Lockdown

by Drauzio Varella

  Tumult in Divinéia

  Often, after talks, inmates would stop me in the halls to tell me about their health problems. They complained of night sweats, feeling weak, swollen lymph nodes, coughs, skin lesions and venereal diseases. They were thin, short of breath and had symptoms characteristic of the advanced stages of AIDS.

  It was impossible to resolve their cases in those on-the-spot consultations, palpate necks, or examine inflamed throats or genital sores amid a throng of curious onlookers. There was no way I could avoid those consultations or not be drawn into their individual dramas. Sometimes, something as banal as oral thrush, common in babies’ mouths and easily cured with a few pills, was stopping the man from swallowing his own saliva. People with symptoms suggestive of tuberculosis self-medicated themselves with useless vitamins and wormseed, a plant said to have medicinal properties.

  The medical assistance in the prison was unprepared to deal with an epidemic of that scale. There were ten doctors, if that, to care for 7000 prisoners. The low salaries and lack of decent working conditions had corroded the spirits of most to such an extent that few of this already small group carried out their work honourably.

  In those days, I would leave the prison feeling a mixture of impotence and guilt. On the one hand, I was unable to forget the sunken eyes of the sick; on the other, what did I have to do with it all? Wasn’t it enough that I already volunteered my time to give talks and risked circulating in that environment? Additionally, many of the men whose facial expressions moved me as a doctor had quite possibly never shown mercy to their defenceless victims.

  There were two solutions to my impasse: to stop going to the prison or to find time to treat the sick, in an organised fashion.

  The second alternative won. That world had worked its way under my skin and it was too late to try and escape it. As a doctor, it wasn’t my place to judge my patients’ crimes; society had judges trained for that. Besides, practising medicine in that place with only a stethoscope, like the physicians of old, after so many years of clinical practice supported by laboratorial exams and X-ray images, was a challenge.

  One winter morning, I made my way up to the fifth floor of Pavilion Four to work out the details with Dr Mário Mustaro, head of the prison’s medical service, who, coincidentally, had been my biochemistry teacher at university. We talked about the internal bureaucracy, the most prevalent pathologies, and I met my first nurse, Edelso, a guy with a middle-class demeanour, doing time for automobile theft and practising medicine without a licence. We were in the middle of this conversation when a staff member came in.

  ‘Doctors,’ he said, ‘you need to get out quick. Three inmates have taken a hostage over in Five and are coming towards Divinéia.’

  On the stairs, the head doctor, who had been in the public service for over thirty years, said to me, ‘See what it’s like? The facilities are primitive, we’re lacking in supplies, medicine, personnel, everything, and when someone wants to extend a helping hand, they run into the problem of discipline. Want my advice? Don’t waste your time here.’

  When we got downstairs, he headed for the exit while I, curious to see the tumult, found a pretext to stay behind with a guard, who explained what was happening.

  Three prisoners from Yellow, each with his own knife, had taken a warder hostage, telling him, ‘This is how it works, boss: if you try anything, you’re dead!’

  With the warder at knifepoint, they had made their way to the ground floor and left the pavilion. The other prisoners stood back to allow them passage through the courtyard. At the door between pavilions Five and Two, the guard realised the situation his colleague was in and said, ‘The three of you can go through and I’ll lock up again. The rest are staying!’

  It took a while to unlock. Meanwhile, there was enough time to bring in the inmates who had been in the Pavilion Two courtyard and close the internal cage.

  A short, stocky mulatto with his shirt unbuttoned was holding the hostage’s left arm behind his back with one hand and pressing a thirty-centimetre blade against his thorax with the other. A white inmate with unkempt hair and no teeth was doing the same thing on the right side, so that the ashen-faced warder had his arms crossed behind his body and a knife at either side of his chest. The third man, muscular from weight-lifting, was pulling the hostage along by his shirt collar while pressing a knife to the underside of his chin.

  They walked along the path connecting the pavilions, and stopped in front of the gate to Two, which led into Divinéia. At this point, on top of the wall, three military police officers were closing in nervously, ready to fire. Inside Divinéia, a group of older warders took up position.

  Negotiations to open the door to Divinéia were tense; by this time blood was streaming from the underside of the hostage’s chin. The inmates were demanding to be transferred to another prison, while the police officers were waiting for an opportunity to open fire, and the warders, to jump on them. There were death threats on both sides, a locked door, shouting and indecision.

  When the order was finally given, only the small pedestrian door was opened – a passage that was narrow for two, impossible for four. The warders forming a circle around the gate stepped back to allow them through.

  The muscular inmate went first with his knife under the hostage’s chin; the two on either side hung back. Big mistake. A police officer on the wall cocked his gun. At the sound, the mulatto ducked in reflex. The toothless one, behind him, was forced to stop. As if rehearsed, two gun barrels sang in the air. Startled, the muscular inmate turned around, relaxing the arm holding the bloody knife. It was a fatal error. The hostage grabbed his kidnapper’s arm and immobilised the weapon.

  A crowd of men in jeans formed around the three prisoners. It was impossible to see details.

  When everything had calmed down, the hostage, as white as wax, his face contorted with pain, was carried away by his colleagues, with his right foot having been fractured in revenge. The mulatto and the muscular inmate, bruised and battered, were carted off in a trolley used to transport pans of food. The toothless one, his shirt in tatters, blood running down his front, right eye swollen closed, incapable of taking two steps in a straight line, accompanied the trolley. Seeing him stumbling towards the infirmary, a warder who had just arrived from Divinéia shouted:

  ‘Still walking, scumbag? My colleagues went easy on you!’

  Welcome

  The week after the attempted transfer, I returned to Pavilion Four.

  The lift was broken, so I took the stairs to the fifth floor, followed the corridor and came out in the infirmary. It was a gallery with twelve cells on one side and ten on the other, a kitchen at the end of the corridor on the left, a large bathroom with more tiles missing than still on the walls and three electric showers, of which only one actually heated the water.

  Under this one, with the water falling in thick drops, a shirtless prisoner who looked like a boxer was rubbing a soapy rag on the skeletal back of a patient while holding him by the armpit with his other hand to keep him standing. The patient had an extensive, red sore on his face that covered the whole right side of his forehead, eyelids and cheeks, caused by shingles, an opportunistic virus frequent in AIDS patients. The boxer-nurse holding up the sick man with the disfigured face was like a scene from a horror film.

  The rooms were, in fact, ordinary cells painted baby blue on the bottom half and white on the top half, high-ceilinged, well lit during the day and dimly lit by night. Inside each was a metal trundle bed with a foam mattress cut with a knife, a toilet, a sink and nothing else. On the wall opposite the heavy door, there was a barred window with a broken pane.

  In the scant space between the bed and the wall, the patients would pile up a few items of clothes, a pair of trainers, flip-flops, plastic bags of food, bananas, stale bread and coffee mugs.

  Some looked in good health; they were recovering from surgery after shoot-outs, knifings, orthopaedic problems, burns from having boiling water poured over them by
their enemies, crises of bronchitis and dermatitis. Others, thin from the tuberculosis that was epidemic in the prison, wandered about in Bermuda shorts and flip-flops, filling the gallery with coughing fits and Koch’s bacillus. On the beds, rolled up in blankets, lay men with fevers, breathing difficulties, the insides of their mouths covered in thrush, bodies wasting away and wet with their own urine. They were in the terminal stages of AIDS and had the resigned gaze that death imposes when it comes slowly.

  With Edelso and two other inmates, I did my first round. At the end, I entered a room where a young car thief, who was just skin and bones, was coughing uncontrollably and spitting out a bloody secretion. The floor was covered with bright red phlegm; there was nowhere to walk.

  ‘You can’t spit like that!’ I said. ‘You’ve got tuberculosis. Anyone who comes in here will step in it and spread the illness through the whole infirmary.’

  ‘Doctor, if I was coughin’ less and felt stronger, I’d be able to spit into the sink, but like this, barely breathin’, I just can’t.’

  The nurses and I stopped outside the infirmary, along with other curious passers-by. I explained to them that the tuberculosis bacillus was present in phlegm and that the invisible droplets were released into the air by coughing, and that the risk of it being transmitted in that environment was real, including to ourselves.

  I finished writing out prescriptions, gave a few instructions and said goodbye. One of the nurses, Juliano – a big, moustached man with a limp, who had been shot in an ambush in which his brother and another partner had lost their lives – walked me to the lift and said, ‘Goodnight, Doctor. Will you be coming back?’

  I went home afraid of catching tuberculosis.

  Making a Difference

  In those days, I had twenty years of clinical experience with critical and terminal patients, and I felt familiar with the prison environment. Even so, I was shocked. I spent the week introspective and uninterested in social events, with memories of the infirmary popping into my mind from time to time. My wife said she’d never seen me so quiet.

  My introspection, however, didn’t reflect the sadness that perhaps I should have felt, as a doctor, faced with that human misery. The perspective of delving deeply into the criminal world, although frightening, fascinated me so much that, to be honest, I was happy, excited about my work and in love with medicine, a profession as demanding as a jealous lover, capable of provoking unexpected crises of passion in me my whole life.

  I began to study tuberculosis, which I hadn’t treated since the 1970s when we thought it would be completely eradicated in Brazil in the near future. For many years, whenever I remembered the prison, I recognised inner sensations that reminded me of my childhood chasing balloons in the district of Brás. Life pulsed stronger there.

  I returned the following week and called together my trio of helpers: Edelso, the fake doctor; Juliano, with the limp, specialised in banks and armoured cars; and Pedrinho, with a thick beard, mysterious past and three bullets lodged in his thorax, who was sentenced to twenty-two years. Before going to the infirmary, I taught them how to administer the medication for tuberculosis and look after the patients. They listened with interest, asked questions and made suggestions on ways to improve the care given.

  The atmosphere was very different to that of the previous week. Several patients said their coughing and night sweats were improving and they were feeling better overall. When we visited the guy who had been spitting blood, he was sitting up in bed, dunking a bread roll in a cup of white coffee. Another, with AIDS-associated pneumonia, in agony from shortness of breath the previous week, was slowly walking around the gallery.

  From cell to cell, from late morning until mid-afternoon, I examined the patients. The three nurses accompanied me and went without lunch, entirely focused. As we left, there was a feeling of professional respect between us. I left thirsty, as I hadn’t had the courage to drink the tap water.

  The next week, on my way to the infirmary, sitting on the bench by the door to the consulting room, half a dozen inmates were waiting. One of them, who had been bodyguard to a drug baron in the Rio de Janeiro favela of Rocinha, whose arms were covered with sores that he scratched incessantly, approached me:

  ‘With your permission, Doctor, we know you come here to treat the guys in the infirmary with HIV, but me and my friends from Eight here are in a bad way. Some of us have fevers and feel weak, others have body itches that won’t let us sleep. So we’ve come to appeal to your goodwill to help us out.’

  They were visibly in need of help. Of the six, four were in advanced stages of tuberculosis, one had a set of peculiar neurological symptoms and the bodyguard with the itch had dermatological lesions all over his body and I had no idea what they represented.

  I finished examining them and went to the infirmary with my trio of helpers. With the exception of one or two AIDS patients who were progressively deteriorating, the others continued improving. We even discharged some.

  Several hours later, as I was leaving, there was a new surprise at the door of the consulting room, this time more numerous: fifteen patients all claiming that they needed help.

  Night had fallen when I finished. Juliano came downstairs with me and called the warder to unlock the cage. He came over with a set of keys.

  ‘Still here, Doctor? I didn’t know you were still up there. And that’s it for you, Juliano. Off you go, ‘cause I’m locking up.’

  Juliano gave him a strange smile and went back upstairs. I left the pavilion, crossed Divinéia and knocked at the gate that leads to the main entrance. Through the little window, the night guard looked me up and down.

  ‘Who are you?’

  ‘I’m a doctor, I was seeing patients over in Four.’

  He stared at me again, slowly, then lowered his eyes to look at my trousers.

  ‘Look, I’m going to talk to the guys on the night shift, and if no one knows you, you stay.’

  ‘I’m a doctor, you can ask the warder who opened the cage in Four for me.’

  ‘You’re not going to tell me who to ask. Wait there.’

  He stared suspiciously into my eyes again and hurried off towards the Rat-trap.

  Although I knew everything would end up being clarified, the fact that I was on the inside and feeling the gruffness of the contact with he who held the key gave me a feeling of discomfort, perhaps similar to what I had noticed in Juliano’s smile when he went back upstairs to be locked in his cell.

  I was lucky; the guard returned with a warder who knew me and apologised.

  ‘Don’t take it the wrong way, Doctor. There’re 7000 men in there. It’s my job to be suspicious!’

  Biotônico Fontoura

  In the following weeks, reality proved to be more complex than I had anticipated. The number of patients who came from the pavilions to the consulting room steadily rose. They didn’t just have AIDS and tuberculosis. The complaints were varied: knifings, asthma attacks, diabetes, hypertension, abscesses, epileptic fits and all sorts of dermatitis. There were crack-heads with laboured breathing, paraplegics with bedsores and even healthy inmates looking to take advantage of the naïve doctor. It was like a crowd flocking to a miracle healer.

  I had to be quick: listen to their complaints, palpate them, examine them with a stethoscope, look them over generally, make a diagnosis and prescribe medication in five minutes at the most. Accurately, if possible. It was old-school medicine: listen, examine and medicate.

  Laboratory exams were pointless because the results, when they came, didn’t arrive on time to be of any use. An old X-ray machine would stay broken for weeks or waiting for radiographic film to be purchased.

  There was no shortage of difficulties. All medications prescribed were subject to complicated bureaucratic processes and when inmates were transferred from one pavilion to another, which was not infrequent, prescriptions got lost along the way. The bureaucracy was so great that six copies had to be made of admissions and discharges in the infirmary, t
hen brought for signing without carbon paper. Often, as is characteristic of the public service, there was an abundance of expensive antibiotics and antiviral medicines, while there was a shortage of aspirin and medicine for scabies.

  In addition to these operational problems, there was also the ignorance of the patients themselves. Traditionally, in the treatment of tuberculosis the symptoms tend to disappear after four to eight weeks, but the medication should be taken for six months at least. Otherwise, there is a risk of a relapse and, worse, the appearance of highly lethal resistant bacilli that can infect others who come into contact with the patient. Adhering to the treatment programme was an insurmountable difficulty for most of these patients, many of whom were addicted to drugs that were used compulsively, such as crack.

  To make matters worse, I wasn’t fully prepared for that antiquated kind of medicine, without X-rays or laboratorial confirmation. The spectrum of pathologies was too far-ranging for someone like me, trained in an era of medical specialisation.

  Skin complaints, for example, which were epidemic in the crowded cells, encompassed the entire field of dermatology: eczema, allergies, infections, bedbug bites, scabies and body lice – a bold variety that hides in folds in clothes and can jump long distances from one person to the next.