2.1 Introduction 

For centuries, women have been afraid of childbirth. Not because of the pain but because of the very real risk of dying of child bed fever. A few simple hygienic measures put an end to this bacteriological infection. We owe this to the Hungarian gynaecologist Ignaz Semmelweis, who in 1847 urgently appealed to his students to wash their hands before entering the maternity ward. His request was met with considerable resistance by colleagues but the results were astonishing: In two months' time, the mortality rate fell from 12.4% to 1.3%.

In the previous chapter, you have learnt that the chance of catching an infectious disease is greater inside the prison than outside. Like child bed fever, most infection risks can be prevented with a few simple precautionary measures. What is easier than using a band aid if you have a little wound? This simple band aid protects from direct blood contact and so from a possible infection with HIV or hepatitis. Another example:

Put on heavy gloves when picking up a syringe from the ground. This prevents a 'prick accident' which could be very costly in the long run, as the HIV stays alive in a used syringe for over three weeks. Other measures either require efforts are not your responsibility. The European Commission, for example, has set an objective to raise the standard in all European jails. In practice, this comes down to promoting health care, improving working conditions, building extra cells and organising training programs for prison staff. Deciding on these measures is not your responsibility but whether the mission of the European Commission is successful, strongly depends on your attitude. As someone involved in the daily routine you, after all, play a key role in implementing and complying with these measures. You probably are not too keen to sacrifice your daily routine to fundamental changes. This only creates unrest - and nobody in a prison needs that. On the other hand, no one is served if things stay the same. Who passively stands by and denies that drugs are being used, allows viruses and bacteria have a field day, with all its nasty consequences.
Therefore, something has to happen. So much is clear. But what and above all: How, and how fast?

y denying that drug injecting "Simply place inside is a reaction that is still all too common. But long experience has shown that drugs, needles and syringes will find their way through the thickest and most secure prison walls."

NAIDS, Point of View, Apri I 1997.

Devise a step-by-step strategy

To begin with the last question: above all, do it at your own leisure. Don't be too ambitious, don't be too demanding and implement your measures step by step. This way, it will not interfere too much with daily prison routine and avoids unrest in the cellblocks. In addition, a step-by-step plan lets you reflect on inbetween successes, and this is very motivating. In the 'Tour de France' the main goal is the yellow sweater, but a stageby-stage success is also very important.

What's more, you, as race participant, had better not think too often about the 4000 kilometres to Paris or else your courage might leave you at the start. In other words, this huge job cannot be completed in one day, either. So don't ever expect this, but take small steps which are easy to achieve. Also, in the European context, it is recognized that in order to eventually reach the desired result, changes have to be made little by little.

In this chapter, a number of suggestions are made to promote a good standard of health in closed institutions. These stepby-step suggestions, however, are not intended as a blueprint; no one is obliged to virtually implement all the steps. If one suggestion does not fit in with prison policy, jump to the next one which can be implemented. No one claims that providing syringes is the ultimate goal. Which path to take, is up to you - or better still: Is up to all of you. Because a collective approach is just as important as a step-by-step approach. Prison staff, guards, medical- and kitchen personnel have to be on the same wavelength and pursue the same goals.

It's even better if an active part is reserved for the prisoners too, as their cooperation, as the largest group, contributes to the promotion of everyone's health. The motivation, however, depends entirely on good information. Therefore, explain to the prisoners why good basic hygiene is so important. Point out to them unsafe drug use practices and other high-risk behaviour. Encourage them to use personal hygiene. And involve them in keeping the prison clean. The better the collective approach, the better the chance that the objective of the European Commission succeeds - and this is in the interest of everybody. And important even for the 'outside world' as the prisoner, sooner or later, returns into society. If, upon return into society, he/she is infected with HIV or another virus, then his/her direct environment (partner and children) is at risk. Within the walls of the prison you run this risk. Protect yourself!