Brutality in a white coat: health care and national oppression in

Amerika's gulags

by a MIM comrade, with reporting by Federal prisoners in Illinois 
and Colorado

November is health care in prisons month, part of MIM's Under Lock 
& Key 2000 campaign. Activists in prisons have written articles 
describing the conditions of their own health care. These articles 
appear in the Under Lock & Key section of MIM Notes. Still more 
comrades have taken up study of MIM's past writings on the 
politics of health care, or have volunteered to lead study groups 
or write reviews on the relationship of health to imperialism. 
Here MIM discusses our analysis of prisons as a tool of national 
oppression, the particular case of denial of health care to 
prisoners with Hepatitis-C infection, and the Maoist approach to 
public health.

Prisons = national oppression

On February 15 of this year, the united snakes locked up its two 
millionth prisoner.(1) If the current trend continues, this 
country will cage 10 million people by the year 2020.(2) Amerikan 
imprisonment is an aspect of the principal contradiction in the 
world today: between the oppressed nations and imperialism. 
Introducing the ULK2000 campaign, MIM wrote:

"Following the surge of revolutionary nationalism in the 1960s led 
by the Black Panther Party, the Young Lords Party/Puerto Rican 
Revolutionary Workers Organization, the original Brown Berets, the 
American Indian Movement and I Wor Kuen, Amerika launched its 
massive imprisonment campaign. Smashing revolutionary nationalist 
organizing and urban rebellion was the goal and increased 
imprisonment was part of the answer. Currently, one in three young 
Black men is in some way under the direct control of Amerika's 
prison system; one out of eight Latino men is in prison, jail or 
on probation or parole.(3) For First Nation men on reservations, 
that number is reportedly about one in two."(4)

Just as Amerika is happy to cage increasing numbers among the 
internal semi-colonies, it is happy to deprive these people of 
their basic needs while in the care of the state. U.$. prisons 
show a general lack of concern for prisoners' health, education 
(most college programs have disappeared), or access to the 
bourgeois legal system (law libraries have begun to evaporate as 
well). 

Anti-prisoner bias affects health care

Hepatitis C virus (HCV) can cause several different liver diseases 
and can be fatal. Currently, between 4 and 4.5 million people in 
Amerika's borders are infected with HCV.(11) Twenty percent of 
those with HCV go on to get some form of disease. HCV is currently 
the most common cause of chronic liver disease in the united 
$tates. Because infected individuals can go many years before they 
get sick, hepatitis C could become a large public health in 10 to 
20 years. "Predictions... indicate that there will be a 60% 
increase in the incidence of cirrhosis, a 68% increase in hepatoma 
incidence, ... a 528% increase in the need for [liver] 
transplantation, and a 223% increase in liver death rate."(12)

Prisoners have a high prevalence of HCV infection. many of the 
risk factors associated with HCV are prevalent among the prisoner 
population: having sex with an infected persyn; intravenous drug 
use with shared needles; sharing a razor, toothbrush, or other 
transmitter of blood with a persyn with HCV. The Virgina 
Department of Corrections estimates that 30 to 40 percent of its 
prisoners are infected.(13) (Remember, that means 6 to 8 percent 
will get liver disease because of HCV.)

Health care professionals argue that high risk groups should be 
screened and treated now, in order to control the spread of HCV 
infection and the resulting morbidity and mortality. Besides 
prisoners, Vietnam veterans, mothers who delivered via c-section, 
and people with HIV are at high risk.(14) Blacks and "Hispanics" 
are three and two times as likely to be infected, 
respectively.(15)

But it is current policy of the u.$. Federal Bureau of Prisons 
(BOP) not to test prisoners for the hepatitis C virus (HCV). The 
BOP does regularly test for HIV, the virus that causes AIDS.(7) 
The BOP argues that most of those infected will not get the 
disease -- and many of those who do get it will not get it in 
prison -- so why should they care? The same logic applied to 
society as a whole would mean 900,000 people were bound to get 
liver disease.

And even if a prisoner does not get liver disease, s/he can pass 
it on to other people in or outside of prison. As former Surgeon 
General C. Everett Koop testified before Congress:

"[P]risons are a pool of infection that can affect the community 
health when prisoners are released into the community. [P]rison 
offers a suitable environment for treatment, and we should make 
every effort to testing and treat those who are infected."(14)

This underscores the stupidity of narrow, chauvinistic thinking -- 
the kind which says, "It's their problem, they deserve it, let 
them suffer the consequences." Prisoners get out of prison. If 
they become infected with HCV in prison, they can spread it on the 
outside. Control of infectious disease requires us to pay 
attention to the health of prisoners, just like it requires us to 
be internationalists. With so many people traveling so far so 
quickly, a deadly epidemic could travel quickly from the most 
remote Third World country to any First World metropolis. You 
can't talk about public health in the united $tates without 
talking about public health in the world any more than you can 
talk about the effects of the ozone hole in the united $tates 
without talking about its effects throughout the rest of the 
world.

Still, there is plenty of bullshit chauvinism to go around. In 
response to the prevalence of lifestyle risk factors among u.$. 
prisoners, a bigoted public official interviewed by National 
Public Radio on the topic argued that the state cannot be held 
responsible for these lifestyle choices and so should not be 
responsible for testing for diseases that are spread in this 
manner.(6) 

The same way Amerika stigmatizes people with AIDS, it portrays 
prisoners as unable to or unworthy of taking part in the larger 
society. Those with serious health conditions are mocked or 
ignored. Prisoncrats and their government see health care for 
prisoners as a privilege, not a right.

A federal prisoner who is subject to these chauvinist standards of 
care points out the opportunism of a government abdicating its 
responsibilities to the population. "We could use this argument 
against prisons too, since most crimes are 'lifestyle' choices 
then being imprisoned by the state (feds) is bogus. Once they 
sentenced me to prison, they took on the responsibility to ensure 
the proper medical care and treatments for all past and future 
conditions are provided."(8)

A full course of treatment for HCV takes six to 12 months. In 
addition, federal prisoners "wishing to be treated must meet a 
complicated 15-step screening process that takes as much as 12 to 
24 months to complete. ... If you have less than 12 months [before 
release], you will be told to get treated after your release, as 
you don't have enough time to complete the full treatment 
inside."(8) There is nothing rational in this policy statement, 
why should a persyn be denied health care for a serious disease 
because s/he is likely to move in the next year? A medical 
ethicist and founder of the Prison Health Journal (now defunct) 
points out that the standard of care for prisoners should be no 
different than for people on the outside. This is basic to seeing 
prisoners both as humyn and as members of the society who live 
under special circumstances. In Amerika, continuing care is quite 
possible for non-prisoners who move from one neighborhood to 
another, or from state to state. Only the antagonism between 
imperialism and the prisoners it cages makes continuing treatment 
for released prisoners an issue.

Socialism better for humyn health

Preventing an epidemic of liver disease due to HCV is indeed a 
difficult task. Millions of people are infected without knowing it 
or even knowing that they might be infected. So controlling the 
spread of HCV requires a massive public education and testing 
program. The capitalist organization of health care makes this 
more difficult, if not impossible. Capitalists are worried about 
their profits and are reluctant to spend money finding and 
treating disease among those who cannot pay for screening and 
medicine. 

In contrast, a socialist government can unleash the creativity of 
the masses and spend social resources on health care regardless of 
profitability. Under Mao's leadership, the Chinese involved non- 
and paraprofessionals in health education and care. The book ITAL 
Science Walks on Two Legs END describes a medical propaganda team 
from a local street committee in Shanghai ca. 1973. The team was 
marching with big character posters and playing instruments to 
draw people's attention to the need to dress properly and use 
traditional medicines to prevent colds. An Amerikan nurse with the 
delegation noted that such involvement in basic health work is 
unheard of among the u.$. population. But in China the 
organization members observed that "barefoot doctors, trained by 
medical personnel at the clinics, treat colds, sore throats, carry 
out birth control propaganda, and do hygiene and sanitation work. 
Essentially they treat the basically healthy individuals, freeing 
the hospital to use its personnel and equipment for serious 
cases."(9)

Under socialism, the relationship between prisoners and the state 
will be different. MIM does not deny that there will still be a 
need for prisons under the dictatorship of the proletariat, but 
who is locked up and why will change. Instead of carrying out a 
thinly-cloaked war on oppressed nations by caging people for non-
violent, so-called crimes like drug possession, socialist prisons 
will be reserved for those who need confinement and physical 
restraint to keep from damaging the dictatorship of the 
proletariat with violence, sabotage or espionage. There will also 
be more open reeducation camps for those who have not committed 
violent crimes.

Prisoners and those in reeducation camps will not be seen as 
distinct from the rest of society. Indeed, the emphasis will be on 
reintegrating prisoners into society wherever possible. If 
economic conditions at the time of the revolution are as good or 
better as they are in the world in 1999, then MIM will guarantee 
that prison conditions will be the most "cushy" seen in history. 
Prisoners will have national heath care, libraries, reading 
materials of their choice and exercise and recreation facilities 
comparable with what is found outside prison walls. Prisoners will 
also have the duty of work to make restitution for their 
victims.(5)

Groups of people have unlimited capacity to expand their 
creativity and overcome obstacles. Capitalism stifles the popular 
imagination by arguing that public programs are too expensive or 
not efficient. Communists say anytime we have a chance to spend 
more on humyn well-being, the society will be paid back at least 
double in humyn creative energy.

Notes:

1. MIM Notes 206, 15 March, 2000.

2. MIM Notes 197, 1 May, 1997. pp. 1, 6.

3. The Sentencing Project, www.sentencingproject.org

4. MIM Notes 201 1 January, 2000.

5. See MIM's 1999 Congress resolution, "'Free speech' under the 
dictatorship of the proletariat," 
www.prisoncensorship.info/archive/etext/wim/cong/freespeech.html. For more on 
prisons in Maoist China, order a copy of Allyn and Adele Ricketts' 
book on their imprisonment as spies against China: Prisoners of 
Liberation. Or check out a copy of MIM's new End the Amerikan 
Lockdown study pack -- includes sections from a former Amerikan 
prisoner in China and China's last Emperor on his own 
imprisonment, $7.

6. All Things Considered, NPR 8 August, 2000.

7. www.bop.gov/ PS6190.02 Infectious Disease Management.

8. A Federal prisoner in Illinois, 19 August, 2000. This prisoner 
used the following documents in reporting: Bureau of Prisons 
Program Statement 6000.05, BOP Program Statement 6190.02, BOP 
Technical Reference Manual 6100.02. MIM points out that the 
principal factor placing most u.$. prisoners behind bars is that 
they are members of the internal semi-colonies; this is not a 
lifestyle choice.

9. Science for the People, China: Science Walks on Two Legs. (New 
York: Avon Books, 1974), p. 215-6. Science for the People was a 
u.$. mass organization of science workers.

10. www.cdc.gov/aboutcdc.htm

11. www.nurseweek.com/news/98-12/7b.html, 
www.hepnet.com/hepc/news072800.html

12. www.hepatitis-central.com

13. Richmond Time-Dispatch 3 May 1999.

14. hepatitis-central.com/hcv/hepatitis/koop.html