Entre muros: reflexões sobre o cuidado em saúde no cárcere

Abstract

Brazil has the third-largest prison population in the world, totaling 644,794 individuals, of which 10,477 are housed in penitentiary institutions in Rio Grande do Norte. These institutions are characterized by violence, poor health and hygiene conditions, and the presence of criminal factions. As prison health care in the country is part of the Unified Health System (SUS), ensuring care for people deprived of liberty is essential. Institutionalized through the National Policy for Comprehensive Health Care for People Deprived of Liberty in the Prison System (PNAISP), comprehensive access to health care for this population is carried out by Prison Primary Care Teams(eABP), which operate through interprofessional collaboration. This study aims to report the experience of a Family and Community Medicine resident as part of the health team in a prison in Rio Grande do Norte. It is a qualitative, descriptive study with ethnographic inspiration. Data were recorded in a field diary between March 2023 and December 2024. For analysis, the data were thematically organized into four categories: i) Health as a trophy, ii) Gender and control, iii) Pharmaceuticals and dynamics of power in prison, and iv) Interprofessional work in health care. The results reveal challenges such as structural limitations, overcrowding, lack of public policies, and failure to ensure comprehensive health care access. It was found that health functions as a bargaining tool within the institution. Gender issues, marked by social stigmas, permeate the dynamics of the prison environment. Additionally, psychotropic drugs are often used as instruments of control and survival, extending beyond their biological purpose. In this context, interprofessional work emerges as a fundamental strategy to ensure access to health care for this population. It is concluded that the work of multiprofessional teams, combined with the presence of Family and Community Medicine as a generalist specialty, contributes to fostering reflections on health care in the prison system. This approach seeks to promote ethical and humanized practices through integrated actions that address the complexities and specificities of this context.