Editorial

• DOI: https://doi.org/10.1108/IJPH-06-2020-075
• Published date: 28 May 2020
• Date: 28 May 2020
• Pages: 93-94
• Author: Austin M. Hopkins
• Subject Matter: Health & social care,Criminology & forensic psychology,Prisoner health,Sociology,Sociology of crime & law,Public policy & environmental management,Policing,Criminal justice

Editorial

Austin M. Hopkins

When I shared my plans to rotate at the women’s prison obstetrics and gynecology

(OB/GYN) clinic, a family member asked me “Why would they send you there?”

Contrary to my family’s reservations,my rotation was a product of my own volition to

gain direct experience with a patient population that had captured my attention during the

early stages of medical school. Training at a large, public academic medical center, I have

been exposed to many patients who have presently, or had previously, been incarcerated,

and I was immediately drawn to these patients because of the sociocultural complexity

accompanying their medical care.However, my early encounters with incarcerated patients

were not consistent with the messages I had subconsciously internalized. Sensationalized

narratives of criminality and punishment from popular media and messages to which I was

exposed in childhood led me to assume prison to be a cruel, cold microcosm in which any

kindness was fleeting in the context of formalized imprisonment. I realized that this

conception of incarceration impeded my ability to truly understand the experiences of

patients affected by the criminal justice system and those of their friends and family

members. I plan to practice medicine as an OB/GYN, and incarceration will affect a large

proportion of my future patients, as the rate of increase of female incarceration has been

twice that of men since the 1980s, and an estimatedone in four Americans will have a family

member affected by the criminal justice system. I createda rotation at the women’s prison to

better understand the realities and challengesof delivering OB/GYN care within the context

of incarceration.

One specific motivation for my rotation was a profoundly influentialexperience with a former

patient who I will call Denise. She had been admitted to the hospital from prison with

uncontrolled type I diabetes and preeclampsia. I loved spending time with Denise, but my

interactions were constrained by the bright red “no visitors” sign on her door and guard’s

unwavering bedside vigil. My interactions were disguised as fact-finding missions or else I

was asked to leave. Within these brief visits, we found ways to connect beyond her illness,

pregnancy and incarceration. My emotional response to her situation was multifaceted –

anger at guards who interpreted policies allowing shackling of pregnant patients to their

beds as overriding ourteam’s medical orders, sadness that she would not getto care for her

new baby after she left the hospital and embarrassment that my request for Denise to go

outside briefly for fresh air was immediately met with roaring laughter from the officers. I felt

distress at Denise’s restriction to a tiny roomfor the month until her scheduled delivery date,

which for security reasons would not be revealed to Denise until the start of her labor

induction. I grappled with deep discontentwhen various team members spoke to and about

her, particularly when she asserted hercapacity to make her own medical decisions, which

were sometimes distinct from the team’splans. I did not see her as a “manipulative” patient-

prisoner as described by some of my colleagues. I saw Denise as a woman who valuedher

independence and who deeply loved her pregnancy. I saw her as someone who had been

sucked into the sprawlingpenal system, an extensive mechanism of hyperregulatingpoverty.

While at the prison, I often found myself subconsciously searching for Denise’s warm smile

amongst the groups of women gathered in the central courtyard. I never did see her again,

but I was able to briefly experienceelements of the forces that shaped her life in prison.

During my rotation, I witnessed many examples of healing-centered care that will shape my

future practice, and the first patient I met remains emblazoned in my memory. She was a

Austin M. Hopkins is based

at the Department of

Obstetrics and

Gynecology, University of

North Carolina at Chapel

Hill School of Medicine,

Chapel Hill, North Carolina,

USA.

This work is the product of an

elective rotation supported by

the University of North Carolina,

Department of Social Medicine.

The rotation was directed by

Lauren Brinkley-Rubinstein,

PhD, and Andrea Knittel, MD,

PhD, to whom I thank for their

guidance and mentorship. I

also extend my deepest

gratitude to the patients whose

experiences and stories

contributed both to this work

and to my education.

DOI 10.1108/IJPH-06-2020-075 VOL. 16 NO. 2 2020, pp. 93-94, ©Emerald Publishing Limited, ISSN 1744-9200 jINTERNATIONAL JOURNAL OF PRISONER HEALTH jPAGE 93