Dressed in her blue prison uniform, 44-year-old Nomonde Thompson is enjoying a few minutes of sun. She counts herself lucky. The Cape Town mother of two has been in prison since January 2015. Within a few days of her incarceration, she was screened and diagnosed with tuberculosis (TB), starting treatment immediately.
“I was losing weight, coughing – but now, with treatment, I am feeling healthy,” says Thompson. Every day she takes six tablets, and by the time she is released in 2016 she hopes to be TB-free.
Thompson is one of close to 90,000 offenders who have been screened since 2013 at Pollsmoor prison, where Nelson Mandela was once held. With new technology like the GeneXpert – a mobile digital x-ray machine – the prison has conducted 13,215 tests and started 915 patients like Thompson on treatment.
“I have to remember to take my tablets, but there is no more coughing and I am feeling good,” she says.
But not everyone at Pollsmoor has been so lucky.
While awaiting trial at the maximum security prison between 1999 and 2004, Dudley Lee contracted TB. He successfully sued prison authorities (pdf) for damages on the basis that the poor conditions caused him to become infected. In 2012 South Africa’s highest court, the constitutional court, ruled in Lee’s favour (pdf). “There is a legal duty on the responsible authorities to provide adequate healthcare services as part of the constitutional right of all prisoners to conditions,” it said.
The landmark judgment has helped to ensure that prisoners in the country’s largest jail, like Thompson, receive treatment.
“Our policies were not clear and TB was a big burden. The Lee case brought some guidelines and now we can see where the burden is and deal with it,” says Geraldine Pienaar, the Western Cape Correctional Service head of development and care. TB is an infectious bacterial disease and, in harsh prison conditions, can be easily passed to others.
Pollsmoor prison, located on the outskirts of Cape Town, is one of the oldest in South Africa. It has housed several other liberation-era heroes including Walter Sisulu and Ahmed Kathrada who, along with Mandela, were transferred from Robben Island to Pollsmoor. Mandela himself contracted TB while incarcerated here, in 1988.
Overcrowding has always been a problem at the prison. It is intended to house 4,000 prisoners but holds more than 8,000, according to prison authorities.
Overcrowding was also highlighted in a recent report (pdf) by an eminent South African judge, Edwin Cameron. He found that Pollsmoor’s remand detention centre, one of the prison’s five complexes, had three times the number of inmates for which it had been built. He said that the “extent of overcrowding, unsanitary conditions, sickness and overall deplorable living conditions at Pollsmoor were profoundly disturbing”. Cameron said he was “deeply disturbed” that those detained cannot always access medicines due to persistent lack of basic supplies, including TB medication, and that the same conditions considered in the Dudley Lee case persist, with “the air so thick one could cut it with a knife” due to poor ventilation.
Prison authorities admit that Pollsmoor is overcrowded but say they are doing the best they can under difficult circumstances. The spread of TB is a particular worry in such conditions, as Dr Gareth Lowndes, head of correctional services at TB/HIV Care, acknowledges. “Driven by overcrowding, poor ventilation and too many people, it’s the perfect storm for TB,” he says. The organisation, with financial support from the Global Fund, has been assisting the country’s Department of Health and Correctional Services to deal with the TB problem. Lowndes reports that TB in Pollsmoor is five times higher than the figure for the general population.
The country’s health minister, Aaron Motsoaledi, believes there cannot be a business-as-usual approach with TB, which was the country’s leading cause of death in 2013. “[The disease] kills silently, and although the situation is improving we regard the [figures] as still unacceptably high,” he says. According to the health department, South Africa is one of the 22 countries with the highest burden of TB; the country reported 318,000 cases in 2014.
South Africa’s national strategic plan for HIV and TB proposed that it targets high risk groups such as mineworkers, and prison staff and inmates. TB/HIV Care is now supporting 95 correctional facilities across the country, including Pollsmoor.
Lowndes said: “Time from sputum collection to initiation of TB treatment [has] decreased from a week to less than two days. Time to treatment for drug-resistant TB decreased even more dramatically, from one month to less than a week.”
On a visit to the TB screening room at the prison, Motsoaledi commented: “I am happy with the programme to screen more prisoners. The aggressive approach is helping.”
The scientific director of the International Union Against Tuberculosis and Lung Disease, Paula Fujiwara, who has worked in prisons across the world, is impressed by the progress made at Pollsmoor in treating the disease, and credits the country’s health minister for his commitment to fighting TB.
“South Africa is certainly much more advanced [on this issue] than most other African countries and it can be proud that it is at the forefront of TB care,” she says. Fujiwara also believes that South Africa can take a lead in assisting other developing countries in reducing rates of tuberculosis. The battle against TB at Pollsmoor is still very much ongoing, but prisoners like Nomonde Thompson are clearly benefiting from the TB treatment programme. Above all, Thompson wants to be healthy upon her release to be reunited with her children.
