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══════════════════【立報】═══════════════════ |
| 教 育 專 題 深 入 報 導《2008-07-10》 |
| 本期內容 | |
| ◎國際專題：監獄風雲 鐵窗下的生活 | |
| ◎英將刪減受刑人膳食 可能引發暴動 | |
| ◎打擊結核病 西伯利亞監獄成典範 | |
| 國際專題：監獄風雲 鐵窗下的生活 | |
| 策劃、編譯■陳銳嬪、陳玫伶 | |
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監獄是個神秘的地方，卻不應該是個黑暗的地方。 住在監獄裡面的受刑人，縱然有千百般過錯，他們的基本權利卻不應該被忽視。 因為監獄的福利與政策，表現出的是一個國家如何看待人權啊！ |
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| （回目錄） | |
| 英將刪減受刑人膳食 可能引發暴動 | |
| 參考來源 ／英國《衛報》 | |
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高漲的食物價格，讓英國監獄打算刪減受刑人的肉類與新鮮蔬菜份量，但是監獄管理相關人士警告英國政府，此舉可能會令過於擁擠的監獄爆發動亂。 提供監獄餐飲的經理私下表示，她刻正努力尋找便宜的替代食材，以維持受刑人每日1.9鎊（約新台幣114元）的膳食費。她表示，近一週以來供應給監獄的肉類不穩定，而漲幅大起的糧食價格更讓所採購到的食材份量變少。 監獄改革組織霍華德聯盟（Howard League）的法蘭西絲‧庫克說：「監獄人口密度一直高居不下，監獄內食材預算一直面臨壓力，所以刪減監獄膳食將是必然的結果。而我們很清楚，膳食變差將是監獄動盪的重要起因。」 英國政府要求政府部門刪減3％的預算，以讓預算運用更有效率，然而庫克要求政府馬上赦免監獄刪減預算。她說：「這個時刻削減監獄運作的預算是很不負責任的決定。」 監獄管理人協會主席科林‧摩西斯也回應說：「減低膳食必需品，將會帶來日後監獄內的動亂。」 英國保守黨影子內閣司法大臣愛德華‧嘉尼耶表示，「良好和適當的營養」對監獄管理是必要的，尤其是對有健康問題或是藥物濫用的受刑人尤其重要。他警告說，變更監獄中的菜單可能產生「立即影響」。他說：「吃飯對受刑人來說是很重要的事情，即使是改變用餐時間也會造成他們沮喪。」 一名監獄發言人堅持「當前沒有計畫降低監獄的膳食水準」。她說，今年年初，政府已經浥注一筆190萬鎊的款項以因應通膨壓力。 發言人認為，監獄必須自己尋找有效的對應方式，每一個監獄管理人都謹慎地將經費花在刀口上。不過她表示，政府目前已嚴密監控監獄管理層級，以確保符合規定並有效運用經費。 庫克指出，監獄膳食供應業者在供應面遇到難題，是監獄預算全面受到刪減的最佳證據。此外，高漲的糧價與油價，也迫使獄方減少花費，包括受刑人的膳食。 上週，英國政府公布了一項全國性的「節約」措施，那即是取消每週五傍晚「核心日」（core day）的正式活動，而一些監獄管理人也取消週末和其他監獄受刑人聯誼的社團活動。對此，庫克和監獄管理人協會不約而同表達了對這個政策的關心。 摩西斯表示這項改變是一種「病態策略，讓管理層陷入危機」。他說一系列縮減資源的步驟，會使得監獄管理人處於愈來愈危險的環境。 http://www.guardian.co.uk/society/2008/jul/06/prisonsandprobation.foodanddrink |
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| （回目錄） | |
| 打擊結核病 西伯利亞監獄成典範 | |
| （路透社） | |
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一個蘇聯時代的監獄坐落在西伯利亞邊緣，監獄裡有一個擁有1千個床位的醫院。笑起來可以看到一排閃亮金屬假牙的亞歷山大‧普斯卡雷，是這家醫院的精神科醫生。 「歡迎來到托木斯克設備第一的康復中心，這是俄羅斯最好的結核治療中心。」 1990年代中，每週都有受刑人因致命的結核病而死，但是在一群美國醫生的幫助下，這個接近全球最大沼澤的監獄，成了抵抗抗藥性結核病的世界典範。 托木斯克計畫原先由美國公共健康研究中心開始倡議，該中心獲得喬治‧索羅斯（譯按：美國著名的貨幣投機家）資金贊助，目前由駐波士頓的醫生團體「健康夥伴」執行。這個計畫扭轉了人們對結核根深蒂固的醫學觀點，因為人們普遍覺得結核難以醫治且需要昂貴治療費。 朱希‧紹寇肯說：「如果沒有托木斯克計畫，現在的結核療法將遠遠比現在落後。」這名來自波士頓的醫生，目前在托木斯克審查計畫。 「在打擊結核問題上，這是重要的分水嶺。」 這個計畫目前已經從監獄延伸到區域的一般民眾，在這個計畫下，8年內托木斯克的結核死亡率已經減少過半，目前死亡率大約為每10萬人中有12人死亡，是西伯利亞平均結核死亡率的1／3。 它的要點非常簡單：只是確保現行療程有正確的被遵守，而不是推介高科技療法或者昂貴藥物。 每年有大約2百萬人死於結核，這數據還在上升當中，使它成為全球最大殺手之一。每年有約3百萬人死於愛滋病，約1百萬人因瘧疾而死。 在過去數10年來，結核問題的出現主要是因為病人沒有完成療程，所以托木斯克康復中心絕對是一個適合的地方：它的利器是紀律。 最有效的反應來自該中心強制的一系列措施，包括加強通風系統、確保醫藥人員獲得適當的訓練、發給病人重要的藥物以及建立嚴謹的監督系統以確保病人完成療程。 對於那些非受刑人，醫生會四處巡視並親眼看到病人服用結核藥物。如果病人逃避療程，州政府給予的補助將會被撤銷，另一方面，檢驗結核的技術與教育也已經有所進步。 醫生使用一系列的抗生素，如果在治療過程中病患沒有反應，醫生會轉而尋找另外一種療法。 世界衛生組織現在推介這樣的策略，並把它稱為「直接監督下的短程化療」（DOTS）。 結核殺死蕭邦與歐威爾 結核之前被稱為肺癆，殺死的人數以百萬，包括19世紀的波蘭作曲家蕭邦、蘇格蘭作家史蒂文生與20世紀英國作家歐威爾。 實際上，生活水準的提高以及抗生素已經讓結核差不多絕跡。在20世紀後50年，先進國也備受結核病侵襲。結核菌通常襲擊人們的肺，導致病人咳到出血與虛弱。 目前，它依然在貧窮國家蔓延，感染人類免疫缺陷病毒的病人最易受感染，數據顯示，目前感染結核的病人比以前更多。 世界衛生組織估計，全球每年有約50萬人感染對兩種以上基本藥物有抗藥性的結核。 俄羅斯的部份地區是其中受到影響最大的地區：在托木斯克發現的15％新病例都是有抗藥性的例子，世界平均例子才超過5％。亞塞拜然的巴庫有全球最高的抗藥性結核新病例──22％。 但是「健康夥伴」指出，抗藥性結核有80％痊癒的機會。這個為了替窮人提供醫療服務而成立的組織，使用它在托木斯克的經驗，在非洲國家如盧安達與馬拉威，以及其他前蘇聯國家設立類似的計畫。 自從「健康夥伴」接手托木斯克計畫後，它獲得比爾與美琳達‧蓋茨基金會與禮來製藥廠的資助；它在2004年獲得全球基金5年1千8百萬的補助以對抗愛滋病、結核與瘧疾，全球基金由世界上最富有的國家設立。 俄羅斯其他監獄現在把受刑人送到這裡來接收治療，而其他地區的當權者也打算於今年在托木斯克成立全球結核研究中心。 數著屍體的8年 建在側邊的監獄防疫線把它與醫院分隔開來，10多個感染結核的受刑人被關在裡面。要進入裡面的人們必須全副裝備──塑膠帽子，全身罩以及面罩。 在美國醫生推介這個計畫前，很少有受刑人會相信自己可以活著離開那裡。 「這或許是為什麼托木斯克可以容納這麼多人的原因。」另外一名「健康夥伴」醫生艾德‧納德爾說：「他們一個一個數著屍體的時候，他們知道他們必須做一些事情。」 一群穿著全身黑的男人從高聳的鋼絲圍牆內向外望，或者從骯髒、被閂住的牢房窗口往外看著外面的天井。他們的頭髮被剃光，表情空洞，臉是枯瘦凹陷的。 一名自稱為拉奇的受刑人表示，在監獄醫院的日子已經有很大的改善。「我在這裡已經8年。」他說著說著就輕輕笑了起來。 「我還會在這裡一段時間。」 Alexander Pushkarev, head doctor at the 1,000-bed hospital in a Soviet-era prison nestling at the edge of Siberia, flashed a row of metal teeth with his smile. "Welcome to Tomsk Correction Facility No. 1," he said. "This is the best treatment for TB in Russia." In the mid-1990s, virulent tuberculosis was killing prisoners here every week, but with the help of a group of American doctors, the jail near one of the world's biggest swamps has set an example to others worldwide dealing with drug-resistant TB. Following an initiative from the U.S. Public Health Research Institute which was funded by George Soros, the Tomsk project now run by Boston-based doctors' group Partners in Health (PIH) has overturned conventional medical thinking that drug-resistant TB strains are extremely difficult and expensive to treat. "Without the Tomsk project, drug-resistant TB treatment would be years behind where it is now," said Jussi Saukkonen, a doctor from Boston who was in Tomsk to inspect the project. "It's been an important benchmark in dealing with this problem." Under the project, which has now extended beyond the prison to the general population in the region, deaths from TB in Tomsk have nearly halved in eight years to around 12 per 100,000 people -- a third of the average in Siberia. Its main thrust is simple: just to ensure existing treatment is adhered to properly, rather than introducing new high-tech solutions or expensive drugs. About 2 million people die each year from TB, a rate which is accelerating, making it one of the world's biggest killers: there are around 3 million deaths a year from AIDS and 1 million from malaria. Drug-resistant TB emerged over the last couple of decades mainly because patients failed to complete courses of medication, so the Tomsk Correction Facility is an appropriate place for this project: one of its core weapons has been discipline. The most effective response was produced by rigorously enforcing a series of existing measures, including improving ventilation, ensuring medical staff have proper training, paying for essential drugs and establishing a strict monitoring system to make sure patients complete their treatments. Among the non-prison population, doctors do rounds and physically watch their patients take their TB medicine. State benefits are withdrawn if the patient skips their treatment, while testing and education about TB have improved. Doctors use a range of antibiotics and are ready to switch patients between treatments if they don't respond. The World Health Organisation (WHO) now promotes such a strategy, called the DOTS (Directly Observed Treatment, Short-course) programme. KILLER OF CHOPIN, ORWELL Previously known as consumption, TB killed millions including the 19th-century Polish composer Frederik Chopin, Scottish author Robert Louis Stevenson and 20th-century English writer George Orwell. Rising living standards and antibiotics virtually wiped out TB -- bacteria spread via droplets which commonly attack the lungs invoking a bloody cough and sapping energy -- in the developed world during the second half of the 20th century. But it still stalks poorer countries, where people infected with HIV are most vulnerable, and figures show there are more people with the disease now than ever. The WHO estimates that nearly half a million people a year worldwide become infected with a form of TB that is resistant to two or more of the primary drugs used to treat it. Parts of the former Soviet Union are among the worst affected areas: around 15 percent of new cases in Tomsk are drug resistant, against a world average of just over 5 percent. Baku in Azerbaijan has the world's highest rate of drug resistance in new cases, at 22 percent. But PIH says it has achieved nearly an 80 percent cure rate for drug-resistant TB. The group, founded to provide medical care to the poor, is using the experience from Tomsk to set up projects to treat drug-resistant TB in the African countries of Rwanda and Malawi, and other former Soviet states. Since PIH took it over, the Tomsk project has also been funded by the Bill & Melinda Gates Foundation and pharmaceutical group Eli Lilly, and in 2004 received a grant worth $10.8 million over five years from the Global Fund to Fights AIDS, Tuberculosis and Malaria, set up by the world's wealthiest countries. The Russian prison service now sends inmates from other regions to the jail to receive treatment, and the regional authorities plan to set up a global TB research unit there this year. EIGHT YEARS AND COUNTING In a wing of the prison cordoned off from the rest of the hospital, a few dozen inmates infected with drug-resistant TB have been locked away. People only enter wearing protective clothing -- plastic hats, overalls and face masks. Before the U.S. doctors launched their project here, few inmates could expect to leave this wing alive. "Maybe that's why Tomsk was so receptive," said Ed Nardell, another PIH doctor. "They were literally counting the bodies and knew that something had to be done." Groups of men dressed in black overalls stared out from behind high wire fences which segregate courtyards or peered through mucky, barred dormitory windows. Their heads were shaved, their expressions blank, their faces gaunt and hollow. A prisoner who gave his name as Rakhid said life in the hospital prison has vastly improved: "I've been here eight years," he said and then chuckled. "And I'll be here a while longer." REUTERS |
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