‘Crime is the outcome of a disease mind and jail must have an environment of hospital for their treatment and care’ - Mahatma Gandhi

2. DESMOTERIC MEDICINE
Presenter : Dr Abhishek S V
Moderator : Dr Pradeep T S
Dept of Community Medicine

3. PLAN OF PRESENTATION
• Introduction
• Definitions
• Type of prisons in India
• Why Desmoteric medicine?
• Major health problems in prisons
• Actions taken
• Challenges
• Conclusion
• References
• Acknowledgement

4. • Prison population are most marginalized groups in society,
people with poor health and chronic untreated conditions.
Often their health problems are neglected. They carry a much
greater burden of illness than other members of the society.
• Knowing the types of morbidities among them will help us in
taking actions which will reduce the disease burden in this
group and will also help in re-integration of prisoners in to
main stream society following their discharge from prison.
INTRODUCTION

5. Desmoteric Medicine:
The branch of medical practice that deals with health problems
occurring among prison inmates.
The term desmoteric medicine or desmotology derived from
the Greek word desmoterion means “prison”
Definitions

6. WHY DESMOTERIC MEDICINE..??
‘Crime is the outcome of a disease mind and jail must have
an environment of hospital for their treatment and care’
- Mahatma Gandhi

7. TYPE OF PRISONS IN INDIA

8. 4.7
90.7
86.4
84.2
84.0
82.6
77.9
77.7
76.0
131.8
128.7
128.0
120.8
120.4
113.2
112.2
110.6
107.2
107.1
103.8
98.3
96.3
94.8
177.0
173.8
168.6
159.5
158.6
154.9
64.6
60.6
57.2
49.1
39.9
32.5
27.0
50.0 100.0 150.0 200.0
UTTAR PRADESH
SIKKI
M
UTTARAKHAN
D
DELHI
MADHYA PRADESH
MEGHALAYA
CHHATTISGARH
MAHARASHTRA
JHARKHAND
DNH & DAMAN DIU
WEST BENGAL
BIHAR
JAMMU & KASHMIR
GUJARAT
HIMACHAL PRADESH
A & N ISLANDS
ASSAM
KARNATAKA
RAJASTHAN
HARYANA
ODISHA
CHANDIGARH
ANDHRA PRADESH
GOA
KERALA
TELANGANA
PUNJAB
ARUNACHAL PRADESH
MIZORAM
TAMIL
NADU
PUDUCHERRY
MANIPUR
TRIPURA
LADAKH
NAGALAND
LAKSHADWEEP
Occupancy Rate
Occupancy Rate (in %) in
All Prisons: 118.0
State / UT wise prison occupancy rate
Total Inmate Population
4,88,511

10. MAJOR HEALTH PROBLEMS
Environment
(sanitation, overcrowding,
Food and Hygiene)
Vectors
(Insects, Rodents,
Contaminated syringes)
Agents
(Bacteria, Viruses,
Protozoa)
Host
(Nutrition status,
Immune system
Social behaviour)

11. RISK FACTORS
Environmental and Social
Overcrowding
Poverty
Poor nutrition
Poor sanitary facilities
Illiteracy
Isolation
Abuse of prisoners
(physical, sexual, mental)
Lifestyle
• Smoking
• Drugs Diet
• Sexual health

12. COMMUNICABLE DISEASES
1. Food borne or water borne diseases
Typhoid fever
Food poisoning
Cholera
HepatitisA & E
2. Blood borne diseases
Hepatitis C & B HIV
3. Vector borne diseases
Malaria Dengue fever, Chikungunyaa
4. Airborne diseases
LRTI, Tuberculosis
5. Sexually Transmitted Diseases
HIV, Hepatitis B, Syphilis.
6. Skin diseases

13. NON COMMUNICABLE DISEASES
• Anaemia
• Diabetes mellitus
• Hypertension
• IHD
• Mental disorders
• Drug abuse

14. STATE WISE NUMBER OF POSITIVE CASES OF PRISONERS

15. DEATHS AND ILLNESS IN
PRISONS
Year Total No. of
Deaths in
Prisons
No. of Natural
Deaths
No. of Un-
natural Deaths
(incl. Suicide)
2018 1,839 1,638 144
2019 1,764 1,538 160
2020 1,887 1,642 189
• 31.1% have died due to heart-diseases and 14.5% inmates have
died due to lung diseases.
• Number of un-natural deaths in prisons has increased by 18.1%.

16. PRAJA
Focused Primarily On:
•Prison conditions (including overcrowding)
•Independent inspections of prisons
•Fundamental basic human rights for prisoners and staff
•Encouraging the use of mediation and counselling to prevent major crimes
•Preventing women and juveniles from being adversely affected by harsh
custodial regimes
•Assessing and promoting the use of good practices (such as Open Prisons,
Community Service for small time offenders, setting up Counselling Units for
reducing the damage caused by locking up and raising legal and general
awareness.)

17. ACTIONS TAKEN
1. Health care:
Medical Care in Delhi Prisons
• 92 Doctors (28 GDMOs, 10 Specialist, 54 SR/ JR). 71
Nursing & Para Medical Staff
• 120 bedded Hospital with medicine, surgery, TB and
Psychiatry Wards and 120 bedded De-Addiction Center
• Mental Health Department - Behavioral therapy ward is
upgraded to 40 bedded.

18. HEALTH CARE
• ORAL SUBSTITUTION THERAPY (OST) : DRUG ABUSERS
• ISOLATION WARD : TB PATIENTS
• PHYSIOTHERAPY: PHYSIOTHERAPISTS FROM H & FW
DEPARTMENT
• DOTS THERAPY: ALL DISPENSARIES OF CENTRAL JAIL
AS PER NTEP
• A MINOR OT / FULLY AUTOMATIC EQUIPPED
LABORATORIES
• X-RAY AND ECG FACILITY - CENTRAL JAIL HOSPITAL
• AYUSH CENTRE (AYURVEDIC AND UNANI CENTRE)

19. Services
• Medical screening- every prisoner on admission is subjected
to detailed medical examination, every prison is entitled to
free health care
• Regular health checkup of inmates
• Management of minor health problems
• Reference of unmanageable cases to higher health centers
• Counseling
• Health education
• MCH care- regular antenatal care, postnatal care

20. • Health care of children- vaccination
• Supervision of treatment for Tuberculosis and HIV
• Alcohol and narcotic drugs De-addiction programmes
• Dental care- Central prison hospital, Banglore

21. 2. Diet:
• Nutritious and balanced food is being served as per prescribed
scale depending upon food habits of the prisoner
• Different varities of Breakfast, Lunch and Dinner.

22. • Special Medical Diet for the HIV/ AIDS, tuberculosis.
• On medical advice special diet such as milk, egg, fruits
and bread are issued
• Male prisoner - 2,320 - 2,730 k/cal per day
• Woman inmate - 1,900 - 2,230 k/cal per day
• BANGALORE: ISKCON's kitchen

23. 3. Education:
• No restriction is imposed on prisoner in respect of reading materials
• Library facility
• Higher education- Prisoners are encouraged to pursue their
education at Government cost through different open universities
• Free distance and Postal education
• Daily newspapers, periodicals, magazines
• Adult education programme- Mysore - Social Responsibility scheme
• English teaching camp

24. 4. Vocational training:
Agriculture,
Carpentry
Handloom
Tailoring / Weaving
Candle making
Home Nursing
Training etc.

25. 5. Recreation:
periodic meditation courses, cultural programmes, recreation
through TV/ Radio, indoor and outdoor sports etc.
6. Daily wages:
• Unskilled Prisoners - Rs. 175/- per day
• Skilled Prisoner - Rs. 200/- per day
• Highly skilled prisoner - Rs. 225/- per day

26. CHALLENGES
• Uniform guidelines throughout country
• Separation of different categories of prisoners
• Inadequate prison programs- planned prison programmes
providing structured daily activities, vocational training,
pre-discharge guidance and post-prison monitoring.
• Poor spending on health care and welfare in India.

27. CONCLUSION
• Prisons health in particular are not always high on the agenda of
politicians, but the threat of transmission of infectious diseases in
prisons and ultimately from prisons to general society demonstrates
the importance of ensuring better access to health care and health
promotion in prisons.
• Prisons represent both a challenge and an opportunity in controlling the
spread of infectious diseases. because the conditions in prison often
increase the risk of transmission.
• The prison population is compact and not excessively mobile, which
makes efforts to screen for infectious diseases relatively easier. Finally,
achieving adherence to treatment can be easier in prison than outside.

28. REFERENCE
1. http://ncrb.gov.in
2. https://www.outlookindia.com/national/overcrowded-inhuman-corrupt-
inside-mumbai-s-arthur-road-jail-news-217940
3. International Covenant on Civil and Political Rights (adopted 16
December 1966, entered into force on 23 March 1976) 999 UNTS 171
(ICCPR)
4. Sarkar’s Code of Civil Procedure, 1908, Vol1, Edn. 3
5. Health in prisons-AWHO guide to the essentials in prison health

29. REFERENCE
6. KUMAR SUNIL D, KUMAR SANTOSHA, PATTANKAR JAYASHREE V
,
REDDY SHRINIVAS B, DHAR MURALI; HEALTH STATUS OF THE
PRISONERS IN A CENTRAL JAIL OF SOUTH INDIA; YEAR : 2013
VOLUME: 35 ISSUE NUMBER: 4 PAGE: 373-377
7. HTTPS://PQARS.NIC.IN/ANNEX/256/AU3110.PDF
8. PRISONS IN INDIA:AN OVERVIEW OF REFORMS AND CURRENT
SITUATION
HTTPS://ECONOMICTIMES.INDIATIMES.COM/NEWS/POLITICS-
AND-NATION/4000-INMATES-BUT-ONLY-TWO-DOCTORS-IN-
BENGALURUS-PRISON/ARTICLESHOW/53735090.CMS

30. THANK YOU