Starting the Conversation

HMS students call for training on care for incarcerated

panel with incarcerated persons

From left: Parsa Erfani, Avik Chatterjee, Joli Sparkman, Allegra Martinez and Arthur Bembury. Image: Mimi Yen-Li

This past August, a nationwide prison strike commenced in the United States, with incarcerated people making a range of demands, from improvement in living conditions and wages to the end of lifetime sentences without parole. The strike reignited conversations among Harvard Medical students regarding how to best provide medical care among incarcerated populations.

Currently and formerly incarcerated patients may be treated at Harvard-affiliated hospitals, and some students may feel unprepared to care for these populations of patients. In recognition of this issue, HMS students organized a panel regarding the health effects of mass incarceration in September.

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“We’re hoping to use this opportunity to start that conversation here,” said Parsa Erfani, a second-year MD student who helped organize the event. During his first year at HMS, Erfani interviewed an incarcerated patient and stated that he felt unequipped to adequately perform a nuanced history and physical.

Jessica Laird, also a second-year student in the MD program, gave a compelling 25-minute overview of mass incarceration at the event, providing information on its effect on physical and mental health, and suggesting alternatives to incarceration, such as abolition and restorative justice.

Laird gained experience working with incarcerated populations in Rhode Island while attending Brown University and she currently volunteers at the Nashua Street Jail in Boston through the Crimson Care Collaborative at HMS.

The panel was moderated by Avik Chatterjee, an HMS instructor and a primary care physician at Boston Healthcare for the Homeless Program, where he  cares for many patients who have a history of incarceration.

More than 100 members of the Harvard community, including students, faculty and staff, attended the panel discussion.

Listening to the stories

Panelists included three individuals who were formerly incarcerated, including Joli Sparkman, a mother of three children who said she was a survivor of the commercial sex trade, and was incarcerated for 18 years at MCI-Framingham. Sparkman currently works as the re-entry coordinator at Bethany House Ministries, a nonprofit that supports people affected by incarceration. She is pursuing a Master in Social Work at Boston College.

Another panelist, Allegra Martinez, said she was incarcerated for almost seven years at MCI-Framingham, where she began taking courses through a Boston University program. She was released in April 2018.

The third panelist, Arthur Bembury, is the executive director of Partakers, a mentoring program that matches community volunteers with incarcerated students who are pursuing degrees from universities in the Boston area. He said he was incarcerated for 15 years.

During the session, the panelists spoke about their own medical experiences during incarceration, as well as the experiences of those they have mentored and supported through their work.

“A trip to the Shattuck [Hospital] is fantastic for somebody who is incarcerated,” Sparkman said with sarcasm in her voice, as she described being shackled and handcuffed for the entirety of her visits, which were supervised by a corrections officer.

Sparkman was diagnosed with Systemic Lupus Erythematosus after only one positive antinuclear antibody (ANA) test. She said she was then placed on Plaquenil, a drug used to treat both lupus and malaria, for the duration of her prison sentence. Upon release, Sparkman had a full lupus workup completed and was told that she had been misdiagnosed.

Sparkman said she began her sentence at MCI-Framingham as a young woman affected by mental illness, behavioral issues and a history of sexual and physical trauma. She said she resorted to self-harm as a result of the retraumatization of the prison environment and added that she was “one of the lucky ones” who was able to receive therapy for her illness.

Allegra Martinez said she also managed a psychiatric illness while incarcerated. She said she was only 18 when she was sentenced to seven years at MCI-Framingham.

Martinez said she had struggled with chronic depression for most of her life and while incarcerated she said avoided medical services at all costs because of fear of mistreatment, including psychiatric treatment and dental care. 

She also described the treatment of other incarcerated people with mental illness that she said she witnessed. She said she particularly sought to avoid placement in the intensive treatment unit, a segregated holding area for people who are perceived to lack the mental capacity to reside with the general population.

Many people are placed in the unit without treatment, Martinez said, and out of fear of placement there, she said she never disclosed the symptoms of her mental illness, which included suicide ideation, to authorities.  

Bembury said he was diagnosed with hypertension while incarcerated, a condition he believes he contracted due to the prison diet. Although he was prescribed antihypertensive agents, which he took for years even post-release, his blood pressure remained at dangerously elevated levels.

After establishing care with a physician outside of prison, Bembury was placed on a different antihypertensive medication that almost immediately reduced his blood pressure. 

“A lot of us inside [prisons] do not know what proper health care looks like,” he said. “We don’t know until later that it’s not [adequate care].”

Bembury left the audience of future health care professionals with a strong message: “We need you to be inquisitive enough and courageous enough to ask questions and not to just accept what’s put in front of you … We need new foot soldiers in the new civil war—and that’s what this is, a civil rights movement.”

Continuing the dialogue

The panel at HMS was organized by the Racial Justice Coalition, a student-led organization at HMS that aims to equip students with the tools to address disparities in health care.

Students worked with Jenifer Drew, a retired professor of sociology at Lasell College who facilitates a speakers bureau of formerly incarcerated men and women, to organize the panel.

Students who attended the event said they were grateful for the opportunity to learn from the panelists and they plan to advocate for the continuation of the conversation as a formal component of their education. They called for a schoolwide effort to promote the health of members of communities affected by mass incarceration.

The event was cosponsored by the Office of Student Affairs and Office of Recruitment and Multicultural Affairs.

Afolabi is an MD student in the Holmes Society at HMS.