The clink-clink of chains along the corridor of area 354 is indicative of the approach of a prisoner. A prisoner is approaching and I am on outpatient duty, on TTOs: to take out. Each of us gets a TTO day; all of us except for Jacquie, the head of the dietetics department in the hospital. Being on TTOs means that you are responsible for attending to all of the patients that enter the dieticians’ office on that particular day. Everyone: new patients; follow-ups; bookings. You need to attend, direct, or counsel, depending on the circumstance. My TTO day is a Wednesday.
‘You hear that?’ Anneke murmurs and my stomach drops. ‘Clink-clink. Clink-clink.’
The prisoners are chained across their wrists and ankles so that they hobble along Hospital Street and chime. Every man has at least one security guard with him. The camaraderie on show between the prisoners and their guards intrigues me. ‘Why?’ Anneke has asked. ‘You don’t see that kind of relationship between the staff and the patients in the wards,’ I told her. ‘A criminal offence is cooler than getting a hernia repaired,’ she said. ‘Do you think that the security guards respect the prisoners?’ ‘I think that they feel responsible for them. Like they need to protect them, to stand up for them.’ ‘Why don’t the ward staff feel that way about the patients?’ ‘The patients are sick.’ ‘The prisoners who come into the hospital are also sick.’ ‘But they’re not sickly,’ Anneke said. ‘Their guards defend them, they don’t look after them. It’s different.’
The clinking stops and the door handle rattles.
‘Push, don’t pull,’ Anneke grumbles.
The handle clicks down, the door is pulled back, and jams.
‘I think I’m going to make a sign,’ Claire says pointedly.
‘What, ‘Push not Pull’?’ Anneke taunts her. ‘When you made a sign for the outpatient consulting times it made absolutely no difference.’
‘That’s because it was torn down.’
‘Well doesn’t that explain everything?’
Is this really the time to be arguing about this? ‘Should I go to open it?’ I ask them.
The door handle clicks again and releases. It clicks again and the door opens. Claire turns her head.
‘Prisoner?’ I ask her. I’m standing opposite, on the other side of the desk, behind Jacquie’s empty chair.
‘Prisoner,’ Claire nods.
‘Is he from your ARV clinic?’
‘I don’t know him, but he’s probably been sent here from 556.’
Anneke offers to see him for me.
‘No it’s fine, I’ll do it.’
‘Don’t let him try his luck,’ Claire bites, anticipating conflict and already taking up arms. ‘There’s a calculator on top of the filing cabinet.’
‘To calculate his BMI.’
‘Right.’ I take a pen off Jacquie’s desk.
The prisoner has two security guards with him: a tall, broad man with a thick moustache, and a younger, shorter guard with excited eyes. The prisoner’s eyes are dark and piercing; his jaw, strong and angular; his body, slim and compact.
‘Can I help you?’ I address the three of them.
The younger guard taps the prisoner’s arm. The man raises his shackled wrists and moves the letter in his hands to the tips of his fingers. The guard gives the letter to me.
‘You’re from 556,’ I see in the top right corner.
‘Yes,’ the young guard replies, ‘from the clinic.’
The other guard slumps down into one of the chairs in our entrance and starts fiddling with a tear in the green plastic covering.
The doctor’s handwriting is illegible. I pick out the words ‘supplement’ and ‘hunger strike.’
‘I can’t read it,’ I say to the guard. ‘I don’t understand,’ I tell the prisoner.
The young guard explains, ‘He says that he was used to getting extra foods at the prison.’
‘The prison where he was before.’
‘He’s moved prisons?’ To more or less severe confinement? I look at the prisoner who’s looking at me, ‘And now?’
‘Now he doesn’t get the foods,’ the young guard answers.
‘What were you getting at the last prison?’ I ask the prisoner.
‘Extra foods,’ the guard answers again.
‘What extra food? Why?’
‘Because I have HIV,’ the prisoner speaks slowly, giving each word weight.
‘He needs extra foods. He have HIV.’
‘You only need extra food if you are underweight,’ I respond to the guard, but keep looking at the prisoner. ‘Come, should we weigh you?’
I can see that the prisoner’s not underweight, but it’s easier to go through the whole ordeal than to try fight through an explanation. If you weigh and measure then they feel serviced, and you feel justified in sending them away. But this is where Claire and I differ – I don’t care about being justified, I just want them to leave. I can’t bear having to go through the whole ordeal.
‘We are going to weigh him?’ The young guard thinks we’re doing something very important.
‘Yes, on the scale. Will you help him to it?’
The prisoner begins walking. His steps are small and locked; his arms swing from side to side. When the guard approaches to assist, he shakes his head and the guard steps back. But when he reaches the scale, he sees that there is a small step. He turns to the guard, who comes immediately.
I write the prisoner’s weight on the back of the referral letter.
‘You can take him,’ I tell the guard, who takes the man’s elbow.
The prisoner steps back. The young guard stays where he is. ‘What it means, the scale?’
‘I want to take his height first.’ The second stage.
I show the prisoner into the consulting area.
The guard wants to come too. ‘I must help him?’
‘There’s no step for the height meter,’ I tell him.
The guard steps forwards and backwards, and then moves from side to side in agitation. He’s acting out his part excellently: he defends, I refuse.
‘With your back against the wall,’ I tell the prisoner. ‘Wait...’
‘What?’ the guard leans sideways.
I extend the measuring arm and then instruct the prisoner to stand back against the calibrations. I write his height under his weight on the referral letter.
‘That’s fine, you can go back to the entrance,’ I tell him then.
I do all of this, labour through it, but I don’t feel any especial antagonism for the prisoners. The strain is about the procedure, not the person. I’m curt because I don’t feel anything for the instructions.
The young guard leans over again, ‘Why you measure him?’
‘I want to see if he’s the right weight for his height. Claire?’
‘Don’t worry, I found it.’
The guard starts talking, but quiets when he sees I’m busy with the calculator. I calculate the prisoner’s body mass index, which falls into the normal range.
‘Your weight is fine,’ I tell him.
‘What you say?’ the young guard asks me.
Does he want me to spell it out? ‘He’s not underweight. He doesn’t need to be supplemented.’
‘You can’t give him something if he is HIV?’
‘Not if he’s normal weight.’
Claire rolls her seat away from her desk. She won’t let me handle it. She’ll intervene so that the whole thing goes up in flames.
‘What’s the problem?’ she comes to stand next to me. ‘If there’s a problem with the food in the prison, you must tell them.’
‘The doctor tell us to come here,’ the guard says.
She ignores him and continues lecturing the prisoner, ‘We cannot change what they are feeding you at the prison.’
‘He was receiving foods,’ the guard says.
‘Apparently before...’ What am I doing now?
‘I heard,’ Claire cuts me off. ‘He must take it up with the prison.’
‘You can’t write him a letter?’ The guard’s provoking her. Not deliberately, he would have asked this of any of us. But for Claire it’s a provocation, and she’s characteristically aggravated by it.
‘No, we can’t,’ she says firmly. ‘We have been instructed by the prison not to write letters of recommendation for their prisoners. They will attend to the problem if there is a problem. He must take it up with the prison.’ She goes back to her seat, having torn up the situation and unnecessarily inciting what have now become our opponents. She creates an opposition and her behaviour makes me want to take the other side.
The tall guard looks up with deadpan eyes. He stands up and stretches his arms, steps to the side and kicks the door by mistake. The young guard turns to look; the prisoner doesn’t turn. He’s kept quiet in all of this, unmoved by Claire’s performance. Unmoved by mine.
‘We go,’ the young guard turns to him. ‘We go back to 556.’
‘That’s fine,’ Claire tightens, but doesn’t look.
The guard doesn’t shut the door behind them, I do. I hang back in the entrance for a moment before going inside. Everyone’s carrying on as normal, although Claire is a wound-up spring.
Anneke watches me sit down. She must be concerned about Claire demeaning my professional ability by stepping in, which is insignificant compared to the scene that has to be made in saying no.
I scratch out the prisoner’s height and weight on the back of the referral letter and throw the piece of paper away into the bin.
‘Was that the referral letter?’ Anneke tries to ease my mood by talking.
That doesn’t usually work with me; I like to think about it first. ‘Hang on.’ I retrieve the letter. ‘Hunger strike,’ I look at her.
‘It says ‘hunger strike’ here in the referral letter.’
‘He’s probably refusing to eat because they won’t supplement him.’
‘I didn’t ask him about it.’
‘It won’t continue for very long.’
‘How do you know that?’
‘He’s new to the prison. He’ll adjust.’
I could have asked him, just so he could say.
‘Do you think that the doctor sent him here for a supplement?’ I ask Anneke.
‘It might have been the sister in charge of the clinic.’
‘The guard said that a doctor had sent them.’
‘What did the referral letter say?’
‘I couldn’t read it.’ I give her the pen that I was using. ‘Please ask Menán to put it on Jacquie’s desk.’
‘That’s my pen,’ Rianna reaches out and Anneke gives it to her.
‘They think that it’s some kind of potion,’ Claire bursts finally.
‘The Mealtime?’ Rianna is impartial here, or more likely, disconnected.
‘The porridge we give out,’ Claire is now talking directly to her. ‘It’s ProNutro. That’s what Jacquie said. It’s basically ProNutro.’
Menán tells us that she once heard Jacquie tell that to a patient. ‘The woman said that it wasn’t a matter of money. She would buy the porridge herself if she had to. It was the only thing that could help her.’
The matter of the prisoner will now be lost in a discussion over the placebo effect of Mealtime porridge. Every encounter is taken on the level of the supplement. I start looking around frantically on my desk for something to do.
‘A male nurse once phoned down from one of my wards asking if he could come and discuss a matter with me in private,’ Rianna says and I begin to sink. ‘He was fidgety when he came down. When we sat down to talk, he told me that his sister was HIV-positive. He wanted to know if there was anything – any type of food – that we gave out to HIV-positive patients. I told him that we give them a porridge, but only if they are underweight and need it. He said that he wanted to have something to eat with his sister to let her know that it was okay. I said that he didn’t need the porridge and I didn’t know if his sister did either. But still he wanted it.’
She speaks with such a lack of understanding, I should get up and walk out. ‘It’s not such a private matter anymore,’ I mutter to Anneke under my breath.
She thinks I’m overreacting. ‘We don’t know who he is. He could be anybody.’
That’s precisely the point. ‘Still.’