Zimbabwe: helping prison authorities improve nutrition
In April 2009, the ICRC launched an emergency assistance operation to improve the nutritional situation in Zimbabwe prisons. Therapeutic feeding programmes for acutely malnourished prisoners and general food distributions to prevent further malnourishment allowed malnutrition rates to drop sharply. For over a year, the ICRC has continued to work with Zimbabwe Prison Service (ZPS) to improve the diet of prisoners and ensure monitoring of the situation. Prisoners and ZPS officers in Masvingo prison describe the remarkable improvements they've experienced.
As the chill of the night slowly wanes in the morning, prisoners are quietly sitting or wandering around the small yard of the 100-year old Masvingo prison, in the southeastern Zimbabwe. Most of them are chatting; some are reading or playing chess.
When the food is brought in plastic containers from the kitchen at the end of the morning, they all warm up and start waiting in line to receive their ration of sadza, the national staple diet made of maize meal, with beans, groundnuts and vegetables. Noise suddenly increases when they all sit or squat together in the yard to eat, shouting and laughing with each other.
Situation dire: lost 20 kilos in six months
After finishing his lunch, one of the prisoners, John*, watches the others eat, and smiles. "When you see that, you wouldn't believe how things were last year," he says. John arrived in the prison in December 2008. "Food was very scarce then. In six months, I lost 20 kilos. My bones were showing, I was really scared," he recalls.
By that time, in June 2009, ICRC nutritionists, medical staff and delegates started working with prison staff and launched an emergency feeding program in Masvingo. As of April, the ICRC had launched its operation in 13 other prisons in the country. The organization provided the necessary therapeutic food items and medicine and helped health staff to set up procedures to identify and treat malnourished prisoners.
"When ICRC started to assist us, it was a huge relief," says Chief Prison Officer (CPO) Madzivire, the Nurse in Charge. "In just a few weeks, the change was dramatic! Here in Masvingo, 50 prisoners were included in the therapeutic feeding program. After three weeks, most of them could be discharged. The ones with underlying diseases like tuberculosis and AIDS were slower to recover, but all eventually recovered after a few months."
For John as well, the change was impressive. "I gained weight very quickly and in just a few weeks, I was feeling good again. After two months I could stop the feeding programme. My skin also changed suddenly and became very smooth, I couldn't believe it. Since then, I feel strong and healthy," he concludes, tensing his biceps.
Supplements provided as prevention
In parallel to therapeutic feeding for malnourished prisoners, the ICRC started to provide beans and oil to all prisoners, as a complement to the sadza and vegetables supplied by the ZPS.
"As soon as the prisoners received three meals per day, and thanks to the proteins and vitamins they got from the beans and oil, the main health problems started to sharply decrease", says CPO Madzivire." Pellagra has virtually disappeared, as we've had only two cases in the last year. And the incidence of tuberculosis has gone down."
Today, the ICRC continues to distribute beans and oil to the 17 largest prisons of the country. This assistance benefits nearly 65 per cent of the total population of Zimbabwe prisons – an average of close to 8,500 prisoners. For its part, the ZPS has been able to regularly supply these prisons with sadza, salt and vegetables, ensuring that all prisoners receive three meals per day. The ZPS supplies full rations in prisons not assisted by the ICRC.
ICRC delegates and health staff continue to visit 26 prisons on a monthly or bi-monthly basis, with the occasional support of a nutritionist. "Our teams monitor the general treatment of the prisoners and their conditions of detention," says Filipa Neto Marques, the ICRC coordinator of detention programmes in Zimbabwe. "They assist the prison authorities in the monitoring prisoners' nutritional status as well as the functioning of the food supply chain."
Tailored assistance in 26 prisons visited
Based on their observations, the ICRC is able to adapt its assistance. In this way, the ICRC started to distribute groundnuts in June, as an addition to the daily diet the prisoners. The niacin contained in groundnuts provides increased protection against pellagra. More importantly, this monitoring allows the ICRC to provide appropriate support and advice to the ZPS authorities and to the health staff of the prisons.
Today, malnutrition primarily affects new prisoners. "Of all the assistance we received from the ICRC," says CPO Madzivire, "maybe the most important for us today is the support we received in establishing appropriate screening procedures and training to ensure that we follow them."
"Thanks to well established procedures, ZPS health staff is now able to immediately identify prisoners who need therapeutic feeding, in almost every prison in the country," Filipa Neto Marques explains. Following an agreement with the Ministry of Health, supplementary food (plumpy nut) is readily available in the prisons' stocks to start appropriate treatment. "This way, we are able to immediately react when we identify malnourished prisoners, before it becomes problematic," concludes CPO Madzivire.
* Name changed to protect the identity of the prisoner