Speaker 1: Hi, I'm Aaron Welsh and this is This Podcast Will
Speaker 1: Kill You. You're tuning in to the latest episode of
Speaker 1: the tp w k Y book Club series, where I
Speaker 1: chat with authors of popular science and medicine books about
Speaker 1: their latest work. We have covered some great books and
Speaker 1: topics so far this season, from the history of phage
Speaker 1: therapy to the origins of language, from the exciting science
Speaker 1: of regenerative medicine to the surprising reality that everything truly
Speaker 1: seems to be tuberculosis. And we've got more book club
Speaker 1: episodes on the way. If you'd like to check out
Speaker 1: the full list of books that we've covered this season
Speaker 1: and past seasons, as well as get a sneak peek
Speaker 1: at the ones we've got coming up, head over to
Speaker 1: our website This Podcast Will Kill You dot com. Under
Speaker 1: the Extras tab, you'll find a link to our bookshop
Speaker 1: dot org affiliate page, which has a bunch of TPWKY booklists,
Speaker 1: including one for this book club series. This is a
Speaker 1: great place to find gift ideas for the book lovers
Speaker 1: in your life. Seriously, check in on these lists regularly
Speaker 1: because I'm always updating them. As always, we love hearing
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Speaker 1: Two last things before moving on to the Book of
Speaker 1: the week. First, please rate, review and subscribe. It really
Speaker 1: does help us out. And second, you can now find
Speaker 1: full video versions of most of our newest episodes on YouTube.
Speaker 1: Make sure you're subscribed to exactly write Media's YouTube channel
Speaker 1: so you never miss a new episode drop. Our modern
Speaker 1: day public health toolkit to prevent and control the spread
Speaker 1: of disease is jam packed. We have diagnostic technology, we
Speaker 1: have medical interventions and treatments, we have epidemiological policies to
Speaker 1: interrupt the chain of transmission, and we have intricate knowledge
Speaker 1: about how communicable diseases behave under different conditions. In short,
Speaker 1: we have the tools to greatly reduce morbidity and mortality
Speaker 1: from infectious diseases. What we still lack, however, is the
Speaker 1: will and the resources to apply these tools everywhere they
Speaker 1: are needed. And one area of great need is our
Speaker 1: correctional facilities, jails, prisons, immigration detention centers and juvenile detention centers,
Speaker 1: places where overcrowded, unsanitary conditions and inadequate medical care allow
Speaker 1: communicable diseases to spread unchecked. This pervasive neglect will continue
Speaker 1: to fuel health inequities until healthcare in these settings is reformed.
Speaker 1: What might meaningful reform look like? The author of this
Speaker 1: week's book holds the answer. In Outbreak Behind Bars, Spider Bites,
Speaker 1: Human Rights and the Unseen Danger to Public Health, correctional
Speaker 1: health physician and epidemiologist, doctor Homer Venors reveals the systemic
Speaker 1: issues driving the rampant spread of disease in correctional facilities.
Speaker 1: As the former chief medical officer of the New York
Speaker 1: City Jail System. Check out his previous book titled Life
Speaker 1: and Death in Riker's Island, and through his current work
Speaker 1: as a federal monitor of health services in several jail
Speaker 1: and prison settings, doctor Venters has extensive firsthand knowledge of
Speaker 1: the barriers that prevent adequate medical care to be delivered
Speaker 1: to these populations, and he has evidence based solutions. The
Speaker 1: scope of this problem is massive, and as this administration
Speaker 1: ramps up its ice raids and expands federal policing, we
Speaker 1: can only expect it to grow. This book serves as
Speaker 1: a powerful and practical overview of the challenges facing healthcare
Speaker 1: in correctional facilities and clearly demonstrates the need for a
Speaker 1: human rights approach to this issue. Before I share this
Speaker 1: interview with you all, I do want to mention that
Speaker 1: both suicide and violence are discussed, so please listen with discretion.
Speaker 1: Let's take a quick break and then we'll get right
Speaker 1: into the interview. Doctor Venters, thank you so much for
Speaker 1: joining me today.
Speaker 2: Thanks for having me. I'm really thrilled to talk about
Speaker 2: the content and also, as I said, I'm really just
Speaker 2: fascinated with all the topics you've delved into already. Oh.
Speaker 2: Thank you. Well.
Speaker 1: As the former chief medical officer of the New York
Speaker 1: City jail System, you have extensive firsthand experience witnessing the
Speaker 1: ways that certain diseases in the institutional settings such as jails,
Speaker 1: can truly thrive, which is what you explore in your book,
Speaker 1: Outbreak Behind Bars. Can you tell me about the making
Speaker 1: of this book and when you decided to write it.
Speaker 2: Yeah, I really thought about writing it. I was actually
Speaker 2: going to. I wrote originally a book on called Life
Speaker 2: and Death in Wrikers Island that was about some of
Speaker 2: the horrible causes of mortality and violence behind bars. But
Speaker 2: then I was going to write a second book about
Speaker 2: something else. And then when COVID hit, I was the
Speaker 2: president of a really small nonprofit and I handed that
Speaker 2: off to people who were probably better at running it
Speaker 2: than I was, and I just started responding to COVID
Speaker 2: outbreaks around the country. So for a couple of years,
Speaker 2: I was on the road constantly, going from outbreak to outbreak,
Speaker 2: different reasons that I would get into the jail. Sometimes
Speaker 2: I'd be invited in, sometimes I'd be have to force
Speaker 2: my way in with through litigation. But for a couple
Speaker 2: of years I was really on the road. I went
Speaker 2: to about maybe sixty or seventy outbreaks, and so as
Speaker 2: I was going around developing tools for myself to use
Speaker 2: to understand the adequacy of the COVID response, it really
Speaker 2: helped me see the broad spectrum of infection control practices
Speaker 2: and resources and you know, learning writers, I learned a
Speaker 2: lot about one place, and in doing all of these
Speaker 2: COVID responses, it taught me a lot about some of
Speaker 2: the common pitfall some of the common gaps, and some
Speaker 2: of the really successful strategies when it comes to infection control,
Speaker 2: infection prevention response, things like that, And so it really
Speaker 2: became a no brainer for me to think as I
Speaker 2: looked back and in the field were kind of lightened
Speaker 2: up for me to think about putting this together in
Speaker 2: a book.
Speaker 1: And as you describe in your book, correctional facilities truly
Speaker 1: really promote the spread of certain diseases for a number
Speaker 1: of reasons, you know, from things like the architecture or
Speaker 1: organization of the buildings themselves to the neglect that's often
Speaker 1: present in these settings. Can you take me through some
Speaker 1: of the systemic factors that drive disease transmission in these settings?
Speaker 2: Sure? And I think you know, I came across a
Speaker 2: word actually on your website ecology, which is really such
Speaker 2: a great term which we don't use much in public
Speaker 2: health and like a lot of public health settings that
Speaker 2: I've encountered, but it's such a perfect way to encapsulate
Speaker 2: the intersection between people's health and these outbreaks and their
Speaker 2: physical surroundings. And so I think most people understand that
Speaker 2: the close proximity of prisons, jails, immigration detention, juvenile detention
Speaker 2: centers that promotes the spread of disease that's communicable. That
Speaker 2: makes sense. I think what is not so apparent to
Speaker 2: a lot of people is that the lack of sanitation,
Speaker 2: the incredibly filthy, unsanitary conditions also promote that spread when
Speaker 2: the conditions are even more cramped than normal. So if
Speaker 2: people are sleeping on floors, touching each other, sleeping in
Speaker 2: common pens and areas that are never cleaned, that promotes
Speaker 2: the spread. And then there's this much more hidden set
Speaker 2: of promoters of outbreaks that include barriers to medical care
Speaker 2: for individuals people can't get to you know, when they
Speaker 2: have a new symptom, they can't get to care, Barriers
Speaker 2: to outside health agencies being involved. So the local public
Speaker 2: health environment might do a great job at a outbreak
Speaker 2: at a church or a nursing home might not be
Speaker 2: involved behind bars. And then I think there are also
Speaker 2: real barriers in terms of infection control resources. One thing
Speaker 2: I often find is that I'll get to a jail
Speaker 2: or prison, I'll get the staffing matrix and there will
Speaker 2: be a line on there for an infection control nurse
Speaker 2: or maybe a half of a part time of part time,
Speaker 2: like a half fte of infection control nurse. That line
Speaker 2: is often unfilled. It's a way to kind of save
Speaker 2: money or not fill a line that some people think
Speaker 2: is an important. And there might also be by the way,
Speaker 2: an infection control officer who's supposed to have like a
Speaker 2: security middle manager like a sergeant or a lieutenant, who's
Speaker 2: supposed to spend a quarter or half of their time
Speaker 2: on infection control, and those lines often are just not filled,
Speaker 2: and so you don't have the people that are doing
Speaker 2: the jobs that we think.
Speaker 1: Are important, right, And it is really just and disturbing
Speaker 1: how much of it is just a money saving aspect.
Speaker 1: It's just let's save money, and it's sort of this
Speaker 1: you know, ounce of prevention, pound of cure, etc. But
Speaker 1: there are these systemic and structural problems with delivering adequate
Speaker 1: medical care to those in prisons and people in prisons
Speaker 1: and other institutional settings accessing medical care. But there are
Speaker 1: also these issues that you discuss stemming from bias leading
Speaker 1: some of those who might be in the position to
Speaker 1: give someone or let someone get access to medical care,
Speaker 1: leading those to downplay or dismiss someone's concerns. What are
Speaker 1: some of the ways that this neglect or this bias manifests.
Speaker 2: Well, I think it starts with just patients who have
Speaker 2: symptoms not being believed. So in the IMMERSA chapter, I
Speaker 2: talk about this I think in actually almost every chapter
Speaker 2: I talk about this, where people are reporting symptoms that
Speaker 2: are exactly kind of textbook symptoms that we would want
Speaker 2: them to so we can know either that a new
Speaker 2: outbreak is afoot, or that it's spreading to a new area,
Speaker 2: or that maybe treatment wasn't complete or effective. But often
Speaker 2: they're either disbelieved or they're kind of fended off with
Speaker 2: very rote and ineffective healthcare encounters. There's something called a
Speaker 2: sick call encounter where a patient might have to pay
Speaker 2: to see a nurse. That nurse might just talk to
Speaker 2: them briefly, might not even do much of a physical exam.
Speaker 2: They might never see a doctor or a nurse practitioner
Speaker 2: or a physician assistant, And they might have to go
Speaker 2: through that cycle of seeing a sick call nurse over
Speaker 2: and over and over, not getting any effective diagnosis or treatment.
Speaker 2: And so those barriers are built into jail's, prisons, immigration
Speaker 2: detention centers in many of the outbreaks I've investigated. So
Speaker 2: there's this.
Speaker 1: Sort of just inherent stance of you really have to
Speaker 1: fight to have your medical concerns addressed at all.
Speaker 2: Yes, and there's a downside to that. I mean there
Speaker 2: is these are paramilitary settings, so unlike you know, as
Speaker 2: much as it's difficult to work in a hospital or
Speaker 2: a clinic, these are places where raising alarm or raising
Speaker 2: concern in a way that makes you stand out from
Speaker 2: everybody else can bring very swift retaliation all the way
Speaker 2: from losing services, being locked in a cell by yourself,
Speaker 2: put into solitary confinement, beaten or subject to physical or
Speaker 2: sexual abuse. And so those things don't happen all the
Speaker 2: time to everybody, but that risk of raising your hand
Speaker 2: and pushing harder than everybody around you to get your
Speaker 2: point across about health issues, there is that risk inherent
Speaker 2: because of the power and security dynamic.
Speaker 1: And you also talk about how mistrust flows in every direction.
Speaker 1: Can you say a little bit more about what you
Speaker 1: mean by that.
Speaker 2: Yeah, it's really profound. You know, we talk a lot
Speaker 2: well at Wrikers. We would talk a lot about this
Speaker 2: problem with dual loyalty, which is when your health staff
Speaker 2: really aren't working to the benefit of the patients that
Speaker 2: they're there to take care of, but the mistrust from
Speaker 2: the patient standpoint, the health service may be involved in
Speaker 2: punishing them or in withholding care in ways that has
Speaker 2: really dramatically impacted them. So imagine you're a person who
Speaker 2: has a mental health crisis and you get in trouble,
Speaker 2: you break the rules of the facility, and then health
Speaker 2: staff say it's okay for you to be punished via
Speaker 2: solitary confinement, which is horrible, punishing, tortuous experience. There are
Speaker 2: many ways in which the health staff may be co
Speaker 2: opted in the patient's view as to become agents of
Speaker 2: the security service, so they're not really acting on behalf
Speaker 2: of the patients. So you know, fast forward to when
Speaker 2: an outbreak occurs, you may not feel like those health staff,
Speaker 2: those nurses, those doctors are really there to help you.
Speaker 2: And I think that the current problems around the country
Speaker 2: with excessive use of lockdowns. This is when people are
Speaker 2: locked in a cell or locked in their housing area,
Speaker 2: and then health staff may come and kind of minister
Speaker 2: to the unit in very limited fashion. I think it's
Speaker 2: easy for patients who are locked up to feel like
Speaker 2: the health staff aren't helping them. And then from the
Speaker 2: perspective of the health staff, they may both distrust the patients,
Speaker 2: they may be afraid of them, but they also may
Speaker 2: only see them in moments of crisis. So in that
Speaker 2: same lockdown scenario, if the doctor or the nurse can
Speaker 2: rarely get to see their patients, those patients may be
Speaker 2: in very agitated, upset moods or frames of mind, very sick,
Speaker 2: So it doesn't help the dynamic of those two engaging.
Speaker 2: And then there's the dynamic of the security service. The
Speaker 2: health staff may both be afraid of them and also
Speaker 2: rely on them for physical protection. So it's a pretty
Speaker 2: difficult cult scenario even when things operate the way they're
Speaker 2: supposed to buy policies, and obviously it's often the case
Speaker 2: that they're not operating that way.
Speaker 1: Let's take a quick break, and when we get back,
Speaker 1: there's still so much to discuss. Welcome back everyone. I've
Speaker 1: been chatting with doctor Homer Venters about his book Outbreak,
Speaker 1: Behind Bars, Spider Bites, Human Rights, and the Unseen danger
Speaker 1: to public health. Let's get back into things, and of
Speaker 1: course this will affect every aspect of health in these settings.
Speaker 1: But you discuss certain diseases or types of diseases that
Speaker 1: have a propensity to spread or to have greater severity
Speaker 1: in prisons, jail, immigration detention centers. What are some of
Speaker 1: those types of diseases that really do thrive in these conditions.
Speaker 2: I think there are many, many communicable diseases that thrive
Speaker 2: in these places for different reasons. So, you know, for
Speaker 2: places that have a great churn of lots of people
Speaker 2: coming in and have lots of overcrowding, especially overcrowding among
Speaker 2: people who just arrived, you may find housing areas or
Speaker 2: pens intake pens where scores of people are sleeping on
Speaker 2: the floor, touching each other, in physical places that are
Speaker 2: never cleaned, that have fecal material that are completely filthy, dirty,
Speaker 2: no sanitation, may not have those people may not have
Speaker 2: access to bathrooms sometimes, and so that dynamic certainly promotes
Speaker 2: the spread of both staphylococcal skin infections, anything that's on
Speaker 2: the skin scavy's light, but also you know, respiratory infections.
Speaker 2: That's one dynamic. Another is that behind bars, almost every
Speaker 2: health crisis is met with the patient being thrown in
Speaker 2: a locked cell. So this sounds insane for people who
Speaker 2: work in other settings, but you know, the leading cause
Speaker 2: of death in US jails has for a long time
Speaker 2: been suicide. Many of those suicides occur when a person
Speaker 2: has been identified as having some mental health issue and
Speaker 2: then they're thrown in a locked cell for what might
Speaker 2: be called a mental observation, or they may be in
Speaker 2: withdrawal or both right withdrawal and having a mental health crisis.
Speaker 2: Those people who are thrown into those locked cells for
Speaker 2: a range of real health crises then are often forgotten.
Speaker 2: And I don't mean forgotten. It may be that a
Speaker 2: mental health person comes by their cells and says something
Speaker 2: to them through a locked door a couple times a day.
Speaker 2: But in the last few years, I've investigated several starvation deaths,
Speaker 2: human beings who are in a jail, a fully staffed
Speaker 2: jail or prison, who starve to death in one of
Speaker 2: these cells. And that happens because people stop caring about
Speaker 2: or even thinking about their physical health. And if you
Speaker 2: look at who has died from starvation, you often find
Speaker 2: that they also have horrible scabies or life infestations. And
Speaker 2: so that tendency to take people with a health crisis
Speaker 2: behind bars and lock them in a cell is another
Speaker 2: type very serious infection risk infection control problem because those
Speaker 2: cells are never going to those cells almost never get cleaned,
Speaker 2: never get effectively, so the next person who come in
Speaker 2: could you get the same problem. So there are other
Speaker 2: dynamics for sure behind bars. But those are two that
Speaker 2: I think really stand out. One is the new intake
Speaker 2: people crammed together and intake pens, and the other is
Speaker 2: this kind of people who are sick from a behavior
Speaker 2: health standpoint, just being locked in a cell by themselves
Speaker 2: and forgotten from a physical health standpoint.
Speaker 1: It is truly horrifying to think about how these problems
Speaker 1: that are so rampant that clearly many solutions are needed,
Speaker 1: and they're needed at all these different stages.
Speaker 2: Right.
Speaker 1: They're needed for preventing the spread of a disease in
Speaker 1: the first place. There's controlling its spread, which has a
Speaker 1: different set of strategies and tools that you need, and
Speaker 1: then there's reducing morbidity and mortality. What are some of
Speaker 1: the solutions that you think will help address these issues?
Speaker 1: I guess practical solutions, and then what are some of
Speaker 1: the barriers to implementing those solutions.
Speaker 2: I think that one of the kind of medium term,
Speaker 2: like it's not the smallest thing, but it's a pretty
Speaker 2: decent thing for a facility, is to make sure these
Speaker 2: infection control rules are filled. It's not hard to find,
Speaker 2: you know, nurses all over this country, millions and millions
Speaker 2: of nurses know about infection control, so do doctors and
Speaker 2: pas and ps, and so it's not hard to find
Speaker 2: people who understand the basics of infection control. I can find,
Speaker 2: you know, the weak spots in a facility where things
Speaker 2: need to be improved. But when those lines are allowed
Speaker 2: to go unfilled or when somebody who's supposed to be
Speaker 2: halftime infection control has like three other full time equivalents
Speaker 2: of work to do, it's not going to happen. And
Speaker 2: the same for the security staff. And so I've seen
Speaker 2: very effective partnerships between the infection control nursing staff and
Speaker 2: security staff when they really are you know, have the
Speaker 2: resources of time. I think, from my standpoint, most of
Speaker 2: my work now is a federal monitor, which means a
Speaker 2: federal court will put me in the role of tracking
Speaker 2: and helping to improve healthcare in a prisoner a jail,
Speaker 2: and that can take years. And so as a federal monitor,
Speaker 2: it's great because I get to work with a facility.
Speaker 2: There's a settlement agreement that other people came up with,
Speaker 2: but then I get to come up with a plan,
Speaker 2: you know, with the facility and track it quarter and
Speaker 2: or quarter. And one of the things that I think
Speaker 2: is most effective is building connections with the outside health
Speaker 2: department outside of jail or a prison. Because we could
Speaker 2: go to about seven thousand jails, prisons, detention centers of
Speaker 2: different stripes around the country. It's pretty rare that a
Speaker 2: local health department is really involved in assessing the adequacy
Speaker 2: of anything that happens inside those boxes. And so from
Speaker 2: my standpoint, infection control and outbreak response is one of
Speaker 2: the few areas where you do have sometimes some involvement
Speaker 2: where a local health department or maybe the state or
Speaker 2: maybe the CDC might be involved. And so when I'm
Speaker 2: a monitor, one of the first things I put on
Speaker 2: the table is I think it's important for us to
Speaker 2: all once we get to the point where we say
Speaker 2: healthcare has improved, we're all feel like the requirements have
Speaker 2: been met, that one of the things where we see
Speaker 2: on the table is a physical connection, an involvement of
Speaker 2: the local health department, so that when we all walk
Speaker 2: away from whatever the legal case is, we know that
Speaker 2: the local health department will be looking checking these things.
Speaker 2: And that's really, from my standpoint, really really important.
Speaker 1: I'm so curue where is how you got into this
Speaker 1: line of work? Like, how how did you find yourself
Speaker 1: in this position and involved in this type of work.
Speaker 2: You know. I was a resident in social medicine at
Speaker 2: Montefior at Albert Einstein, and I loved that program. I
Speaker 2: went to that program because I knew that there would
Speaker 2: be more training in human rights and epidemiology. And I
Speaker 2: had patients at our clinic in the South Bronx who
Speaker 2: would tell me these really incredible stories about what happened
Speaker 2: to them in jail, like in Wrikers and other places.
Speaker 2: And I then I started a project as a resident
Speaker 2: seeing patients over in the Legal Bronx Defenders, which is
Speaker 2: like illegal aid type organization across the street from US,
Speaker 2: and I just learned so much. And then I then
Speaker 2: my fellowship looked at healthcare for people in immigration detention,
Speaker 2: and I was also working as an attending in the
Speaker 2: Bellvue as a program for survivors of torture, and I
Speaker 2: just this kind of interplay between human rights and health,
Speaker 2: I think is so makes this such a natural area
Speaker 2: to want to be in, because you know, in some ways,
Speaker 2: traditional public health and medicine are really antithetical to some
Speaker 2: of the precepts of human rights in that we're not
Speaker 2: trained in a hospital to kind of identify problems and
Speaker 2: not fix them. You know, we find a problem and
Speaker 2: we fix it, right, and you wouldn't want to be
Speaker 2: on the hook for not fixing a problem. But in
Speaker 2: you know, some of the core principles of human rights
Speaker 2: involve documenting with your patients or survivors what's happening to them,
Speaker 2: with the notion that you might not fix that, but
Speaker 2: to tell the truth, like use your skills as a
Speaker 2: doctor or an engineer or whatever it is. And so
Speaker 2: I found that and we did publish a lot when
Speaker 2: I was at Rikers about a human rights framework how
Speaker 2: we thought it was important to correct health hasn't really
Speaker 2: taken off like wildfire, but I find it just really
Speaker 2: gratifying in terms of this, you know, learning from patient.
Speaker 2: It's about the reality of their experience. Using whatever little
Speaker 2: skills you have and authority you have to kind of
Speaker 2: like put that on the map and say this is
Speaker 2: what they say. It might be consistent or inconsistent with
Speaker 2: other sources of data, and that kind of help get
Speaker 2: that information into the crucible of you know, how we
Speaker 2: should make decisions.
Speaker 1: It's an incredibly important and I think especially with this
Speaker 1: current administration, which maybe we'll talk a little bit more
Speaker 1: about later sort of all of what's happening with ice raids.
Speaker 1: But you know, I want to touch on a story
Speaker 1: that you discuss in your book, which is about tuberculosis,
Speaker 1: and you kind of highlight tuberculosis as this case study
Speaker 1: in how diseases can be spread through systemic failings. You
Speaker 1: describe how delivering medical care is a you know, quote
Speaker 1: unquote constant exercise in interruptions. What are some of those
Speaker 1: interruptions when it comes to something like tuberculosis TB.
Speaker 2: You know, I have a great friend, slash Mentor Mukherjee
Speaker 2: who's partners in health, who I really have learned so
Speaker 2: much from over the years. But I think she would
Speaker 2: often describe, and many others before her, for zillions of years,
Speaker 2: have described TV as a poor people's disease, and so
Speaker 2: I think that it is. One of the things about
Speaker 2: tuberculosis is that most jails and prisons in this country
Speaker 2: care about it like it for a long time has
Speaker 2: been established as something that you don't want to have
Speaker 2: happened in your facility, and so most places have a
Speaker 2: system to check people for active pulmonary TV when they
Speaker 2: come through the front door. And that could and then
Speaker 2: evolves some questions about screening and involve a PPD. It
Speaker 2: might involve some other things like an interfer on gamma
Speaker 2: test or a chest X ray, but there's some effort.
Speaker 2: Then once a year, if you look at most prisons,
Speaker 2: for people who have been in any state prison system
Speaker 2: or the federal prison system, for you know, any amount
Speaker 2: of time, there's supposed to be a check once a
Speaker 2: year to see do you have new symptoms that might
Speaker 2: indicate you have pulinary TV. That kind of yearly check,
Speaker 2: if it's not a big priority, and this is the
Speaker 2: case I mentioned in the book, could be swept aside
Speaker 2: or could be kind of ignored. And you know, we
Speaker 2: know that probably five or more percent of people with
Speaker 2: latent tuberculous infection will develop at some point in their
Speaker 2: lives pulmonary TV. And so when we stop looking for it,
Speaker 2: then it obviously is going to occur because it's a
Speaker 2: pretty prevalent situation. And then there's also the component of
Speaker 2: people not being believed. So people may report actively report
Speaker 2: that they have symptoms that are indicative of pulinary TV,
Speaker 2: they might not be believed. But I think another part
Speaker 2: of this is in this country. Let's say we have
Speaker 2: two million people about incarcerated today or locked up in
Speaker 2: different places. That might represent about ten million or eight
Speaker 2: million incarcerations a year because of the churn, But most
Speaker 2: of those those incarcerations are happening in county jails. County
Speaker 2: jails rarely get into the business of assessing if you
Speaker 2: have latent tuberculosis infection, are we going to initiate treatment
Speaker 2: for you? Because the idea is the smaller the circle
Speaker 2: of things we care about as the health service of
Speaker 2: a jail, the less we have to do. So if
Speaker 2: you're a big county and you're let's say in New
Speaker 2: York or Chicago or Seattle, and your jail is also
Speaker 2: part of a local health department or a public hospital service,
Speaker 2: then you care. Then you want to know everybody who
Speaker 2: has latent tuberculus infection, and you want to make sure
Speaker 2: that they get connected, you know, with their consent to treatment,
Speaker 2: whether it's in the jail or when they go home.
Speaker 2: But for most of the three thousand or so county
Speaker 2: jails in this country, the circle of things they care
Speaker 2: about is pretty small, and it has to do with
Speaker 2: trying to prevent death. For the little time they're in jail,
Speaker 2: and so you miss that, and I think that it
Speaker 2: really goes towards this framing of healthcare. Behind bars is
Speaker 2: most mostly cut away from the rest of healthcare in
Speaker 2: this country, and so the things we say are important
Speaker 2: about quality, about continuity everywhere else kind of evaporate for
Speaker 2: a lot of people who are locked up.
Speaker 1: Let's take a quick break here. We'll be back before
Speaker 1: you know it. Welcome back, everyone. I'm here chatting with
Speaker 1: doctor Homer Venters about his book Outbreak behind Bars. Let's
Speaker 1: get into some more questions. In addition to tuberculosis, another
Speaker 1: infection that you touched on previously is MRSA or methasilone
Speaker 1: resistance Staphocloccus aureus, which is of course spread through close
Speaker 1: quarters and absolutely thrives. And this is something that you know,
Speaker 1: We've known about the hazards of MRSA and the challenges
Speaker 1: with controlling its spread for decades, and yet it continues
Speaker 1: to cause severe infections in these settings, in jails, prisons,
Speaker 1: immigration detention centers. What are some of the reasons for this,
Speaker 1: Like how does MRSA manifest differently, not manifest differently, but
Speaker 1: sort of play out differently in these settings compared to
Speaker 1: you know, community or hospital settings.
Speaker 2: Hospitals generally have a pretty strong rubric or structure of
Speaker 2: infection control because hospitals know that there are bugs of
Speaker 2: all sorts and hospitals, and that when people get infections
Speaker 2: new infections, they're more likely to die, They're more likely
Speaker 2: to get sick. It's very bad for the hospital for
Speaker 2: a variety of reasons. Just like you said, we know
Speaker 2: and have known for decades that these staphlocarcical skin infections
Speaker 2: are a serious problem behind bars. Anytime we find ourselves
Speaker 2: cramming more people into space than we know is a
Speaker 2: good idea. Anytime we stop doing the basic sanitation of
Speaker 2: these places, anytime we start to fall down on things
Speaker 2: like sick call or letting people get assessed for the
Speaker 2: care they need, then these are very quick response outbreaks.
Speaker 2: It's not some of these outbreaks could take a long
Speaker 2: time to develop, but these can flourish very quickly when
Speaker 2: these conditions get bad, when access to care is denied.
Speaker 2: I mean, one of the things I usually start with
Speaker 2: as a monitor is looking at I'll get all of
Speaker 2: the records of people who reported a boil, a blister,
Speaker 2: a sore on the skin, and then I'll go through
Speaker 2: those records and compare those to who got a culture,
Speaker 2: and you know, I'll find often that a great number
Speaker 2: of people had an open ulcer or sore on their
Speaker 2: skin that did not get a culture. That lack of
Speaker 2: adequate diagnosis means that we're undercounting likely these are staff
Speaker 2: for cocko skin infections, that some of them are MURSA.
Speaker 2: I would add in that, you know, the few times
Speaker 2: the researchers have looked at colonization rates colonization rates that
Speaker 2: I can think of two or three different studies where
Speaker 2: they find that the rate of colonization for MRSA behind
Speaker 2: bars is about ten times higher than in the community.
Speaker 2: And it's a little bit of a chicken in the
Speaker 2: egg like think of that solitary cell I mentioned where
Speaker 2: somebody was stuck in there for months. If that kind
Speaker 2: of place doesn't get cleaned, or these intake pens don't
Speaker 2: get cleaned, then you cycle people through and you develop
Speaker 2: newly colonized people. Even if they don't develop an infection
Speaker 2: that's an acute you know.
Speaker 1: Boil or sore, there's no effort for prevention or control
Speaker 1: once once it's already there, it just sort of is
Speaker 1: you know, managed the best you can, and you talk
Speaker 1: about you touch on this issue of the problems with
Speaker 1: data and accurate reporting, and in terms of reportable diseases,
Speaker 1: MRSA and someone ELLA do but they don't necessarily, as
Speaker 1: you said, are accurately reported. But something like heat doesn't count.
Speaker 1: So there are other ways that morbidity and mortality and
Speaker 1: you know, disease can manifest in these settings but may
Speaker 1: not be accurately reported. What are some of the issues
Speaker 1: with this?
Speaker 2: Both MRSA and heat are interesting because so MRSA, there's
Speaker 2: a great variation in what's reportable, but most states, if
Speaker 2: you have what you think is a MRSA outbreak, you're
Speaker 2: supposed to report it to the department of health. I
Speaker 2: think that in my position would be if you have
Speaker 2: a mercy case in a jail or a prison, somebody
Speaker 2: needs to go figure out is that an outbreak because
Speaker 2: it's hard to imagine a mercy case in a jail
Speaker 2: or a prison where you don't have exposure of other
Speaker 2: people and maybe other cases. So I think that that's
Speaker 2: a great example of where if you have a local
Speaker 2: health department with a little savvy who's been in a
Speaker 2: jail or prison, they would say, geez, we got one case,
Speaker 2: then maybe we should go look. I think heat is
Speaker 2: a great example, because you know, there are many jails
Speaker 2: and prisons and immigration detention centers around the country that
Speaker 2: have high heat conditions, so over eighty five degrees in
Speaker 2: living spaces, and you know that's sporadic, right. It might
Speaker 2: happen sometimes and it might go for days, it might
Speaker 2: go for one day. One of the things that all
Speaker 2: of these places know is they know which patients are
Speaker 2: heat sensitive. So there's a standard list that's used to
Speaker 2: identify people who are older, high bmi, anti who are
Speaker 2: taking anti psychotics, diuretics, certain there's like in New York City,
Speaker 2: we had a standard list where we looked at everybody
Speaker 2: coming in the door during I think maybe from April
Speaker 2: to October, and we would say are you heat sensitive?
Speaker 2: Yes or no? And then on high heat days it
Speaker 2: was the job of the Health Service and the security
Speaker 2: service to make sure all those people were in air
Speaker 2: conditioned housing. And most jails and prisons can't do that.
Speaker 2: And that is a problem because first of all, there
Speaker 2: are a lot of places, and Texas is where a
Speaker 2: lot of the cases I cite are from there are
Speaker 2: a lot of places that just have no air conditioning.
Speaker 2: But even the places that have air conditioning do have
Speaker 2: air conditioning that breaks down, you know, or there's an emergency,
Speaker 2: or people have you move housing areas something like that.
Speaker 2: And so this data about who's heats sensitive is known,
Speaker 2: but my experience is it's not really utilized by the
Speaker 2: Health service because nobody's given them the job. Look, these
Speaker 2: are high heat conditions. You may have to this circumstance
Speaker 2: or that circumstance, find who's heat sensitive, and then go
Speaker 2: do extra monitoring of them, or check on them, or
Speaker 2: make sure they're okay, or get them into AC housing.
Speaker 2: But I think that this is increasingly a problem because
Speaker 2: you have more facilities in the Midwest. I mentioned, you
Speaker 2: know that I was in the Northwest and it was
Speaker 2: like over one hundred and fifteen degrees one hundred and
Speaker 2: eighteen degrees or something in Washington, and so it was
Speaker 2: a good exercise for us to practice. But this is
Speaker 2: an increasing problem, and as AC units break or as
Speaker 2: people are in places that weren't previously so hot, you know,
Speaker 2: we need to figure out how to keep people safe.
Speaker 1: The things that we've talked about are the ways that
Speaker 1: disease spreads differently in these settings compared to community settings.
Speaker 1: And there also seems to be this barrier of just
Speaker 1: you know, caring about attention to these issues. And so,
Speaker 1: you know, did disease spread within correctional facilities really only
Speaker 1: seem to matter to people when a disease threatens to
Speaker 1: spill over to the into the community. But how do
Speaker 1: infections behind bars also drive community outbreaks? And why is
Speaker 1: that reality so often either ignored or denied?
Speaker 2: Well, that last part is a pretty deep question. I'm
Speaker 2: not sure I have expertise or insights to answer. I
Speaker 2: think you know, a colleague, Eric Reinhardt, who's a physician
Speaker 2: and an epidemiologist, did some great He and a team
Speaker 2: did great, great research around COVID in the Cook County
Speaker 2: jails in Chicago's County jails driving local outbreaks. So they
Speaker 2: tabulated what it looked like, how many cases for an
Speaker 2: in jail outbreak we're driving out of jail context, much
Speaker 2: more than you would expect from just normal community spread.
Speaker 2: And certainly if you pick any one of these diseases,
Speaker 2: keeping in mind, especially with jails, you have the churn
Speaker 2: of people going in and out, in and out in
Speaker 2: and out or immigration detention where it's like a pinball
Speaker 2: machine where people are going from one place to another
Speaker 2: to another to another. That obviously can drive transmission from
Speaker 2: staff and other people around them, whether they're going home
Speaker 2: or they're just going to a new facility. And so
Speaker 2: I think that the concept is pretty understandable. I don't
Speaker 2: know why it is hard to figure out a better
Speaker 2: path to pay attention to. I think that a big
Speaker 2: part of it is people ultimately don't care. A lot
Speaker 2: of policymakers just don't have as a high priority these people,
Speaker 2: or their families or their communities. One of the last
Speaker 2: things we did before I left Rikers is we looked
Speaker 2: at blows to the head. So most jails and prisons
Speaker 2: don't report anything about TBI or how often their patients
Speaker 2: get hit in the head. But what we did is we,
Speaker 2: because we had an electronic medical record, we built in
Speaker 2: this like very good tool for tracking new blows to
Speaker 2: the head. We then tried to extrapolate to the rest
Speaker 2: of the country how many people were accruing new blows
Speaker 2: to the head, new concussions or more severe traumatic brain injury,
Speaker 2: and then what that means for their communities and their families,
Speaker 2: is they go home not just for the shortened medium
Speaker 2: term TBI, but for CTE to think we have all
Speaker 2: these poor communities, heavily police communities where people are going
Speaker 2: home with having new blows to the head. They also
Speaker 2: either way have like all these obligations of things they're
Speaker 2: supposed to do, appointments they're supposed to keep, and so
Speaker 2: we try to calculate kind of what we estimate the
Speaker 2: national rate of this TBI could be. But it goes
Speaker 2: towards this question you asked, which is you know who
Speaker 2: cares about this? And I think that health people and
Speaker 2: doctors are not going to fix these social problems. But
Speaker 2: I do think it's the role of public health agencies
Speaker 2: to care about them. So if you're a local health department,
Speaker 2: you should know that people have come home from a
Speaker 2: jail with scabies and they didn't get the forty dollars
Speaker 2: treatment or you know, a second forty dollars treatment that
Speaker 2: they needed because it was ineffective in the jail, or
Speaker 2: you should know that they came home with these problems.
Speaker 2: Because these do it should matter for you as a
Speaker 2: public health authority.
Speaker 1: And I think what rolls into this too is resources
Speaker 1: and just the investment cost upfront. And you know, the
Speaker 1: for profit prison system is dystopian and horrific for a
Speaker 1: myriad of reasons, endless reasons. And one of those reasons
Speaker 1: that you discuss in your book is that there's often
Speaker 1: or sometimes a policy of withholding medical care to save
Speaker 1: on expenses. How does this approach lead to just overall
Speaker 1: higher death and disability, especially from treatable conditions.
Speaker 2: Well, I think it goes towards this question of like,
Speaker 2: how narrowly have you drawn this circle about health things
Speaker 2: that you care about inside? So you know, a good
Speaker 2: example is goneria chlamydia diagnosis and treatment. So we know
Speaker 2: that if you test males for connery and chlamydia who
Speaker 2: are coming into jails who are asymptomatic, we know that
Speaker 2: that's not just effective for them personally, but it's also
Speaker 2: effective for their partners. There are sexual partners when they
Speaker 2: go out, and so that makes very good sense from
Speaker 2: a cost effectiveness and also a kind of a public
Speaker 2: health framework for reducing high risk pregnancies for instance, for
Speaker 2: you know, transmission of gunneryia chlamydia. I think though, that
Speaker 2: the sanity or the good evidence behind these ideas isn't
Speaker 2: hard to represent. I think it just shows kind of
Speaker 2: the relative weakness of public health in our country, especially
Speaker 2: now that we know we have good strategies for effective treatment.
Speaker 2: We know that putting people behind ours who have a
Speaker 2: mental health crisis or behavioral health crisis or of substance
Speaker 2: use issues isn't an effective way to treat their substance
Speaker 2: use or their mental health problems. But there is. I
Speaker 2: don't think it's just that there are champions of the
Speaker 2: policies that are bad for public health. It's that there
Speaker 2: is a long list of people who will make a
Speaker 2: lot of money off of those policies being implemented in
Speaker 2: a way that causes harm.
Speaker 1: One of the things that you discuss, and one of
Speaker 1: the biggest sources of harm, of course, is the COVID pandemic,
Speaker 1: and you write about ones in specific, the Farmville super
Speaker 1: spreader event and sort of the bureaucratic apathy that really
Speaker 1: fanned the flames of this virus. Can you take me
Speaker 1: through this event briefly, just you know how it began,
Speaker 1: how it worsened, some of the errors that were made,
Speaker 1: and hopefully any lessons that we have learned from that.
Speaker 2: Yeah, I don't again. You finished with the hardest, most
Speaker 2: sobering part which lessons learned. Jeez, I think that you know,
Speaker 2: when I wrote the book, I was worried that the
Speaker 2: Farmville chapter would seem fantastic or over the top, the
Speaker 2: story of what I kind of knew happened and the
Speaker 2: reporting that people, not me, but others did. But now
Speaker 2: it doesn't seem so fantastic. But the problem was COVID
Speaker 2: was in full swaying. It was the summer of twenty twenty.
Speaker 2: The CDC had already given very good guidance about some
Speaker 2: basic steps to prevent COVID in detention setting. So this
Speaker 2: was the CDC had come out with specific guidance for
Speaker 2: what to do and not to do behind bars, and
Speaker 2: two of the things were don't move people around, certainly,
Speaker 2: don't move them from places with COVID place without COVID.
Speaker 2: And when they get to the new place, they're going
Speaker 2: to take all these steps to make sure that they
Speaker 2: don't have COVID before you put them into the main
Speaker 2: kind of area with everybody else. Those are two things
Speaker 2: actually that were happening at farm So Farmville is a
Speaker 2: for profit detention center that was, you know, an ice
Speaker 2: detention center, but then, for reasons that weren't clear to
Speaker 2: me or I didn't know about when I did the inspection,
Speaker 2: people were moved in the summer from three ICE facilities
Speaker 2: that had current or very recent COVID cases, two in Arizona,
Speaker 2: one down in Florida. Seventy four people moved into the
Speaker 2: Farmville Detention Center, and this place had never received seventy four.
Speaker 2: I'm not sure they had really received seven or eight
Speaker 2: very often, but certainly they'd never gotten this kind of
Speaker 2: big group of people before they tried to stop it.
Speaker 2: They were steamrolled by you know, ICE authorities, and not
Speaker 2: only were all these people forced upon them, but then
Speaker 2: their standard approach, which had been very effective up to
Speaker 2: that point, which was to keep people off site for
Speaker 2: fourteen days in a separate building for their intake quarantine,
Speaker 2: that also was steamrolled. So they said, no, you have
Speaker 2: to go right into let's push that process. So these
Speaker 2: two things the CDC had said you should do, which
Speaker 2: is not moving people from places with COVID into places
Speaker 2: without COVID, this kind of fourteen day quarantine that obviously
Speaker 2: was pushed aside, and within days people had COVID symptoms
Speaker 2: and they went from zero COVID to about ninety percent
Speaker 2: of the people in this facility getting COVID, including a
Speaker 2: man from Canada who died from COVID and his family,
Speaker 2: I put in the book heartbreakingly had pleaded to let
Speaker 2: him just come home to Canada. They were going to
Speaker 2: set up a special place for him in their house
Speaker 2: where he could do an actual intake quarantine in the house.
Speaker 2: They made changes, and he's the gentleman who died. But
Speaker 2: I think that what came out afterwards this wasn't part
Speaker 2: of my work, But what the Washington Post report was
Speaker 2: that this was kind of a crass effort to get
Speaker 2: ice and federal agents moved from one part of the
Speaker 2: country to another part of the country, and that there
Speaker 2: were apparently some federal laws or regulations about you couldn't
Speaker 2: just move them around, and so somebody had ended up
Speaker 2: this idea that well, we'll move these all these people
Speaker 2: and then with them move these federal agents so that
Speaker 2: they can be in the DC area to put down
Speaker 2: the Black Lives Matter protests. That's the reporting of the
Speaker 2: Washington Post. You know, what I saw was just the
Speaker 2: outbreak side of this, which was this place had this
Speaker 2: pretty standard approach. It was pushed aside, and then you know,
Speaker 2: COVID was everywhere in the facility.
Speaker 1: And there was really this ultimately kind of this lack
Speaker 1: of accountability.
Speaker 2: I think there are two important principles that you need
Speaker 2: both of one is transparency and the other is accountability
Speaker 2: and so and this is again where I think human
Speaker 2: rights framing is very effective. Although you could find this
Speaker 2: in community health too, But the transparency about what's the
Speaker 2: truth of what happened, what actually occurred, was hard to understand,
Speaker 2: but we've eventually got there. The accountability, which is well,
Speaker 2: who is punished, who gets in trouble, who pays for this?
Speaker 2: I'm not sure. I think that there was a lawsuit.
Speaker 2: I was there because there was litigation, and so I
Speaker 2: was an expert for people, family members I think, and
Speaker 2: others who had brought this suit. And for a while
Speaker 2: the facility was limited in how many people they could
Speaker 2: have in the building by the courts. But I think
Speaker 2: that it goes towards this much bigger issue. You know,
Speaker 2: if a hospital or a dialysis clinic screws up in
Speaker 2: a way that really harms people, they often will lose
Speaker 2: their ability to either function. Right. If a transplant team
Speaker 2: or a central line infections whatever, they may lose their
Speaker 2: license the state Department of Health or CMS. There are
Speaker 2: real consequences for health systems that screw up in a
Speaker 2: way that's disavoidable and that hurts people. This is almost
Speaker 2: never the case behind bars, even though these are big
Speaker 2: health systems, and it really goes to the fact that
Speaker 2: the structures that do that important job, not just to
Speaker 2: the transparency but the accountability, they're pretty much a wall
Speaker 2: when it comes to healthcare behind bars.
Speaker 1: Mmmmm hm. And you discuss in your book and you
Speaker 1: have mentioned that you carry out inspections, you know at
Speaker 1: these different settings in jails and prisons. What are you
Speaker 1: looking for with these inspections and why is an in
Speaker 1: person inspection so critical compared to like a video inspection
Speaker 1: for example.
Speaker 2: Another thing I've learned in human rights is there's always
Speaker 2: a legal context for what you're doing, so you may
Speaker 2: not if you find yourself in a place doing something,
Speaker 2: you really need to understand what's the context for what
Speaker 2: you what got you there? And so for me, you know,
Speaker 2: when I go to a jail or prison, it may
Speaker 2: be that me being there if I'm there is a
Speaker 2: monitor where every like a court or the state of
Speaker 2: whatever a governor's officer or somebody has asked me to
Speaker 2: go there, then I'm able to kind of go pretty
Speaker 2: broadly and look in all the nooks and crannies that
Speaker 2: I need to. If I'm there, it's part of litigation.
Speaker 2: There may have been a very serious fight about either
Speaker 2: keeping me out of the facility, and then if I
Speaker 2: am ultimately able to go in limiting my ability who
Speaker 2: I can talk to, what I can do, what I
Speaker 2: can look at, and so from my standpoint, it's important
Speaker 2: to understand at the outside what am I there to do.
Speaker 2: So if it's a COVID outbreak, I want to know
Speaker 2: kind of some basic questions about what are they doing
Speaker 2: to prevent COVID coming in, what are they doing to
Speaker 2: diagnose and treat people once COVID is inside, and what
Speaker 2: are they doing to protect high risk people. So there
Speaker 2: are certain physical places I'll want to go, data I'll
Speaker 2: want to review, but probably the most one of the
Speaker 2: most essential tools is confidential interviews with people who are there.
Speaker 2: Those people sometimes take a risk in talking to an
Speaker 2: outside inspector because it's knowable, right, It's known who is
Speaker 2: talking to this outsider, and I wouldn't say every time,
Speaker 2: but I often hear from people that they were warned
Speaker 2: or threatened before they speak with me or speak with
Speaker 2: somebody else. But those confidential interviews are really critical because it's,
Speaker 2: you know, it's as if you're walking into a hospital
Speaker 2: and you don't know how the hospital works, or what
Speaker 2: floor anything's on or where you know. So those confidential
Speaker 2: interviews for me are important for the inspection, but they're
Speaker 2: also important for you know, what documents do I ask
Speaker 2: for or what parts of medical records do I look at?
Speaker 1: I want to touch on, you know, something that we've
Speaker 1: kind of circled around a bit here and there, and
Speaker 1: that is this astronomical rise in ice raids and a
Speaker 1: number of people that are being put in or moved
Speaker 1: around these immigration detention centers with this current administration. And
Speaker 1: in your book, you discussed this horrifying story from twenty
Speaker 1: nineteen about the sixteen year old boy who was diagnosed
Speaker 1: with influenza and died in a holding cell after being
Speaker 1: detained by border patrol. And I was curious to hear
Speaker 1: your thoughts on you know, what do you see happening
Speaker 1: and how much or will will we actually hear about
Speaker 1: or learn about these things as they're happening, versus in
Speaker 1: the future in.
Speaker 2: The narrow frame of outbreaks. I worry a lot about
Speaker 2: people having infections or communicable diseases that they can spread
Speaker 2: to each other. One of the problems at Farmville is
Speaker 2: the basic infection control measures that were in place that
Speaker 2: Ice said let's do this, those got pushed aside just
Speaker 2: so you could cram more people into this box. I
Speaker 2: think that that approach, I'm concerned is much more widespread now.
Speaker 2: If people are being put into a system in places
Speaker 2: that aren't used, like if they're being, for instance, put
Speaker 2: into offices, if they're put into gymnasiums, if they've been
Speaker 2: put into these places and they're not being screened for
Speaker 2: all the basic kind of health issues, including signs and
Speaker 2: symptoms of infections when they come in, then it not
Speaker 2: only increases their risk of morbidity and mortality, but it
Speaker 2: also actively dramatically increases the risk of spread of all
Speaker 2: these problems. I think that, you know, the problem sometimes
Speaker 2: with assessing morbidity and mortality for people in immigration detention
Speaker 2: is that many of them end up somewhere else. They
Speaker 2: get off a plane or a bus or somewhere in
Speaker 2: another country, so we don't know what happened to them.
Speaker 2: So if a person you know, was just about to
Speaker 2: start dialysis and then they get off the plane in
Speaker 2: a place where they're never going to get dialysis, we
Speaker 2: don't know that they're going to die of renal failure,
Speaker 2: but they may. The same goes for you know, infection,
Speaker 2: for people that have any kind of communicable disease. So
Speaker 2: I think that my experience is that when you jam
Speaker 2: and cram more humans into these tight spaces and move
Speaker 2: them around, if you also at the same time push
Speaker 2: aside your basic infection control and medical screening processes, which
Speaker 2: was the case in Farmville, then you really create a
Speaker 2: much higher likelihood of the spread of communicable disease for them,
Speaker 2: but also for the staff or you know, doing all
Speaker 2: this transportation and interacting with people.
Speaker 1: We have touched on so many different issues and at
Speaker 1: every level, from you know, individual bias, to these structural
Speaker 1: problems to these like systemic issues that are so pervasive
Speaker 1: in these settings, and it really does feel in some
Speaker 1: ways almost like this massive, insurmountable problem. But I'd like
Speaker 1: to end our conversation with just sort of talking about
Speaker 1: what you might see as a path forward. Like, I
Speaker 1: know this is another maybe difficult question, but like what
Speaker 1: are the immediate steps that can be taken, and I
Speaker 1: know you touched on some of them, but how do
Speaker 1: we ultimately overcome the apathy and disregard for human rights?
Speaker 1: Which maybe is again that the deep philosophical question that's
Speaker 1: really challenging to answer.
Speaker 2: I mean it is. I don't think it is a
Speaker 2: kind of existential problem or question, but I do say
Speaker 2: think that having a little bit of humility about our ability,
Speaker 2: like in epidemiology and medicine and public health. Most of
Speaker 2: the world is not in those domains, but we do
Speaker 2: have local health departments and state health departments, and in
Speaker 2: some circumstances we can hold them to account to say,
Speaker 2: you need to worry about these things. And the fact
Speaker 2: that we're losing right now, the fact that we're you know,
Speaker 2: resources are being stripped away. I understand that it's a horrible,
Speaker 2: painful process, but I do think that it's important as
Speaker 2: a principle to establish or to keep circling back to.
Speaker 2: You know, if you're a health department, you have to
Speaker 2: care about the health of the most vulnerable people, the
Speaker 2: people who have conditions that we want to diagnose and treat,
Speaker 2: and that shouldn't and can't stop when they're behind the
Speaker 2: bars of a jail or a prison or a nice
Speaker 2: detention center, and so as a monitor in very few places.
Speaker 2: But one of the things I've been able to push
Speaker 2: for is to get a local health department to build
Speaker 2: up some resource to do that. And I think that
Speaker 2: that won't fix some of the problems. There are inherent
Speaker 2: health risks of incarceration. So this is kind of your
Speaker 2: where I love this this term. You know the ecology
Speaker 2: of epidemics, but people should know that who are in
Speaker 2: the health departments, they should understand that, and they should
Speaker 2: be they should have on their radar and their responsibility
Speaker 2: list being involved in those risks and being involved in
Speaker 2: those places. And so I think that anywhere that I'm
Speaker 2: involved now recently and for the rest of my career,
Speaker 2: it will be how can we get the health public
Speaker 2: health experts on the hook for looking into these places.
Speaker 1: Doctor Venters, This has been just such an insightful and
Speaker 1: really important conversation and I really appreciate you taking the
Speaker 1: time to chat with me today.
Speaker 2: Thank you so much. It was really great to meet
Speaker 2: you to learn about your podcast and the other fantastic
Speaker 2: episodes you've done, so thank you.
Speaker 1: A big thank you again to doctor Homer Venors for
Speaker 1: taking the time to chat with me. This is such
Speaker 1: a crucial topic, especially with the current political climate. If
Speaker 1: you would like to learn more about the topics featured
Speaker 1: on this episode, check out our website This podcast will
Speaker 1: Kill You dot com, where I'll post a link to
Speaker 1: where you can find outbreak behind Bars, spider Bites, human Rights,
Speaker 1: and the Unseen Danger to Public Health, as well as
Speaker 1: a link to doctor Venter's website where you can find
Speaker 1: his other great work, like his other book, Life and
Speaker 1: Death in Riker's Island and Don't Forget. You can check
Speaker 1: out our website for all sorts of other cool things,
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Speaker 1: episode and all of our episodes. Thank you to Leona
Speaker 1: Scuilacci and Tom Bryfocal for our audio mixing and thanks
Speaker 1: to you listeners for listening. I hope you liked this
Speaker 1: episode and our loving being part of the TPWKY book Club.
Speaker 1: A special thank you, as always to our fantastic patrons.
Speaker 1: We appreciate your support so very much. Well, until next time,
Speaker 1: keep washing those hands.