Corrections_Today_Fall_2025_Vol.87_No.3

COMMITTEES

prescriptions. Most referrals to Dr. M were for scabies. I remember one stretch of the day where I must have sent a dozen cases in a row. It became so common that we placed a chair next to his desk and dubbed it the “scabies chair” — though chairs were a precious commodity. Every chair had a designated purpose and was strategically placed, but despite our best efforts, chairs kept migrating — sometimes moved by prisoners, sometimes by local staff trying to be helpful. The scabies chair was con stantly missing. We spent most of the day sit ting in the shade, taking short 5–10 minute breaks to eat pre-made sandwiches. By the end of the first day, Dr. Marc, Dr. M, and I had seen 125 inmates. There were some interesting cases; one suspected TB patient had a mass on his neck. A memory penguin buried deep in an ice cave from residency resurfaced: Scrofula — a diagnosis I had only encountered in academic quizzes 15 years earlier. Why some penguins persist and others that are far more relevant swim off the iceberg is a great mystery of my life. As the sun set and bats emerged, we wrapped up and dragged our exhausted selves back to the hotel to enjoy a proper meal at our rooftop restaurant. Day 2 At the start of the second day, we rearranged the workflow slightly. In doing so, we lost our three big physician tables and were left with two small, low tables labeled “bush babies.” My back immediately protested, so I found some cement

bricks to prop mine up. Creative problem-solving was key. Dr. M had also lost his desk, so I recruited a few staff, and we went on a small pillaging mission to commandeer a desk from an office across the compound. Part of the art of medicine is to walk through profound situations, be able to absorb, appreciate and even learn from the lesson, but then to quickly fall back into stride. Soon enough, we were back in full swing. By the end of the day, we had processed another 150 patients. One particularly memorable case was a man with a below-knee ampu tation hopping on one foot without crutches or prosthetics. He didn’t even complain about it; he sim ply informed me his crutches had broken months ago, and the prison was still trying to replace them. His initial injury dated back to an indus trial accident in 2018. After he left, I asked the prison director if we could simply purchase crutches for him — and he readily agreed. The last patient of the day was also the hardest. A terrified 17-year old boy sat across from me, his gaze locked onto mine with silent des peration. He had been imprisoned at 16 and clearly felt unsafe. A guard stood uncomfortably close to our interaction, limiting what I could ask. Later, Dr. Marc shared that he

had done the boy’s intake earlier in the day and felt the same unease with concerns for sexual abuse. We advocated to the prison leadership to consider transferring him to a youth facility and arranged to have him be followed up the next day. Day 3 As the third and final day I de cided to wear a mask, not because of the concern of TB, but because the cooking stove on the other side of the yard was blowing black smoke across our entire operation the entire day. Before the end of the morn ing we finished up with the men’s prison. One of my last patients had complained of a large testicular swelling that had been ongoing for years. Since we were in an open-air environment, I took him into my “office” for an exam, which was the single-person bathroom around the corner. Cossa, my translator, came with us. I had him drop his pants and he had a very large grapefruit sized inguinal hernia in his testicle. This was not something I hadn’t seen before, but I could feel Cossa’s eyes widen at the shock of the thing. As I was carefully examining him, he stopped me and simply in structed me in Portuguese to watch as he could get it to go back inside. At that cue, he reached down, fisted his entire scrotum, and gave a good firm squeeze, which caused the bowels that were resting in his scrotum to fall back into his abdo men. This made a horrible squishy sound followed by what can only be described as a ‘plop.’ Cossa nearly fainted as he was holding the wall

Corrections Today | Fall 2025

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