Dermatology for incarcerated populations
Poor access to medical care in Australian prisons has a negative impact on disproportionately incarcerated minorities (1,200 words, 6 minutes)
The Skin Spectrum Weekly e-newsletter is supported by Bausch Health Canada
Disproportionate incarceration rates for Aboriginal persons and Torres Strait Islanders in Australia are compounded by inadequate healthcare access for incarcerated persons, leading to serious dermatologic needs. This was the focus of Dr. Dana Slape’s keynote presentation at the 2022 Indigenous Skin Spectrum Summit on June 11.
Similar to the situation in Canada, the proportion of Indigenous peoples incarcerated is much higher than the proportion of the overall population they represent, said Dr. Slape. She noted that approximately 3% of the general population is Aboriginal or Torres Strait Islander, while roughly one-third of all incarcerated adults are members of these groups. The rate of incarceration is even higher at younger ages, with more than 50% of incarcerated youth between the ages of 10 and 18 being members of these populations.
“So there is a significant maldistribution and misrepresentation of Indigenous people in jails, which is the main reason why I go there [to provide medical care],” said Dr. Slape, the first Aboriginal dermatologist in Australia.
Making the situation worse, while Australia provides universal health care to its citizens, she said this law does not apply to wards of the state—including the incarcerated.
This has led to a system of nurse-led healthcare for the incarcerated with several inadequacies:
Patients, many with limited literacy, are required to submit requests for medical care in writing
Nurse practitioners are not equipped to diagnose many conditions adequately
Essential emollients, antifungals and shampoos are used to attempt to treat inflammatory dermatoses
First contact with a physician will be with a GP
A referral to a dermatologist may take 600 days
Teledermatology infrastructure is underfunded and inadequate, resulting in poor image quality
Dr. Slape noted that even evaluating the severity of dermatologic disease among incarcerated persons is complex. Standard tools such as the DLQI (Dermatology Life Quality Index) ask questions not relevant to the prison experience—for example, questions about accessibility for shopping, gardening work around the home and influences on clothing decisions.
“My patients do not have any choice on what they do or what they wear,” Dr. Slape said. “We do not have a good way of standardizing or measuring somebody's degree of psychosocial impact [in the prison environment].”
“Health care accessibility within prison, particularly for First Nations people, matters because of the human rights and equivalence of care requirements of the United Nations,” Dr. Slape said. “Prisoner health is public health. If we can get it right for prisoners, and particularly First Nations prisoners, we can get health right for everybody.”
Bottom line: Dermatologic care for incarcerated persons is being neglected in some nations. The disproportionate rate of incarceration for Indigenous and other racialized populations, represents a significant health challenge related to skin of colour.
From the literature on dermatology and incarcerated populations
Skin cancer in the incarcerated population—A single-center study
In this study, researchers measured the time between a biopsy diagnosis of skin cancer and intervention in 113 imprisoned patients.
The biopsies were taken between Jan. 2009 and Dec. 2019.
Among the 113 patients, 191 skin cancers were detected—118 basal cell carcinomas (BCC), 58 squamous cell carcinomas (SCC), and 15 melanomas. The researchers found the average time from biopsy to intervention in melanoma cases was 57 days. This long time to intervention may have raised the mortality risk, they write.
Dermatologic care of incarcerated patients: A single-center descriptive study of teledermatology and face-to-face encounters
In this letter, physicians from the University of Utah detail the provision of providing teledermatology and in-person dermatology care to incarcerated patients.
They describe how teledermatology is valuable for managing severe cases of psoriasis and acne that need systemic treatments and regular monitoring. However, they found that caring for prisoners was complicated because many procedures were performed that required in-person care and follow-up.
Medical malpractice cases involving lack of access to dermatologists for incarcerated patients in the United States from 1982 to 2018
A search of the LexisNexis Academic database of legal records from 1970 to 2018 identified U.S. federal malpractice cases related to dermatology and incarcerated patients. The authors of this paper reviewed 89 specific instances in which prisoners were unable to see a dermatologist.
Of those cases, 76% only saw a primary care prison physician for their skin concerns.
The authors identify several barriers to prisoners accessing a dermatologist. They write that better collaboration between prison officials, prison medical staff, and dermatologists could help improve prisoner care and reduce malpractice risk.
Unnatural resources: The colonial logic of the Holmesburg Prison experiments
This article discusses the medical trials performed by Dr. Albert Kligman on the inmates of Philadelphia's Holmesburg Prison between 1951 and 1974—widely considered exploitative.
The author explores the seeming contradiction between the American medical community lauding Dr. Kligman for his efforts while at the same time condemning abusive medical experimentation in the Second World War and supporting the development of the Nuremberg Code.
VIDEO: Michigan prisoner: We suffered ‘unbearable itching’ for months
At the intersection of skin and society
On June 12, 2022, the CBC, BIPOC TV & Film and the Canadian Film Centre (CFC) announced the creation of a new accelerator program to support the career advancement of senior writers who identify as Indigenous, Black or People of Colour.
According to a press release, the new program, called the CBC-BIPOC TV & Film Showrunner Catalyst, will provide professional coaching through a hands-on, on-set experience. The goal is to support these senior writers in becoming showrunners in the Canadian film and television industry. Showrunners have overall creative authority and management responsibility for a television program.
All three supporting bodies have made an initial commitment of three years to the program, with the opportunity to renew.
“It is imperative that while we are opening doors at entry-level for BIPOC creatives, we are simultaneously creating pathways for mid-level and senior BIPOC writers to have the opportunities to bring their careers to the next level,” said Kadon Douglas, Executive Director BIPOC TV & Film, in the release. “The Canadian industry needs to see BIPOC writers as showrunners—leaders who can helm the vision of a show, from both the creative and business standpoint.”
The first part of the program will include a series of substantive and hands-on masterclasses covering topics related to the role and responsibilities of a showrunner.
After that, the second part of the program will have participants in a senior writing and producing role on a CBC series, working with an experienced showrunner and participating in all key elements of production. Each participant will also be paired with an external showrunner, who will serve as a mentor.
The inaugural year will run through the summer and fall of 2022.
This week
June 20 is World Refugee Day
June 21 is National Indigenous People’s Day in Canada
June 25 is World Vitiligo Day
Something to think about in the week ahead…
Next week
As part of an overview regarding Indigenous dermatology in Canada, Dr. Rachel Netahe Asiniwasis discusses some of the challenges to understanding the full scope of skin disease in these populations.
If you enjoy Skin Spectrum Weekly, why not check out some other e-newsletters and podcasts from Chronicle Companies?
Women in Dermatology provides updates on new findings concerning dermatologic issues that affect women and the female dermatologists who care for them. Read the current issue here.
Enjoy podcasts? In the current Skin Spectrum Podcast, Dr. Erin Dahlke and Gagandeep Singh discuss the lack of skin of colour images in dermatology education, approaches to making dermatology education more inclusive, and the intersectionality of healthcare and racism. Listen here.