Post 2: Seeing Vulnerable Populations in a New Light

The word jail immediately brings to mind images from a first-grade field trip to my town’s holding center. A group of sodden-looking seven year olds walked through a row of cells under an overhang of harsh fluorescent lights. Afraid to step too far to the left or the right, we walked past cells with people’s heads hanging low to avoid making eye-contact with the curious, small faces cautiously peering in. Even as a first-grader I remember having a pit in my stomach as I passed through that long hallway. Automatically associating the jail with terrible crimes and people my parents told me to avoid at all costs, my insides churned at the idea of imprisonment. On a separate occasion, a driving instructor directed me to a high-security prison. Eyeing the silvery barbed wire and high gates, the instructor commented, “I wonder what you have to do to end up in there,” sending chills down my spine and my hand to place the gear into reverse. 

The concept of vulnerable populations was first introduced to me in Sociology of Body and Health. Some populations, such as pregnant women, the elderly, or racial minorities, made sense to me, and others, such as the incarcerated population, caused me to raise my eyebrows. 

How can a population that is known to illicit violence and unrest among the community be considered vulnerable? Working in Bellevue’s Emergency Department (ED) and learning more about Riker’s Island, the largest jail in the world, has taught me a great deal regarding the circumstances surrounding incarceration in the United States and in particular, its intersectionality with race and gender. 

Riker’s Island Jail, home to New York City’s main jail complex.

Riker’s Island, home to New York City’s main jail complex, has recently been under fierce debate. Known to house up to 15,000 inmates, and notoriously known for the violence and corruption within its walls, it has been proposed to close within ten years by Mayor Bill de Blasio. The plan, though highly controversial, aims to reduce incarceration rates by 25%, create a more humane environment within smaller jails, and provide inmates with more opportunity for growth and recreational activities. Studies have shown that providing inmates with educational and therapeutic socialization, as opposed to traditional solitary confinement and violence, is indicative of a positive return to citizenship and a lowered re-incarceration rate. 

Part of a doctor’s job is to release patients back into a safe environment, but what happens when that environment is a vague and misunderstood idea? Healthcare providers often fail to fully comprehend the true conditions that incarcerated individuals are released into. Oftentimes, inmates are mistreated, abused by other inmates or guards, and are constantly being disrespected. Learning more about what it is like to live on Riker’s Island, I realize that my uneasiness surrounding the idea of imprisonment isn’t necessarily placed on the prisoners themselves–rather, on the unrealized dangers surrounding the prison system in the United States that has turned what is meant to be a system of rehabilitation and reform into a grossly violent and unjust environment. 

Kailef Browder, a teenager held at Riker’s Island for three years without trial was eventually released with dropped charges.

Take Kalief Browder, a sixteen-year old African American boy at the time of his arrest. Browder was held in solitude for over three years at Riker’s, without trial, for stealing a backpack. Ultimately, the trauma of abuse and confinement led Browder to commit suicide when he was released back into the custody of his parents at age nineteen. Browder’s trial had continuously been delayed by the courts until they decided to drop his charges, but at too large of a cost.

Graph depicting the racial disparities in incarceration rates. Data is taken from Prison Policy Initiative.

It is not a secret that incarceration rates disproportionately affect people of color. African Americans are more likely to receive longer, harsher sentences than their white counterparts and are more likely to become incarcerated in the first place. There is little evidence to indicate that either race is unequally committing the same crimes, so why does this discrepancy exist within our jails? Imprisonment is a life-changing event. Having a criminal record makes it extremely difficult to obtain employment in the United States because of the stigma surrounding incarceration, regardless of the crime committed. 

This stigma is something I personally encounter at Bellevue. Incarcerated patients treated at Bellevue come from Riker’s Island. Nearly 85% of inmates at Riker’s are still awaiting trial. The liberty of “innocent until proven guilty” is something that I consciously have to remind myself of when I see a patient handcuffed to their stretcher or a corrections officer hovering in their corner. Making an effort to remind myself that this person could be in for anything, from subway fare-evasion to multiple homicides, has helped me come to the rationale that it is not my place to judge or fear them. Their basic human right is to receive the same quality of healthcare that is given to every other patient that walks through the ED. 

A personal goal of mine, after learning more about Riker’s Island in particular and observing the care given to incarcerated individuals, is to distance myself from the ideas I was taught surrounding imprisonment. Realizing that there are many factors that determine incarceration beyond simply committing a crime, I have shifted my view on prisoners to see them as capable of redemption and of having a second chance in our society. Changes in my body language and time spent speaking with prisoners, reflective of how I interact with other patients, helps incarcerated patients recognize my positive take on their current state.  

The incarcerated is a population that I will inevitably encounter as a future healthcare provider and I am so grateful to have interacted with them in a healthcare setting as my career is just beginning to develop. I understand their positions as a vulnerable population better. Following this experience, I want to educate myself more on the vast number of issues surrounding mass incarceration and I stay hopeful that proposed criminal justice reforms will begin to stabilize the inequalities that permeate our justice system. 

I recognize there is a much larger societal movement needed to address vulnerability among our groups, particularly the incarcerated, and so I leave you with some food for thought: “Of all the forms of inequality, injustice in health care is the most shocking and inhuman because it often results in physical death.” -Martin Luther King Jr.

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