Health Problems Encountered by Inmates in Legazpi City Jail, Ligao City Jail and Tabaco City Jail

Ellie Marie M. Aguilar Honey Kaye E. Alejo Keesha Mariel P. Alimon

Abstract The study aimed to identify the health problems encountered by inmates in Legazpi, Ligao and Tabaco City Jail. The findings were drawn from the data gathered by the researchers through their collaboration with the respondents and the support of the Bureau of Jail Management and Penology. The majority of the target population belongs to the 18-25 years old age group, mostly high school undergraduates. Almost all are Roman Catholics with varied past occupations. Among the diseases, Angina Pectoris topped cardiovascular diseases, Influenza on respiratory and Muscle Spasms under musculo-skeletal. In gastrointestinal, Dental Caries was the most prevalent and Urinary Tract Infection and Prickly Heat topped genito-urinary and skin diseases respectively. Overcrowding was identified as the leading cause of health problems while the use of spoon and fork was the least hygienic practice used. The inadequate supply of medicines and equipment was the highest self service deficit identified. The inmates are provided with a bi-annual Medical and Dental Mission, a monthly supply of personal items from BJMP, and medical services after a referral and court order is released. It was then concluded that the overall health condition of the respondents are quite poor, the facilities in the jail are inadequate and the health services they receive are lacking. Introduction The world prison population, according to estimates published by the World Prison Population List as of October 2006 has reached 9.25 million people with prisoners held in penal institutions throughout the world, mostly as pre-trial detainees (remand prisoners) or sentenced prisoners. Almost half of these are in the United States with 2.19 million prisoners, China with 1.55 million and Russia with 0.87 million. It is probable that this number is likely to be much higher, in view of general under-reporting and a lack of data from various countries, especially authoritarian regimes. In the Philippines, based on an estimated national population of 91.98 million, the prison population rate is 111 per 100,000 of national population. According to the Bureau of Jail Management and Penology (BJMP), the countrys prison population as of February 2011 is 62,870 with a projected annual jail population increase of 6.17%. Two thousand one hundred nineteen of these prisoners are from Region 5 alone, 168 of them are sentenced and 1951 of them are being detained in different provincial jails, municipal or city jails and district jails across the region, controlled and supervised by BJMP. These numbers continue to rise globally and so as the problems that arises along with it. According to Lisa Gayagay, the crime rate all around the world has increased tremendously with the advancement of time and is also due to a lot of factors which can increase the chances of a person to commit a crime. These factors are economic condition, population, education, establishments, lifestyle, age, stability of population, family condition and location. Poverty for an instance can trigger a persons deviant behaviour leading to breaching of rules or laws for which some governing authority can ultimately prescribe a conviction. Once convicted,

he/she can be imprisoned. Imprisonment is generally viewed as the appropriate consequence of most serious crimes. It is a clich of modern penology that placing the offender in prison is for the purposes of punishment, deterrence, and reform. The idea of punishment as the purpose of imprisonment is plain enough the person who has committed a wrong against a person or law of the land must suffer in return. Its a punishment, not only by depriving the individual of his liberty, but also by imposing painful conditions under which the prisoner must live within the walls. Some people would find the treatment of the prisoner inevitable and unsurprising; while others may find it appalling and harsh. But even though prisoners are deprived of liberty, they are still entitled to basic human rights. Extreme overcrowding is the most punishing aspect of doing time in jails maintained by the Bureau of Jail Management and Penology (BJMP), which is an agency of the Department of Interior and Local Government. In 2001, about 35,000 inmates in Metro Manila were fighting for space in jails supervised by the bureau. Today, the number has jumped to 102,267. The jails in Metro Manila account for 22,000 inmates which are 400 times more prisoners than the official capacity they can accommodate and is way beyond the capacities of these holding facilities. At the Manila City Jail and other prisons in the National Capital Region, inmates have to take turns sleeping on the floor. Over congestion also brutalizes life in penitentiaries and in provincial jails. As of the month of February 2011, the BJMP nationwide percentage of congestion has reached 382%. In the Bicol region alone, out of 35 jails, 29 are congested. The projected populations of national prisons administered by the Bureau of Corrections, an agency of the Department of Justice and the jails maintained by the provincial governments must be as dreadful. Herding individuals in cramped spaces is cruel, inhuman, ill, degrading, and unjust punishment. Overcrowding is dangerous to health and to human life. It breeds diseases, breaks down discipline and exacerbates tensions. Having to fight for air and space 24 hours a day make prison, in the words of inmates, a living death. Add dirty tap water, dingy toilets, substandard meals, gang war, poorly trained guards and prison administrators favouritism, and you have a system built for punishment, not for rehabilitation. This is not the enlightened approach to penology which is reform geared towards a subsequent productive life upon re-entry to the community. In connection with this, the researchers have chosen the three city jails in Albay to conduct the study. Legazpi City Jail which is located in Brgy. Bogtong, Legazpi City, houses the BJMP Regional Office V. The jail is composed of eleven (11) operation cells, one of which is the female dormitory. The jail also has the basic amenities for the inmates activities such as a basketball court, a chapel and a recreation area. The jail currently holds a total of 150 inmates. In Ligao City Jail, a total of 68 inmates are presently detained in the penal institution which is located in Dunao, Ligao City. It is composed of seven (7) prison cells with a mini chapel inside the building and a garden outside which the inmates maintains and cultivates. Tabaco City Jail, on the other hand, is situated in Burac St., San Lorenzo, Tabaco City, three kilometres away from the city proper. The jail structure is composed of six (6) operation cells with a basketball court inside the compound. The jail currently houses 116 inmates all of which are males. The researchers are interested in determining and identifying the most prevalent illnesses or health problems encountered by the respondents while imprisoned aggravated by personal, social and environmental factors and to seek or find out proposed measures that may be recommended to the improvement of the respondents facilities, lifestyle and living conditions.

Materials and Methods The study utilized two sources of data: primary and secondary. The primary data for this study were obtained from the respondents responses to the questionnaire checklist that were distributed to the three jails. Secondary data were gathered from records of the jail management of each jail and the Bureau of Jail Management and Penology (BJMP) as well. Professional journals, magazines, books, other research papers, government documents and internet websites have also been utilized to provide additional background and support for the foundation of the study. To facilitate data gathering, the researchers utilized their observation skills, formal interviews and a comprehensive questionnaire checklist they had revised and redeveloped from previous studies to meet the needs of their study. These three methods seemed the most accurate in data gathering when put together. A thorough review and evaluation of important documents such as the list of inmates meeting the desired criterion for respondents provided by the three jails, verification of the approved letters stating the confidentiality of personal information and any other unrelated information that may have been accidentally included in the course of the study and the like, was done. The formal interview was conducted for respondents and also for jail administrators to ensure coercion of data and to supplement any questionable or vague answers received through the questionnaire checklist in order to come up with accurate and valid results. The researchers used open ended and closed ended questions to elicit accurate results to different questions. The questionnaire checklist was subdivided into four parts: (1) the demographic profile, (2) the diagnosed health problems the inmates experienced or are experiencing, (3) the possible causes of the problems, and (4) the health services provided to them. The tool covered the most prevalent health problems, its probable causes that the inmates could answer, and still provided space for any other concern that may not have been included. The questionnaire checklist was constructed as simple as possible, both in the English language and in Filipino, to accommodate easy understanding and preference. The respondents need only to place a check mark inside a box corresponding to their answers and only needed little additional writing. Results and Discussions The demographic profile of the respondents is shown in table 1. Included here were the age, educational attainment, religion, civil status, past occupation, health history, and the inmates length of stay in the institution. Age. As shown in table 1, it has been noted that the majority of respondents in Legazpi City Jail belong to the 40-46 years old age group which is middle adulthood, with 23.33%. In Ligao City Jail however, the majority of respondents are young adults in the 18-25 years old age group with 26.67%. Respondents from Tabaco City Jail present a similar result with a 40% ranking in the 18-25 year old age group. The table also reveals that the majority of the total population of respondents belong to the 18-25 year old age group, comprising of 28.89%, followed by the 33-39 year old age group with 22.22%, and the 26-32 year old age group in third with 18.89%. Ranking fourth with 15.55% is the 40-46 year old age group, the 47-53 year old age group in the fifth rank with 8.89% and lastly, the 54-60 year old age group with 5.55% and the least number of respondents in the study.

Table 1. Demographic Profile of the Respondents

Legazpi City Jail Frequency Percent Ligao City Jail Frequency Percent Tabaco City Jail Frequency Percent Total F/P

Profile

RANK

AGE 18 - 25 26 32 33 39 40 46 47 53 54 60 Total EDUCATIONAL ATTAINMENT No formal schooling Elementary Undergraduate Elementary Graduate High School Undergraduate High School Graduate College Undergraduate College Graduate Vocational Total RELIGION Roman Catholic Iglesia ni Kristo Jehovahs Witness Born Again/Baptist Others Total CIVIL STATUS Single Married Separated Widowed Live-in Total PAST OCCUPATION Government Private Self-Employed Student Others None Total LENGTH OF STAY 3 years below 3 4 years 5 6 years 7 8 years 9 10 years Total

6 3 4 7 6 4 30

20 10 13.33 23.33 20 13.33 100

8 6 7 6 2 1 30

26.67 20 23.33 20 6.67 3.33 100

12 8 9 1 30

40 26.67 30 3.33 100

28.89 18.89 22.22 15.55 8.89 5.55 100

1 3 2 4 5 6

3 10 9 2 4 1 1 30

10 33.33 30 60.67 13.33 3.33 3.33 100

4 5 7 5 8 1 30

13.33 16.67 23.33 16.67 26.67 3.33 100

10 6 10 2 2 30

33.33 20 33.33 6.67 6.67 100

4.44 20 25.55 26.67 13.34 6.67 1.11 2.22 100

6 3 2 1 4 5 8 7

27 1 1 1 30

90 3.33 3.33 3.33 100

27 2 1 30

90 6.67 3.33 100

30 30

100 100

93.33 3.33 1.11 1.11 1.11 100

1 2 3.5 3.5 3.5

14 10 4 1 1 30

46.67 33.33 13.33 3.33 3.33 100

14 10 3 2 1 30

46.67 33.33 10 6.67 3.33 100

14 12 1 3 30

46.67 40 3.33 10 100

46.67 35.55 8.89 3.33 5.55 100

1 2 3 5 4

4 5 4 11 6 30

13.33 16.67 13.33 36.67 20 100

1 6 4 1 12 6 30

3.33 20 13.33 3.33 40 20 100

2 6 7 2 9 4 30

6.67 20 23.33 6.67 30 13.33 100

7.78 18.89 16.67 3.33 35.56 17.78 100

5 2 4 6 1 3

16 9 3 2 30

53.33 30 10 6.67 100

13 14 2 1 30

43.33 46.67 6.67 3.33 100

20 7 1 1 1 30

66.67 23.33 3.33 3.33 3.33 100

54.44 33.33 6.67 4.44 1.11 100

1 2 3 4 5

The data indicates that the majority of respondents belong to the young adult age group. This may be because young adults still lack the maturity to make the right decisions and lack of self-control.

Educational Attainment. The majority of respondents from Legazpi City Jail are elementary graduates garnering a total of 33.33%, while in Ligao City Jail the highest rank of 26.67% of respondents are high school graduates. In Tabaco City Jail however, the ranks tied that 33.33% of respondents are elementary undergraduates and another 33.33% are high school undergraduates. The data revealed that the majority of the total populations of inmates are high school undergraduates garnering 26.67%, followed by elementary graduates with 25.55%. Ranking third with 20% are elementary undergraduates, fourth is high school graduates with a 13.34% ranking, and fifth are college undergraduates with 6.67%. The respondents who had no formal education ranked sixth with 4.44%, and those who graduated from a vocational course ranked seventh with 2.22%. And lastly, 1.11% of the respondents are college graduates. The table showed that the majority of respondents are high school undergraduates, which supports the idea that they are capable of simple health practices to avoid various diseases and that they have the ability to learn. It also implies that most of the respondents lack experience in social interaction making them hesitant to approach health care professionals or go to health care facilities. Religion. Respondents from Legazpi City Jail and Ligao City Jail are mostly Roman Catholics with 90% each, unlike in Tabaco City Jail, where 100% or all of the respondents are Roman Catholics. In connection with the religious affiliations of the total population of respondents, it is clear that the majority are Roman Catholics with 93.33%. Respondents who are Iglesia ni Kristo ranked second with 3.33% while tied in third with 1.11% are Jehovahs Witness, Born Again or Baptist and Church of God listed under Others. The data imply that although the majorities are Roman Catholics, their belief in this faith is not enough to keep them from committing a sin or a wrongdoing. According to the law and gospel of Christianity, where sin appears to be the fundamental problem or disease that mankind shares, sins are the symptoms of that disease revealing themselves as transgressions of the law. The inmates manifest these sins as the crimes they have committed. Civil Status. Table 1 indicates that 46.67% of respondents from Legazpi City Jail, Ligao City Jail and Tabaco City Jail are single. It also ranks first in the total population of respondents with 46.67%. Followed by 35.55% which are Married, 8.89% who are Separated and 5.55% who cohabitate or live-in with their partners. And lastly, a 3.33% ranking for respondents who are Widowed. As shown in table 1, the majority of respondents are Single supporting the data previously discussed that most of the respondents belong to the young adult age group. Statistics show that 40.88% of Filipino men remain single until they are 25-29 years old. This may be because of mental, emotional or financial instability or it may also imply that the inmates lack fear to commit crimes because they have less to lose or leave behind. This may also indicate that perhaps they have not yet accomplished a number of personal goals or do not feel the desire to move into a new stage of adult-level responsibility. Past Occupation. The majority of respondents in Legazpi City Jail, Ligao City Jail and Tabaco City Jail listed their past occupations under Others (e.g. farmer, fisherman, construction worker, etc.) with 36.67%, 40% and 30% respectively. It also garnered the highest rank in the total population of respondents with 35.56% followed by being employed in private companies with 18.89%. Respondents who were previously unemployed ranked third with 17.78%, while those who were self-employed ranked fourth with 16.67% and 7.78% were government employees. And lastly, 3.33% of respondents were previously students.

The data that most of the respondents past occupations are in the form of manual labor is reflective of the educational attainment previously discussed in the conceptual framework of the study. Society today practically dictates that people who attain higher education have more chances at having better paying jobs than those who have none. Having financial troubles, lowincome or unstable jobs or being unemployed unquestionably leads a person to have motivation to commit crimes or succumb to criminal behavior. Length of Stay. The majority of respondents in Legazpi City Jail, Ligao City Jail and Tabaco City Jail have stayed in the jail for less than 3 years with 53.33%, 43.33% and 66.67% respectively. It also has the highest rank in the total population of respondents with 54.44% followed by a length of stay of 3-4 years with 33.33%. Respondents who have stayed for 5-6 years ranked third with a 6.67% rank, while those who have stayed for 7-8 years ranked fourth with 4.44%, and lastly those who have stayed for 9-10 years ranked fifth with 1.11%. The data indicates that the majority of respondents who underwent our study have stayed in the jail for a period less than three years, making them least susceptible to chronic illnesses but at the same time the primary source for new infections that they may have acquired outside the jail. Health History. The respondents also stated past illnesses or history of hospitalization. In Legazpi City Jail, 20% of inmates had said that they have had the flu, while 6.66% have had either Diabetes, Edema or Pulmonary Edema. Only 3.3% had said that they have been hospitalized before due to a vehicular accident. The same frequency goes for being hospitalized for an appendectomy and for treatment of pulmonary edema. In Ligao City Jail, 13.3% of inmates have had ulcers, 10% have had hypertension and 3.33% have had the flu. 6.66% of inmates have been hospitalized due to a penetrating trauma and 3.33% for epilepsy. In Tabaco City Jail, 10% of inmates have had Angina Pectoris, 6.66% had said that they had the flu and 3.33% have had ulcers. Being hospitalized due to a penetrating trauma, Asthma or for a surgical amputation all had a 3.33% frequency. The respondents had also indicated whether they have family members who suffer any medical condition which they may have inherited or may increase their risk for illness. In Legazpi City Jail, 3.33% of respondents families have a history of Hypertension and Arthritis. In Ligao City jail however, 16.66% had said that they have family members with Hypertension while those with Diabetes and Ulcers have 3.33% each. In Tabaco City Jail, 20% of inmates had said that their families have a history of Hypertension. Asthma was also stated with 10% while those with Pneumonia have 6.66%. Health Problems Encountered by the Inmates Excessive alcohol intake, drug and substance abuse, lack of exercise or physical activity, poor nutrition, poor hygiene, financial instability or poverty, unsanitary living conditions, climate changes, and limited access to health care services are some of the many factors which weaken a persons immune system. It puts a persons health and the health of those around them at great risk through successive cross-infections creating a cycle within the jail and the community. Jails are not health-promoting environments. Most jails are congested, have poor ventilation and protection from extreme weathers, and lack space to segregate inmates who are sick from those who are well especially those with contagious diseases. Inmates lack physical and recreational activity outdoors, seldom meet nutritional needs and receive less than adequate medical attention putting them at greater risk for diseases like hypotension, influenza, gastrointestinal ulcers and skin problems.

Table 2 presents the health problems encountered by the inmates of Legazpi City Jail, Ligao City Jail and Tabaco City Jail covering Cardiovascular, Respiratory, Musculo-Skeletal, Gastrointestinal, Genito-Urinary and Integumentary health problems. Cardiovascular Diseases. The highest ranking cardiovascular disease in Legazpi City Jail is Hypotension experienced by 36.67% of the respondents unlike in Ligao City Jail and Tabaco City Jail where Angina Pectoris is the most prevalent with 33.33% and 36.67% respectively. In the total population of respondents, Angina Pectoris still ranked first with 27.78%, followed by Hypotension with 25.56% and Hypertension with 18.89%. Stroke was identified as the least with 2.22%. Angina Pectoris is a clinical syndrome usually characterized by episodes or paroxysms of pain or pressure in the anterior chest. The cause is insufficient coronary blood flow, resulting in a decrease oxygen supply when there is increase myocardial demand for oxygen in response to physical exertion or emotional stress. The pain is often felt deep in the chest behind the sternum. Typically, the pain or discomfort is poorly localized and may radiate to the neck, jaw, shoulders and inner aspects of the upper arm usually the left arm. The patient often feels tightness or a heavy choking or strangling sensation that has a viselike, insistent quality. The inmates complain of experiencing this tightness but that it is relieved by adequate rest. Hypotension is a decrease in blood pressure to less than 100/60 mmHg that compromises systemic perfusion. Hypertension is a blood pressure that is persistently greater than 140/90 mmHg. Stroke is a cerebrovasular disorder that refers to a functional abnormality of the central nervous system that occurs when the normal blood supply to the brain is disrupted. It is the least common health problem identified by the respondents. Respiratory Diseases. Influenza is the highest ranking respiratory disease in Legazpi City Jail, Ligao City Jail and Tabaco City Jail with 46.67%, 63.33% and 56.67% respectively. It is also the most prevalent in the total population with 55.56% followed by Asthma with 11.11%. Tuberculosis and Chronic Bronchitis both rank with 6.67% and lastly, Pneumonia with 4.45%. Influenza is a viral infection that affects mainly the nose, throat, bronchi and, occasionally, lungs. Infection usually lasts for about a week, and is characterized by sudden onset of high fever, aching muscles, headache and severe malaise, non-productive cough, sore throat and rhinitis. The virus is transmitted easily from person to person via droplets and small particles produced when infected people cough or sneeze. Influenza tends to spread rapidly in seasonal epidemics. Influenza is commonly experienced by the inmates primarily because of the sudden changes in temperature, congestion, poor ventilation and lack of segregation. Asthma is a chronic inflammatory disease of the airways that causes airway hyperresponsiveness, mucosal edema, and mucus production. This inflammation ultimately leads to recurrent episodes of asthma symptoms: cough, chest tightness, wheezing, and dyspnea. Tuberculosis, or TB, is an infectious bacterial disease caused by Mycobacterium tuberculosis, which most commonly affects the lungs. It is transmitted from person to person via droplets from the throat and lungs of people with the active respiratory disease. Chronic Bronchitis, a disease of the airways is defined as the presence of cough and sputum production for at least three months in each of two consecutive years. Pneumonia is an inflammation of the lunch parenchyma caused by various microorganisms, including bacteria, mycobacteria, fungi, and viruses. It is the least common health problem identified by the respondents. Musculo-Skeletal Diseases. Muscle spasm is the highest ranking musculo-skeletal disease in Legazpi City Jail, Ligao City Jail and Tabaco City Jail with 40%, 30% and 36.67% respectively. It is also the most prevalent in the total population with 35.56% followed by Fractures with 16.67% and Arthritis was identified as the least prevalent with 15.55%. A muscle spasm is an involuntary contraction of a muscle, and is frequently painful. Some causes of muscle

Table 2. Health Problems Encountered by Inmates

Legazpi City Jail Health Problems Frequency Percent Ligao City Jail Frequency Percent Tabaco City Jail Frequency Percent Total F/P RANK

CARDIOVASCULAR DISEASES Hypertension Hypotension Stroke Angina Pectoris RESPIRATORY DISEASES Asthma Tuberculosis Influenza Chronic Bronchitis Pneumonia MUSCULO SKELETAL DISEASES Arthritis Fracture Muscle Spasm / Sprain GASTROINTESTINAL DISEASES Alcoholic Hepatitis Ulcer Dental Carries Typhoid Fever GENITO URINARY DISEASES Urinary Tract Infection Kidney Stones SKIN / INTEGUMENTARY DISEASES Dermatitis Scabies Prickly Heat Athletes Foot Ringworm Others

6 11 4

20 36.67 13.33

8 6 2 10

26.67 20 6.67 33.33

3 6 11

10 20 36.67

18.89 25.56 2.22 27.78

3 2 4 1

3 3 14 3 2

10 10 46.67 10 6.67

2 2 19 1 2

6.67 6.67 63.33 3.33 6.67

5 1 17 2 -

16.67 3.33 56.67 6.67 -

11.11 6.67 55.56 6.67 4.45

2 3.5 1 3.5 5

9 2 12

30 6.67 40

4 8 9

13.33 26.67 30

1 5 11

3.33 16.67 36.67

15.55 16.67 35.56

3 2 1

5 15 -

16.67 50 -

8 12 1

26.67 40 3.33

1 6 12 -

3.33 20 40 -

1.11 21.11 43.33 1.11

3.5 2 1 3.5

5 2

16.67 6.67

5 1

16.67 3.33

2 -

6.67 -

13.34 3.33

1 2

1 1 3 1 4

3.33 3.33 10 3.33 13.33

2 1 3 4 2 2

6.67 3.33 10 13.33 6.67 6.67

1 8 4 -

3.33 26.67 13.33 -

3.33 3.33 15.56 10 2.22 6.67

4.5 4.5 1 2 6 3

spasm include straining of a muscle, dehydration, trauma, diseases like cerebral palsy or multiple sclerosis (MS), as well as a reaction to certain poisons like strychnine, and damage to nerves or to the spinal cord. In a muscle spasm, the brain sends a mixed signal to the muscle to contract that is not willed by the person. Deep breathing and relaxation exercises may help the muscle gradually relax. The inmates experience muscle spasms primarily due to their lack of physical activities because they are confined in their cells. Fracture is a break in the continuity of the bone. Arthritis is a form of joint disorder that involves inflammation of one or more joints. Arthritis is common in jails because the inmates lack exercise and their physical activities are limited. It is the least common health problem identified by the respondents. Gastrointestinal Diseases. Dental caries rank as the highest gastrointestinal disease in Legazpi City Jail, Ligao City Jail and Tabaco City Jail with 50%, 40% and 40% respectively. It is also the most prevalent in the total population with 43.33% followed by Ulcer with 21.11%. Alcoholic Hepatitis and Typhoid fever rank last with 1.11% each. Tooth decay is an erosive

process that begins with an action of bacteria on fermentable carbohydrates in the mouth, which produces acids that dissolve tooth enamel. Tooth enamel is the hardest substance in the human body, but dental erosion occurs for several reasons. Contributing factors include nutrition, soft drink consumption, and genetic predisposition. Dental decay begins with a small hole, usually in a fissure or in an area that is hard to clean. Left unchecked, the decay extends into the dentin. Because dentin is not as hard as enamel, decay progresses more rapidly and in time reaches the pulp of the tooth. Measures used to prevent and control dental caries include practicing effective mouth care, reducing the intake of starches and sugars, applying fluoride to the teeth or drinking fluoridated water, refraining from smoking, controlling diabetes and using pit and fissure sealants. The inmates have dental caries mainly because they lack in dental care, due to nicotine use and unplanned diets. An ulcer is a crater-like lesion on the skin or mucous membrane of the mouth, stomach, and other body areas. Alcoholic hepatitis is a syndrome of progressive inflammatory liver injury associated with long-term heavy intake of ethanol. Typhoid fever is a bacterial disease, caused by Salmonella typhi. It is transmitted through the ingestion of food or drink contaminated by the f eces or urine of infected people. Alcoholic Hepatitis and Typhoid fever are the least common health problems the respondents identified. Genito-Urinary Diseases. Urinary Tract Infection (UTI) ranks as the highest genitourinary disease in Legazpi City Jail, Ligao City Jail and Tabaco City Jail with 16.67%, 16.67% and 6.67% respectively. It is also the most prevalent in the total population with 13.34% followed by Kidney Stones with 3.33% as the least prevalent. Urinary Tract Infection (UTI) is caused by germs, usually bacteria that enter the urethra and then the bladder. This can lead to infection, most commonly in the bladder itself, which can spread to the kidneys. Most of the time, the body can get rid of these bacteria. However, certain conditions increase the risk of having UTIs. Women tend to get them more often because their urethra is shorter and closer to the anus than in men. Because of this, women are more likely to get an infection after sexual activity or when using a diaphragm for birth control. Menopause also increases the risk of a UTI. Signs and symptoms of an uncomplicated lower UTI include burning on urination, frequency, urgency, nocturia, incontinence and suprapubic or pelvic pain. Inmates are susceptible to contracting UTI primarily because of poor hygiene practices with limited resources and a diet high in sodium. Kidney stones can form when urine contains too much of certain substances. These substances can create small crystals that become stones. It is a less common health problem among inmates. Skin/Integumentary Diseases. In Legazpi City Jail, the highest rank listed by the respondents was under Others pertaining mostly to allergic reactions, rashes and edema with 13.33%. Ligao City Jail however ranked highest in having Athletes Foot with 13.33% while Tabaco City Jail ranked Prickly Heat the highest with 26.67%. The total population showed that Prickly Heat was the highest ranking skin disease in prevalence with 15.56%, followed by Athletes Foot with 10% and Others with 6.67%. Edema of the feet was the leading condition listed by the inmates under this category. Dermatitis and Scabies followed, both ranking 3.33% and lastly, Ringworm ranked with 2.22%. Prickly heat is a type of heat rash characterized by tiny bumps or even water blisters. It is brought about by clogging of sweat glands, resulting into tiny bumps. The forehead (under caps or visors), body folds, the upper back and chest, and the arms are the most common locations. It is most common when it is hot and humid. A person will experience a prickly sensation, and the rash can look quite similar to one caused by infected hair follicles, but there are no hair follicles in prickly heat bumps. It can be prevented by taking a bath every day, limiting exposure to the sun, always drying up the sweat from the skin and by wearing light, loose clothing. Due to the extreme changes in weather, congestion and lack of ventilation, the inmates are predisposed to developing prickly heat. Athletes foot is a fungal infection of the skin that causes scaling, flaking, and itch of affected areas. Edema means swelling caused by fluid in your body's tissues. It usually occurs in the feet, ankles and legs, but it can involve your entire

body. Contact Dermatitis is an inflammatory reaction of the skin to physical, chemical, or biologic agents. A non-allergic reaction results from exposure to an irritating substance, or it may be an allergic reaction resulting from exposure of sensitized people to contact allergens. Scabies is an infestation of the skin by the itch mite Sarcoptes scabiei. The mites frequently involve the fingers, and hand contact may produce infection. Causes of Health Problems The condition of a mans environment is manifested through him: He will live in the constraints of the resources available to him. The lives led by the respondents before they were incarcerated are unknown to us: they might have been living in the streets, had nothing to eat or had been sick. Tables 3 to 5 reflect the possible causes of the health problems the inmates have identified. They would include: conditions of environments, facilities and resources present in the jail, health practices of the inmates, and health services the inmates avail. Conditions of Environments, Facilities and Resources Present in the Jail Table 3 shows the respondents environment inside the jail and the condition of their resources and facilities. The researchers had identified the top three problems under this category that may have been the leading cause of the health problems. Overcrowding was identified as the biggest problem the jail facilities have in Legazpi City Jail and Tabaco City Jail with 53.33% and 63.33% respectively, 36.67% of inmates from Ligao City Jail however, had said that their facilitys biggest problem was that it lacked in ventilation. In identifying the results in the overall population of respondents, Overcrowding was still the leading problem in jail facilities with 48.89%. Lack of ventilation followed with 30% and a short supply of food with 24.44%. The respondents also identified having dirty toilets as the least cause of health problems with 1.11%. Table 3. Causes of Health Problems
Causes of Health Problems Conditions of Environments, Facilities and Resources Present in the Jail Overcrowding Dirty tap water Dirty toilet Unsanitary surroundings Improper waste disposal Lack of ventilation Short supply of food Lack of utility worker 16 4 2 7 10 1 53.33 13.33 6.67 23.33 33.33 3.33 9 4 1 2 11 1 2 30 13.33 3.33 6.67 36.67 3.33 6.67 19 1 2 9 11 63.33 3.33 6.67 30 36.67 48.89 8.87 1.11 3.33 4.45 30 24.44 3.33 1 4 8 6.5 5 2 3 6.5 Legazpi City Jail Frequency Percent Ligao City Jail Frequency Percent Tabaco City Jail Frequency Percent Total F/P RANK

Majority of jails are congested primarily due to the lack of government funding for necessary infrastructures and the increasing crime rate in society today. Apart from increasing chances of skin-to-skin transmissions of certain diseases, overcrowding or congestion inside jail cells force the inmates to sleep on bare floors and generally limit their physical activities. Since there is a lack of funding for separate cells for segregation of inmates with communicable diseases, transmission within congested jails is high.

The lack of ventilation may be attributed directly to the overcrowding inside jails. The extreme temperatures may also be a contributing factor to the lack of ventilation, as well as institutional policies limiting the inmates exposure to outdoor activities and fresh air. A short supply of food is mainly due to lack of funds. Grown men generally require more food and nutritional intake than women, which may have led them to say that the food supply is inadequate. Toilet sanitation is not a cause of health problems for the inmates for they have stated on more than one occasion that they themselves clean and maintain it to avoid acquiring bacteria that will cause disease. Health Practices Table 4 shows the inmates health practices. These include daily practices that help decrease the risk of acquiring diseases through prevention. The researchers identified the three activities least performed by the inmates inside the jail as the possible sources of health problems. Only 60% of respondents from Legazpi City Jail use utensils like spoons and forks during meals and use shampoos when they bathe. Inmates from Ligao City Jail and Tabaco City Jail also identified the use of utensils during meals as the least practiced with 73.33% and 30% respectively. In the total population of respondents, only 54.44% of inmates use utensils during meals making it the least practiced, followed by eating on a clean table with 64.44% and with only 72.22% of inmates who use deodorant. 98.89% of inmates however, have said that they take a bath upon waking up, making it the most practiced hygienic behavior. It is no surprise that only 54.44% of the respondents use utensils when they eat since the Bureau of Jail Management and Penology mandates that any metal object including spoons and forks are not allowed inside jails for use of inmates in the interest of the safety of fellow inmates and jail facilitators alike. Also, some inmates are used to eating with their hands only. Hand washing before and after meals is highly practiced in the jails with 97.78%. People who do not use utensils when they eat increase the risk of ingesting microorganisms through hand-mouth contact. Only 64.44% of respondents eat on clean tables or surfaces mainly because some facilities do not have dining areas or tables that would accommodate them during meals. Eating on dirty surfaces or on the floor, predisposes them to vector-borne diseases from insects or animals. Their food may be indirectly contaminated by microorganisms brought by these vectors when exposed to unclean surfaces when they eat. The majority of respondents who admit to not using deodorants or any kind of antiperspirants state that they simply do not have this resource. The use of antiperspirants slow bacterial growth produced with sweat. Since the inmates have no means of purchasing antiperspirants, it would be beneficial if antiperspirants would be included in the supplies given by the jail administrators. Daily bathing is a must especially for the respondents. The climate in the Philippines is generally warm to hot, and the facilities inside the jail make the inmates sweaty and uncomfortable. Most of them take baths twice a day to relieve the discomfort brought by the heat.

Table 4. Health Practices of Inmates

Causes of Health Problems Health Practices Takes a bath upon waking up Takes a bath before going to bed at night Brushes teeth 3 times a day Changes to clean clothes after bath Shaves mustache/beard Washes hands before eating Washes hands with soap and water Covers leftover food Washes face Uses shampoo Uses deodorant Uses spoon and fork Eats on clean table Washes hands after eating Legazpi City Jail Frequency Percent Ligao City Jail Frequency Percent Tabaco City Jail Frequency Percent Total F/P RANK

30 27 27 29 25 29 30 28 29 18 19 18 19 27

100 90 90 96.67 83.33 96.67 100 93.33 96.67 60 63.33 60 63.33 90

30 29 30 30 30 29 30 29 27 28 24 22 29 29

100 96.67 100 100 100 96.67 100 96.67 90 93.33 80 73.33 96.67 96.67

29 25 29 29 27 30 28 28 27 21 22 9 10 27

96.67 83.33 96.67 96.67 90 100 93.33 93.33 90 70 73.33 30 33.33 90

98.89 90 95.56 97.78 91.11 97.78 97.78 93.44 92.22 74.44 72.22 54.44 64.44 92.22

1 10 5 2 9 2 2 6 7.5 11 12 14 13 7.5

Health Services Table 5 shows the inmates personal views on what aspect of health services are lacking. The researchers had identified the top three problems for this category that may have been the greatest contributing factors that cause health problems. Respondents from Legazpi City Jail identified that the highest deficit in their health services is the inadequate supply of medicines and equipments with 66.67%. Ligao City Jail also ranked this as the highest deficit together with the absence of health care professionals each with 40%. Meanwhile, Tabaco City Jail identified that the lack of/absence of medical check-up as the highest deficit with 50%. In the total population of respondents however, the inadequate supply of medicines and equipment still ranked the highest with 45.56% followed by the lack of/absence of medical check-up with 45.55% and the absence of health care professionals with 42.22%. The lack of government sponsored health services and environmental programs were identified as the least cause of health problems with 34.45%. Table 5. Health Services
Causes of Health Problems Health Services Lack of government sponsored health services and environmental programs Inadequate supply of medicines and equipments Lack of health care funding Lack of/absence of medical checkup Absence of health care professionals Legazpi City Jail Frequency Percent Ligao City Jail Frequency Percent Tabaco City Jail Frequency Percent Total F/P RANK

15 20 14 16 13

50 66.67 46.67 53.33 43.33

5 12 9 10 12

16.67 40 30 33.33 40

11 9 10 15 13

36.67 30 33.33 50 43.33

34.45 45.56 36.67 45.55 42.22

5 1 4 2 3

These three identified deficits correlate to each other in the sense that the causes of the deficits are the same: lack of funding. Without funding, there would be no medications to provide, or anywhere to get a health care professionals salary, or a starting fund to materialize medical check-ups for the inmates. These are forms of secondary prevention methods through

early detection and treatment. Without these health services, minor illnesses may worsen without proper medication. Some illnesses may go undetected and untreated and cause a chain of infection within the jail. The health status of these inmates may deteriorate if not taken care of properly by people who have the knowledge and capability to promote health. The respondents said that the health services and programs provided to them were adequate. The few who said that there was a lack mentioned that some of the health problems that were not emergencies or life-threatening were not acknowledged. Upon an interview with the warden of each jail and a corresponding licensed nurse that works for each jail, the researchers had inquired about the specific health services that are offered to the inmates during their stay. A bi-annual Medical Mission is conducted in the jails, which includes a provision of free medicine for their consumption. Another would be a bi-annual Dental Mission which includes free dental services. When asked about inmates who have serious illnesses or those who need continuous medical attention throughout their stay, the policies vary depending on the severity and urgency of the situation. For moderate to severe cases that are not considered as an emergency, the jail waits for a formal referral from a district hospital before discharging the inmate for medical attention in national institutions. In case of an emergency wherein the inmates life is in danger, the jail immediately takes it to the nearest hospital for treatment. If the inmates condition is not an emergency but still requires medical intervention, the jail not only waits for a referral from the district hospital but also waits for a court order allowing the release of the inmate to be treated. The Bureau of Jail Management and Penology (BJMP) also releases a monthly supply of hygiene-directed items like bars of soap, tooth pastes, shampoos and hand towels, to promote good health within the facility and to give support to those inmates who have nothing to use. Conclusion Based on the findings, the following conclusions were drawn: 1. The respondents of the studies differ in their demographic profiles. The respondents families have illnesses in common, predisposing the inmates to similar diseases. 2. The overall health conditions of the respondents are quite poor: nearly all the respondents have had illnesses during their stay in the jail and their diseases differ. 3. The facilities present in the jail are inadequate. Their health practices differ, therefore, the diseases they encounter vary. 4. The health services they receive are the same, but are lacking. 5. There are various measures that can be proposed and can be done in order to prevent the diseases inside the jail. Recommendations In view of the findings of this study, the researcher presents the following recommendations: Bureau of Jail Administrators 1. Make health services that prevent and treat disease accessible and available to all inmates. 2. Strengthen the conduct of livelihood, education and skills training.

3. Provide uniform treatments and facilities for all city and district jails by providing functional small clinics manned by doctors and nurses and an adequate supply of medicines for common diseases that are readily accessible for inmates use. Members of Jail Health Team 1. Increase the frequency of medical and dental services, and the scope of its activities to include not only free check-ups and medications, but follow-up check-ups, workshops and health-promoting activities especially to those inmates who were already sent home or who are nearing release to limit the risk of transmitting communicable diseases. 2. Raise awareness regarding environmental sanitation practices through symposiums based on health-related problems and queries of the inmates, clean-up drives and proper waste management and segregation and health education to inmates. 3. Promote physical fitness and sports programs for inmates as well as spiritual upliftment activities. Local Government Unit Officials 1. Find willing sponsors and families to aid the dwindling budgets for inmates needs and to finance a learning program for them during their stay to strengthen their education. 2. Create support groups for family members of inmates and help connect inmates who are nearing release to re-enter society with suitable jobs. 3. Strengthen and increase public health surveillance. Inmates-Respondents 1. Improve health practices, personal hygiene and practice healthy lifestyles. 2. Participate in health programs organized by the BJMP, Jail Health Team and LGUs. 3. Increase health awareness to prevent or minimize likelihood of acquiring diseases. General Public 1. Encourage support in every aspect of the rehabilitative process, especially those reentering society. Future Researchers 1. Conduct future studies on related topics focusing on the different aspects governing the lives of the inmates. References Books Ardeles, Venecio B., 1992. Basic Concepts and Methods in RESEARCH. Great Books Trading, Quezon City. Brunner and Suddarths, 2010. Medical- Surgical Nursing. United States: Lippincott- Raven Publishers. Grant, John J. and Pirthe, Wayne, 1976. Social Problems and Human Concerns. San Francisco: Body and Publishing.

Kozier ,Barbara, 2004. Fundamentals of Nursing: Concepts, Process and Practices. Singapore: Addison Wesley Longman Inc. Nieswiadomy, Rose Marie, 2004. Foundations of Nursing Research, 4th Edition. Pearson Education South Asia PTE LTD. Pender, N.J., 1987. Health Promotion in Nursing Practice 2nd Edition. Norwalk, CT: Appleton and Lange. Journals, Magazines and Newspaper Articles Grant, Elizabeth, 2008. Overcrowding in Americas Prisons: Can Rehabilitation help lower the growing numbers of Repeat Offenders .University of Adelaide. Mahon, Nancy. Methodological Challenges in Studies of Prisoners Sexual Activity and Drug Abuse. Center on Crime, Communities and Culture, Open society Institute,888 Seventh Avenue, New York. Unpublished Works Cordial, Maria Theresa,2003. Situational Profile Offenders in Sorsogon Provincial Jail. An Unpublished Undergraduate Thesis, Bicol University College of Arts and Science. De Villa, German C., 2003. The Effects of Counseling on the Behaviour and Rehabilitation of Inmates in Quezon Provincial Jail. Unpublished Thesis MSEUF, Lucena City. Fazel, Sheena et.al., 2001. Health of Elderly Male Prisoners: worse than the general population, worse than younger prisoners. Institute of Criminology, Faculty of Law, University College Dublin, Ireland. Guiterrez, Monette R., 2001. The Study of Various Jail Problems as Perceived by the Jail Guards in Quezon Provincial Jail .Unpublished Thesis, MSEUF, Lucena City. Loba, Benicto L., 1999. Rehabilitation Services of the Bureau of Jail Management and Penology in the Province of Albay: An Appraisal. Luce, Jessie P., 1998. Jail Correction Security/Safety. Unpublished Study, Camp Guillermo Nakar, Lucena City. Manding, Michael Floyd, 2008. A Study on the Health Services Received By Bohol Detention and Rehabilitation Center Inmates In Relation to Their Health Status. Holy Name University, Tabilaran City, Bohol, Philippines. Pazzibugan, Jose, 1998. Outbreak of Diseases in Manila City Jail.

Simbulan, Nymia P. et.al., 2000. High-Risk Behaviours and the prevalence of Sexually Transmitted Disease among women prisoners at women state penitentiary in Metro Manila. University of the Philippines Manila, Ermita, Philippines. Toledo, Ronaldo, 1998. The Status of Prisoners in Legazpi City Jail. An Unpublished Undergraduate Thesis, Bicol University College of Arts and Sciences. Internet http://www.kcl.ac.uk/depsta/law/research/icps/downloads/world-prison-pop-seventh.pdf http://www.bjmp.gov.ph/datstat.html http://www.helium.com/items/1931537-factors-that-affect-crime-rates http://www.opcatph.org/prison%20conditions.htm http://www.bjmp.gov.ph/data/congestion.html http://www.thefreedictionary.com/prisoner http://topics.law.cornell.edu/wex/prisoners_rights http://www.scribd.com/doc/28847454/Common-Problems-Encountered-by-Selected-Inmates-ofQuezon-Provincial-Jail http://www.cdc.gov/ncidod/EID/vol12no03/05-0625.htm http://en.wikipedia.org/wiki/Infectious_disease http://www.prisontalk.com/forums/showthread_php?t http://www.urban.org/uploadedpdf/410629_ReleasedOffenders.pdf http://www.who.int http://www.unafei.or.jp/english/pdf/RS_No79/No79_27VE_Herradura.pdf http://www.urbaninstitute.org/publicacations/311213.html http://www.ojp.usdoj.gov/bjs/ http://www.saps.canterbury.ac.nz/sowk/research/postgrad.shtml http://dspace.lib.ttu.edu/etd/bitstream/handle/2346/ETD-TTU-2009-12-239/TROOKTHESIS.pdf?sequence=6 http://www.dtir.mi/

http://old.texarkanacollege.edu/~sdroske/UnitIIlecture.htm http://books.google.com.ph/books?id=l2nIANas5J0C&pg=PA179&lpg=PA179&dq=agent+host+ environment+theory&source= http://currentnursing.com/nursing_theory/models_prevention.html http://www.humanrights.asia/news/ahrc-news/AHRC-STM-229-2010 http://law.jrank.org/pages/9386/Prison-Prisoners-Rights.html http://www.news-medical.net/health/What-is-Cardiovascular-Disease.aspx http://en.wikipedia.org/wiki/Respiratory_system http://marriage-statistics.findthebest.com/directory/d/Philippines http://emedicine.medsacpe.com/article/170539-overview http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001549/ http://www.doh.gov.ph/healthadvisories/prickly_heat/