companies can help to fill this growing gap in Healthcare and also help governments to make prison systems better and more of a correctional facility than a punishment process.