Monday, 5 November 2012

Better be Home Soon


Better Be Home Soon - "Australia's Band :)"

6th of November 2012

It’s been a while since the last update. Since then:

  • the Mexico IPAC Conference has finished 
  • the LONG flight from Mexico City to Los Angeles to Auckland to Wellington has  been completed
  • and a brief tour of the Rimutaka Prison has occurred

Rimutaka Prison is set to open the country's first dementia unit later this year. Rimutaka Prison is in Upper Hutt, north of Wellington. It is one of New Zealand's largest prisons, and opened the country's first container-cell unit in 2010. Rimutaka Prison is New Zealand’s largest prison with capacity to accommodate up to 1216 minimum to maximum security male prisoners.  The prison was opened in 1967.

The New Zealand Government has set a corrections wide reform package with some significant and challenging targets. Prison Manager (not Warden or Superintendent) Richard Symonds explained that in order to meet the targets he, and all of corrections, had to rethink the way they do corrections – that a fine tuning around the edges exercise would not be enough to meet the targets. He was speaking the same words heard in Mexico from Jane Von Dadelszen, Director of Policy & Research, who presented on the reform.


Given the inmate population size Rimutaka have primary care health model that is staffed during the day. There is a GP and nurse on site. Acute care needs are supported through the local hospitals. They have identified the need for aged care assistance for their older offenders and they currently house them in a secure observation where inmates who are at risk of self harm are also kept. 

They are in the process of refurbishing a youth wing of Rimutuka (young inmates are no longer housed at the prison). An aged care team of corrections staff have consulted and the refurbishment will make the facility aged care friendly: level flooring, larger accommodation areas, and larger shower areas. It will be staffed like an aged care facility carers supported by nurses and also have a corrections officer as well. The facility is at the top of the hill overlooking the entire Rimutaka complex with view of the forest behind. Access to the outside: light fresh breeze and sun is easy for the older prisoners.

Currently they have some aged care providers who assist with transition into the community but there are some challenges. It would be good to revisit Rimutaka after the new aged care area is open; there system looks very good and appropriate for their population size. 

Yesterday on arriving  I took in a couple of views of the city:
The cable car


The City Views 

Te Papa Tongarewa - the museum






On my last night before returning home, Wellington seemingly treated me to a fireworks display! 
It is Guy Fawkes Night, still celebrated with fireworks in New Zealand (yes you can buy them in the super market!) Apart from hundreds of private fireworks one could see across the city from the 19th floor of the Travelodge – Wellington City Council also supported a huge display.....




It was quite spectacular to take this in after a lovely Chinese meal of Crispy Tan Beef – amazing. (slow cooked initially in a “secret” marinade – then – rolled in potato starch and deep fried – it was divine!




So this is my last entry, the study tour comes to an end. I am privileged, having:

  • had the opportunity for this educational and eye opening tour
  • met so many devoted and caring people
  • made some great friendships and contacts 
  • learnt so much from so many 
  • had time to reflect on learning’s and write and rewrite and then relearn from others around learnings previously made – this has been so amazing 
  • seen so many different custodial approaches
  • driven and toured over 3000 miles of great American area
  • seen so much of the history and touristy things you could take in on a trip like this 
  • only experienced 2 days of rain
  • not put on weight (yet to decide if I have lost any) 


I have of course missed:

  • Maree, Meg, Jack and Kate terribly. The conversations the company - just US! There was not a day go by that I did not think about how much they would have loved seeing what I was seeing. 
  • Jones and Anna – our dogs; I have stopped and talked to any dog that would listen
  • Family, friends and colleagues
  • Work – yes, being at work with colleagues and clients, being part of a team helping “our guys” (and girls) 
  • Aussies voices
  • Tap water – yes Melbourne tap water – the best in the world 
  • Lamb – American’s just don’t do Lamb
  • Vegemite – how did I forget to take a small jar!
  • The sounds and smells of home – gum trees, birds
  • The Spring Carnival - the sound of the call of the race
  • The Ranger
  • The Routine of life 


Now, the challenge lay ahead- to distil the learning’s into a plan  – how, to best provide care for this group of ageing people, who are incarcerated for their crime, but have the right to have their health care (aged care needs) met. 
To fine tune the write up and to share it with those who have shared.

Thanks again to Rose and Nat who helped set up this blog and to those of you who have sent messages along the way.

and finally ....

A Very special thanks to  Bryan and Dot Lipmann for your trust and your Trust's sponsorship of this educational tour. 

Signing off for the last time on this blog – Phill Goulding – 6th November 2012 



Tuesday, 30 October 2012

Dia de los Muertos


This coming Thursday Dia de los Muertos, or Day of the Dead will be celebrated here in Mexico City.

The ritual is celebrated in Mexico and some other parts of the world - but it is mainly a Mexico City celebration. 

The history is interesting. 

Although the ritual has since been merged with Catholic theology, it still maintains the basic principles of the Aztec ritual, such as the use of skulls. The Aztecs kept skulls as trophies and displayed them during the ritual. The skulls were used to symbolize death and rebirth.

Now, during the celebration, people don wooden skull masks called calacas and dance in honor of their deceased relatives. The wooden skulls are also placed on altars that are dedicated to the dead. The skulls are used to honor the dead, whom the Aztecs believed came back to visit during the month long ritual.

Unlike the Spaniards, who viewed death as the end of life, the native Aztec's viewed it as the continuation of life. Instead of fearing death, they embraced it. To them, life was a dream and only in death did they become truly awake.  

As the Spaniards considered the ritual to be sacrilegious. They perceived the indigenous people to be barbaric and pagan. (sound familiar?)

In their attempts to convert them to Catholicism, the Spaniards tried to kill the ritual. But like the old Aztec spirits, the ritual refused to die.

To make the ritual more Christian, the Spaniards moved it so it coincided with All Saints' Day and All Souls' Day (Nov. 1 and 2), which is when it is celebrated today.

Stay tuned for Photo's...

oh yes - dinner was a prawn cocktail - Mexican style - chilli, tomato, avocado - with a cerveza!


Sunday, 28 October 2012

Mexico City

Food & Weight.
Now out of the USA, one can feel slightly relaxed about the diet issue (not too relaxed); So - have I lost weight? Well.... I can say I have not put on weight. Clothes & pants the same - the scales in Mexico indicate I have NOT put on weight, but the real truth will occur on the weigh in at head office (and home).


I indulged in the THE most delicious - Taco - completely different to what I have ever had - rolled like a cannelloni and stuffed with shredded roast chicken with; minced avocado, very finely sliced lettuce, an amazing bean sauce and.... feta cheese. Taco's will never be the same.



Today I took a quick tour of Mexico City.  It is Sunday, so naturally I went to two churches (catholic of course) - the first San Augustine Palanco. To enter the church and hear the piped organ and choir singing would have and affect on an atheist. 



A quick trip to central Mexico City revealed (on a Sunday morning) revealed a history that, as an Aussie, is difficult to comprehend. It is quite and easy to move around (see later) When you look carefully at the following photo's you will notice that some buildings (their walls) appear to be leaning;  It's a common phenomenon in this city, where many buildings are sinking, as each year Mexico City's 23 million thirsty residents suck up water from the aquifer beneath one of the world's largest metropolises. As the water level in the aquifer drops, the ground above it sinks (unevenly) which means in some parts of the city, sidewalks buckle, window frames lean, subway lines need expensive repairs and drainage canals no longer flow downhill!




















Following a visit to the sights above, it is 2pm. 
It is now a crowded city (23 Million people awake!)
The same population we have in Australia.

A true extrovert would love this moment! 

so many people, so many cars, so much activity and so many conversations,
all in Spanish (Mexican) and I have NO Spanish knowledge. 

 - It's a great experience, making you appreciate what it must be like for so many people who, for what ever reason, can not - or have difficulty with communication. 

Mexico City is the host city to the 2012 ICPA Conference - ( International Corrections and  Prison Associations) The ICPA was formed to operate as an Association for corrections and prison professionals, dedicated to improving global understanding and professionalism in the sector. 
There are over 500 delegates from countries all over the planet.

The question is - is someone working in the care of aged prisoners.

Saturday, 27 October 2012

San Luis Obispo – California Mens Colony



The main “East  Facility” that was visited houses medium security (level 111) inmates, with individual cells, housing two prisoners in each cel; it has a fenced perimeter with armed guard coverage from watch towers. The housing is divided into four quadrangles. Each quadrangle has its own dining room, work rooms, recreational area and two three-story housing units. There is also a fully licensed hospital located centrally to the four quadrants that provides a comprehensive  range of medical services; those services that are not provided on site are provided either at other correctional institutions (Haemodialysis) or the general hospital system (specialist surgery). The facility has a comprehensive Mental Health Delivery System in the form of an Enhanced Outpatient Program and Outpatient treatment for inmates. Offenders may also be  assigned to the Correctional Clinical Case Management System, as well as a Mental Health Crisis Bed Unit.

There is also a West facility that houses minimum security inmates in dormitory settings – this facility was not reviewed. 

As of March 2012, the CMC’s total population (East & West)  was 5,524, which is 143.9 percent of its design capacity of 3,838. The West Facility opened in 1954, and the East Facility opened in 1961; whilst the facility is somewhat old and seemingly overcrowded, it is essentially well maintained and an air of harmony within the prison walls is sensed.

The security arrangements are again different at the CMC East area. I am checked in at the first / front entrance and my passport is cross referenced to an approval form. Shoes off, belt off and walk through scan. I receive a prison visitor ID and I am only allowed to proceed through locked doors, and lethal high voltage fencing with my contact host. During the process, I notice other corrections staff walk in with bags etc. show ID’s and walk through. Some are carrying pizza boxes and other sort of food containers. Long terms staff appear to be considered less risk and do not have to undergo a daily complete screen. Whilst, no doubt, some correctional authorities would not tolerate this risk; I consider there is something refreshing and trusting about this approach and wonder what I will see ahead.
Once inside the prison, another check occurs at the central area. We quickly tour the hospital, which on quick inspection is similar to other hospitals visited. My host and I agree, there is more learning to be gained by reviewing the housing units for the cognitively impaired and seeing the Gold Coats working; than reviewing another hospital. (The Gold Coats are prisoner support roles)

As mentioned, the east  facility is designed as a set of four quadrants (A,B,C,D) each separately secure and each radiating from a central court yard. There are two three story buildings (housing units) that run the two external walls of each quadrant. Each housing unit / building houses approximately 300 offenders – that is approximately 600 offenders per quadrant. Each quadrant has wide open yard about 100 metres x 100 metres square. One side of the quadrangle has  a high solid wall (that is use for racket and hand ball) and the other side of the quadrangle is staffing / support areas.
 
D







C





A
B




Guards are visible on the route to each quadrant, but once you are in the quadrant, you have to look hard to see guards. There are towers on the most external corner with armed guards, these seem unobtrusive and no threatening despite their presence.Again, this whole security overlay is different to what has been observed. There are at least 100 to 200 offenders intermingling in the court yard. Some playing ball, some sitting and talking some doing exercises some just pacing. It reminds me of the high school yard I spent many years at (it was a quadrangle to – run by the Christian Brothers ) I am struck by the large amounts of offenders grouped in one area and the apparent harmony. Offenders are dressed in blue trousers, white tee shirts and intermingled amongst the blue and white are gold (faded yellow) coats. These are the Gold Coats. I also notice a few women? I am told these are transgender offenders. (This answers a question I had in the back of my mind – where are transgender offenders placed – male or female prisons? – In California at least, in male prisons.) Some offenders are noticed to be wearing vests. Hearing impaired and vision impaired have special observable vest so guards and others offenders (Gold Coats) will know that an offender who fails to respond to a call or whistle etc, has a special need and should be assisted not reprimanded.

As we walk across the yard to observe one of the housing units, one notices a female staff member (social worker) walk across the yard on her own, unaccompanied. This seems out of keeping with other correctional structures viewed before. Here you see single women (she is not a guard), walking through approximately 200 medium security, cognitively impaired offenders, in a yard 100 x 100 metres unaccompanied. Yes there are guard towers, I have not witnessed such “freedom” in other correctional facilities I have visited before.

I discuss these observations with my host. In some ways, it is difficult for them to understand my fascination as it is what they live every day, what they have become used to. I wonder why this works the way it does. I am also told that CMC is the prison most offenders in the State of California want to be transferred to. This is interesting in itself. There is nothing glamorous about CMC. It is an old prison. Sure you can see the sky and some mountains and the climate seems very comfortable. I initially think to myself “the other places must be pretty bad” – but again I reflect on the observed harmony, the “freedom” of staff to walk through a large cohort of offenders – yes this is behaviourally very different. My host, a senior psychologist tells me, he thinks it has a lot to do with offenders having their own key to their cell. “What?” – I think to myself.

On entering the housing units one is greeted by a guard in a raised platform desk type area that is  central to two long corridors. Off each side of the corridors are the offender’s cells. As mentioned, each offender has a key to their shared cell.  Most cells are shared cells some are single cells. 

One is immediately confronted by the small size of the cells. These cells are the smallest I have seen. They are small for one person, let alone two. One bed must fold upwards during the day so offenders can move in the cell and use the toilet in the cell. My guess is that these cells are 2.5 metres by 1.5 metres! Each cell has a solid door with a small window and the other external window is barred and approximately 300mm x 300mm. The other two longer walls are solid concrete. Offenders are locked in during the night, approximately 2100 – 0600, by a central locking system, but during the day the doors to the cells are controlled by the offender and their “roomy”. Some rooms do not have a power outlet and some do. Some offenders have televisions. Rooms are heated but there is no cooling. There is a central showering area for each floor and a small TV room (2 metres x 4 metres with rowed seating. (I am told group counselling session also occur in these rooms)


It is hard to describe one’s emotion / feeling on seeing the size of the cells. I inwardly protest and think how inhumane these cells are, thinking “this is wrong – this is so wrong”. I cannot help but comment to my host and I feel somewhat embarrassed at my escaped thoughts. My host acknowledges the cell size as an issue but says it is all that they have, and the offenders don’t seem too bothered by it. We view some more cells and I have chat with a couple of offenders. Again I notice the harmony, there is definitely less agitation here. A couple of offenders confirm, CMC is considered one to be the best prison in the State to be at.

As meals are served on the third floor of each building; there are no offenders with significant ambulatory concerns at CMC. Older more frail offenders, who cannot manage their own care or ambulation, are either transferred to the hospital or another facility that is better equipped for offenders with disability needs. Unit D does house offenders who have mental health concerns and or cognitive impairment (including dementia). Offenders who are capable, self manage their medication. (Opiate and mood altering medication are controlled and dispensed through similar structures and staffing systems seen in other facilities). There is one registered nurse per quadrant who oversees and provides triage for offender’s health care needs (1:600). There is a significant number of psychologists and counselling staff (approximately 1:30).

There is nothing like the moment when you have your whole world turned on its head! The assumptions you have made; the opinions you have formed; I can’t help smiling and thinking wow! The cells are very small. Some don’t have power. There are quite a few older offenders here. The outside yard, whilst a good size is relatively crowded. This is an old prison.  So against all of these factors, what makes CMC a popular prison as judged by offenders?
  • ·         Is it the offenders control over the key to their cell, as my host has indicated? I am told CMC is the only Californian prison where offenders have a key to their cell. I am not aware of other US prisons with this practice but it appears this is a practice in the UK with some controversy http://www.guardian.co.uk/politics/2007/mar/26/immigrationpolicy.ukcrime http://www.correctiveservices.qld.gov.au/Publications/Corporate_Publications/Miscellaneous_Documents/Healthy%20prisons%20handbook.pd
  • ·         Is it the significant mental health program and mental health support offered? CMC appear to have a greater provision of mental health service than other facilities visited. All facilities visited in the USA have had, by Australian standards, significantly more mental health support; but CMC seems to have more support than their US comparators. There is a respectful transaction noticed between correctional staff and mental health physicians that is different to other facilities visited. I had formed the opinion at other facilities that correctional concerns over-road all other concerns; in turn this provided correctional staff with the “final say” over issues of concern. At CMC’s guards were seen to defer questions of behavioural concerns to the mental health physicians; that is, their default on behaviour concerns was to the psychologists. There appeared to be a subtle difference in the custodial power relationship within CMC. One example of this occurred during my discussion with Michael the recreation therapist. Michael is youngish and full of energy (he could easily fit into the Wintringham’s Recreation Team) Michael descries the recreation program; there is a significant exercise routine; some of which, he tells me, is about maintaining function (use it or lose it). Other activities include basketball, and other modified ball games, domino’s and jigsaw. He indicates there are budget restrictions and corrections considerations that impede some recreational ideas. Further he says he would like to get more involved with the offenders, be involved in their ball games etc,  but he has been advised, by the custodial authority, that he should not – because of the risk an offender may take advantage of the situation and the possibility Michael could be hurt. This is interesting given my previous discussions with my psychologist hosts. One doubts the guards would insist the same concerns and precautions with the psychologists and I raise this doubt with my hosts. They tend to agree with this observation. There are other examples where the risk assessment and activity is left to the discretion of the psychologist. This does seem quite different to other institutions visited. Eventually this same deference of risk may extend to other staff?
  •       Could it be because of the “Gold Coat’ program? The program is now about 15 years old. It involves younger offenders being trained to support a cognitively impaired prisoner. I am counselled and assured this support model does not involve assistance with personal care. If an older / cognitively impaired offender needs support with any form of personal care, they are either transferred to the hospital or another facility. On further discussion with my host and a Gold Coat by the name of Phillip, I find the role is like a buddy role. They prompt, they advocate, they support; they are in effect the peer support, the team leader. Examples are sited where the general prison population defer concerns to a Gold Coat. (there are examples sited where some of the more hardened inmates might call them “dogs”, but these occurrences are few and far between. Phill (gold coat) tells me, the program has given him a total new outlook on life. The themes he raises are similar to what I have heard from other: orderlies/prisoner supports. I am absolutely convinced of the benefit a prisoner support model has for a correctional facility: enhanced caring culture, savings in cost of care, prompt and improved care delivery, improved self esteem of inmates and more harmonious correctional environment.
  • ·     Is it the approach to the correctional support and security overlay seem to have a more trusting approach (of staff and offender alike)  and this “culture” provides for greater harmony? – as it would in any work place.

·      It is probably all of these issues and more? Before this visit, I had placed a large significance on design and structural issues. I m left believing that whilst the design and structure are important for enhanced care of older inmates, they are not the key issue.

I was able to return to CMC the next day to observe the recreation program with a group of cognitively impaired older offender. The program was being run in an indoor  hall / recreation area that doubled as a gym, basket ball court area. Whilst it was aged and dated with signs of patch repairs – it was a good space away from the business of the the court yards. I am greeted by Michael the recreational therapist. Friday was movie day. My hosts were disappointed that I could only observe movie day as there were a lot of other recreation activities the older offenders are involved in but they genuinely enjoined movie day. The film on show was Captain America (2012). About 20 offenders were observed (16 cognitively impaired / aged and 4 gold coats). The Gold Coats were evenly dispersed amongst the group. 

I observed the session for about 30 minutes whilst talking with my hosts and “Marti” one of the guards. At first nothing seemed too grand; seeing these offenders watch a program. All of these “guys” just sitting quietly and enjoying the program. After some further thought about this seemingly unremarkable event, one realises that most of these men have cognitive impairment. One is noticed to get up and pace around a table every so often, and another staring blankly into a distant spot “somewhere”. They are generally well engaged and well behaved during the show. Gold coats are noticed, every now and then to help focus some individuals.

During these observations I have a discussion with Marti, the guard. Marty has been working with this group for at least 25 years. I ask why here. Marty shares he has a family member with special needs, so he understands the issues. He also says he loves coming to work. “There has not been one day, that I have not looked forward to coming to work”. Marty also tells me, “you have got to learn about the guys. You have to know what’s normal and what’s not. You need to know how to listen & not just with your ears – your eyes as well”. I observe the offenders and Marty are on first name basis. (no Sir, Mr. or Boss) Marti also tells me there are times you need to correct a behaviour, but you need to understand why the behaviour occurred. He says the education he has received from the doctors has been very helpful. 
Every prison needs a Marty.

I later wonder..... “could we possibly introduce a structured “gold coats” program at Wintringham? Could some of our younger more active residents be engaged as a support person for some of our more impaired residents? ..........

There is no doubting that the cohort of offenders D block have support needs beyond the standard offender populations and similar to populations previously observed. They are well supported to maintain their independence so they can stay in their “home” environment. Following the review of the recreation program I engage in further discussion with my hosts. They inform me, every new prisoner has a cognitive screen undertaken. CMC use the QUICK assessment too lhttp://www.pearsonassessments.com/HAIWEB/Cultures/en-us/Productdetail.htm?Pid=015-8328-000 Offenders who are flagged through this tool may have a follow up assessment completed using the TONI assessment tool.

Some other important considerations come to light. California has a highly litigious culture. Several significant cases are quoted, where an offender’s representative has taken legal action against the State and the resultant law suit has seen major changes to care and support within the correctional environment. The result of which drives a watchdog approach from many authorities which result in further “quality improvements” to support offenders. There is no doubt the support and care is available and working for CMC, but one is left thinking the same support and care could be achieved differently.

Thursday, 25 October 2012

San Luis Obispo – California Mens Colony



Today’s visit was to the California’s men colony. Again the visit was very enlightening. There is something brilliant about having your assumptions / hypothesis destroyed. Ideas that that you have developed from seeing other systems turned on their head because the next system you see, does it so differently that you realise the reasons for behaviours are not about a structural design issue (they may have something to do with behaviour – but they are not the key issue) – more on that later. 

Given a food review has not occurred for some time – this update will be about food and diet.

The diet. You may ask, how is the diet? Well, limiting food intake has helped, but it has been difficult. 

Having committed to salads for nearly the last week and forgoing the South’s “deep fried expertise”- there was not a lot to write about. Have I mentioned baby carrots? They are my best friend. You can buy small bags of these finger size delicacies and they are REALLY nice – sweet and crisp. Combine these with baby broccoli and some humus and you have a very nice meal.... but give me MEAT.  Hello California!

Last night, the choice was grilled calamari and onion rings. Well, I tried! On presentation the grilled calamari was crumbed and deep fried “what the!”. Oh well, combine that with a Samuel Adams Seasonal Octoberfest Ale and you have a nice (but high fat meal)

Today, an early lunch saw me at Franks Hot Dogs http://www.franksfamoushotdog.com ; where the choice was an easy Bacon Lettuce and Tomato. When I ordered, I was not asked “what sort of bread?, What sort of sauce etc etc etc....I asked for a BLT and I got the BEST BLT I have ever had: heaps of lettuce, fresh tasty tomato and REAL bacon on wholemeal toasted bread. Simple but wonderful. Thanks Frank! Seriously – the simplicity was the best bit. 

Whilst at the CMC today, there was an under current of excitement between the staff. (and no, it was not because I was visiting!) One of the staff had delivered home made Tamale. http://en.wikipedia.org/wiki/Tamale I was offered one, but because I knew they were “currency” and  I politely refused. My host “Hed” insisted, so I agreed – OMG – sensational! THE BEST TAMALE I have ever had (here comes Mexico!

Following my visit to CMC, I made my way to Montana De Oro State Park – to see the park, to see GUM TREES (I love a gum tree) and I needed to put my feet into the easterly Pacific Ocean. After a good walk to the beach and back I noticed the following signs!









but then again - I might have missed these views







I then, on advice from Cheryl from CMC, I strolled through the local evening farmers market. http://visitslo.com/cm/Activities/Farmers%20Market.html – What great advice! 

Given it was the farmers market before Halloween, many store owners and many families came in fancy dress. There was music, entertainment and Food! So many choices and SO MANY calories. The choice – a Mediterranean style gyros with garlic yoghurt and large amounts of lettuce accompanied by two home made dolmas (they were small!)  






Tomorrow night ... I have been saving myself for this moment... It’s off to Mo’s http://www.smokinmosbbq.com/awards.htm

follow up to Mo's Smoke House.....
There were so many meat choices, I went with the "Meat Sampler"...  ribs, chicken & shredded pork, beans, cole slaw, and corn bread.
This was Massive! and I now fee like a grizzly bear ready for hibernation. This was a very nice but big and heavy meal. The meats were moist and the sauces were very nice. I ate too much - I could not eat the corn bread.....  just could not fit it in