WORLD EDUCATION CONNECT MULTIDISCIPLINARY E-PUBLICATION
Vol. V Issue IX (September 2025)
International Circulation
This is an open-access, peer-reviewed, and refereed international publication in online & printed versions that features research papers, abstracts, theses, dissertations, and journals. It is registered to the ISSN National Center of the Philippines, and ISSN International Center, the Global Index for Continuing Resources with ISSN (Online) 2799-0842 and ISSN (Print) 2799-130X.
World Education Connect Multidisciplinary e-Publication, Vol. V, Issue IX (September 2025), pp.224-225
RUBIE ROSE C CABALLES
MAN (Nursing), UPHSD Student, Metro Manila
Abstract
Correctional facilities concentrate health risks, amplifying the burden of noncommunicable diseases and tuberculosis (TB). This report synthesizes qualitative evidence on how persons deprived of liberty (PDLs) with hypertension, diabetes, and TB access and experience care at the Sablayan Prison and Penal Farm (SPPF), Philippines. Methods: Using a descriptive phenomenological approach, nine PDLs—three each with hypertension, diabetes, and TB—were purposively sampled for in‑depth interviews. Data were analyzed thematically. Results: Five themes emerged: (1) Health service provision and accessibility—PDLs appreciated free medicines and approachable staff, but diagnostic practices were uneven, with TB pathways more standardized than those for hypertension and diabetes; (2) Nutrition and food policy gaps—standard prison meals were misaligned with therapeutic diets; (3) Continuity of medical supplies—intermittent stock‑outs, especially of insulin, generated health risks and anxiety; (4) Staffing, monitoring, and support systems—health workers were kind but stretched, and monitoring tended to be reactive; (5) Psychosocial and long‑term care blind spots—prayer and endurance substituted for formal counseling and structured psychosocial support. Conclusion: SPPF health care is present and often compassionate, yet reactive and fragmented. Standardized diagnostics, diet reform, reliable drug supply chains, strengthened staffing and prevention programs, and integrated psychosocial care are actionable levers for improvement.
Keywords: persons deprived of liberty, hypertension, diabetes, tuberculosis, correctional health
Introduction
Noncommunicable diseases such as hypertension and diabetes are rising worldwide while tuberculosis persists, and prisons magnify these risks through crowding, poor ventilation, and rationed resources. Philippine penitentiaries are hotspots for transmission and chronic complications, highlighting the need for “equivalence of care” for persons deprived of liberty (PDLs). At the remote Sablayan Prison and Penal Farm (SPPF), hospital records showed caseloads of diabetes, hypertension, and TB, yet little was known about how these conditions were managed once patients returned to camps. This paper addresses that gap by capturing PDLs’ lived experiences of chronic illness management at SPPF and examining how institutional policies, food systems, medicine logistics, and psychosocial contexts shape outcomes. Beyond cataloguing constraints, the study foregrounds PDLs’ coping strategies, expressed needs, and practical recommendations. The report synthesizes findings for administrators, clinicians, and policymakers, retaining participants’ voices while situating results within current literature on prison health, NCD management, and TB control.
Methodology
This study examined how persons deprived of liberty (PDLs) at the Sablayan Prison and Penal Farm (SPPF) manage chronic illness day to day, using a descriptive phenomenological design. The approach prioritized thick description of lived experience and reflexive bracketing of researcher assumptions from recruitment to reporting. Purposive sampling identified nine adult men—three with hypertension, three with diabetes, and three with tuberculosis, including one with concurrent diabetes and TB—aged 33–66 with varied schooling and prior occupations. Participant characteristics supported diversity of illness trajectories and living conditions across the SPPF camps.
Data were generated through in-depth, semi-structured interviews conducted in a private room within the SPPF hospital. Conversations, held in Filipino or English, lasted 30–40 minutes, were audio-recorded with consent, transcribed verbatim, and translated when necessary. The guide explored diagnosis and treatment pathways, access to medicines, food routines, self-management strategies, and perceived system gaps. Field notes captured contextual and nonverbal cues. Ethical clearances, institutional permissions, and written informed consent were strictly observed.
Analysis followed Braun and Clarke’s six-phase thematic process. Two researchers coded independently, reconciled differences, and refined themes through iterative review. Credibility and trustworthiness were reinforced via member checking, peer debriefing, an audit trail, and reflexive journaling. Findings were reported with illustrative quotations to preserve participant voice and contextual detail.
Results
Five interlocking themes emerged—uneven yet compassionate care, dietary misalignment, medicine supply gaps, strained monitoring, and missed psychosocial needs—framed by brief participant profiles. Compared with the relatively standardized tuberculosis pathway, hypertension and diabetes care appeared reactive and inconsistent. Comorbidities, lengthy detention, and scarce resources shaped daily management inside SPPF.
Participant profile
All nine participants were men aged 33–66 detained for two to thirty-one years. Schooling was mostly secondary level or below; prior work included taxi driving, farming, factory work, tinsmithing, welding, and copra labor. Multimorbidity was common—e.g., hypertension with diabetes, and diabetes with TB—creating layered demands on medication, monitoring, and diet.
Theme 1: Health service provision and accessibility
Participants appreciated free medicines, approachable staff, and routine checks. Nonetheless, diagnostic practices varied. Several with hypertension were placed on maintenance drugs after serial blood-pressure readings without laboratory confirmation, whereas TB care generally followed structured diagnostics and monthly reviews. Diabetes management more often included blood chemistries or fasting tests. Overall, TB care felt standardized; NCD care felt symptomatic and uneven.
Theme 2: Nutrition and food policy gaps
Diet was a daily stressor. Standard rancho meals were described as salty or oily for those with hypertension and carbohydrate-heavy for those with diabetes. When options were limited, some resorted to quick starches or coffee with rice. Many tried to follow advice—smaller rice portions, less salt—but the institutional menu rarely aligned, making adherence difficult and glycemic or blood-pressure control fragile.
Theme 3: Continuity and consistency of medical supplies
Irregular availability of medicines, especially insulin, recurred across accounts. Participants described stock-outs and delays that forced them to wait, endure symptoms, or improvise. Missed insulin doses were particularly distressing, heightening perceived risk of complications. TB drugs were generally accessible but occasional delays undermined confidence in uninterrupted therapy and raised worries about relapse.
Theme 4: Staffing, monitoring, and support systems
Clinicians and nurses were consistently portrayed as kind and helpful. Reminders to take medicines and routine vital-sign checks were lifelines. Yet capacity felt stretched: monitoring often reacted to crises rather than preventing them. Participants asked for more staff, steadier schedules for check-ups, and education sessions to build self-management skills. Peer reminders and health aides partially bridged gaps.
Theme 5: Psychosocial and long-term care blind spots
Beneath the logistics lay quiet anxieties about deterioration and dying in custody. Prayer, acceptance, and endurance were common coping strategies, but participants reported no structured counseling, peer-support groups, or mental-health services tailored to chronic illness. The result was a largely private labor of coping that paralleled formal health care without being integrated into it.
Overall synthesis
Care at SPPF was present and humane but fragmented where it mattered most—diagnostics, diet, supply chains, and prevention. Participants’ experiences point to pragmatic levers: standardize NCD diagnostic cascades, align meals with therapeutic goals, ensure medicine continuity through buffer stocks and early-warning inventory systems, strengthen proactive monitoring, and embed psychosocial support. Together, these adjustments would reduce avoidable complications, steady day-to-day self-care, and restore confidence that chronic illness can be safely managed behind bars with dignity and fairness for PDLs.
Discussion
It has long been known that jails are a breeding ground for health problems, and this qualitative investigation confirms that fact. Participants' accounts at Sablayan Prison and Penal Farm (SPPF) demonstrate how rules, routines, and resource transfers structure risk. Decades of investment in screening, monthly evaluations, and structured therapy make tuberculosis (TB) care predictable and auditable. Treatment for hypertension and diabetes is often began after symptomatic rises, laboratory testing is unreliable, and diet—the daily “dose” that makes or breaks control—often misaligned with physician counsel. TB has a route, NCDs have good intentions.Three practice and policy implications follow.
1) Standardize diagnostic cascades for NCDs. What works for TB can be adapted for chronic disease. Hypertension and diabetes management should include routine, scheduled tests—periodic creatinine/eGFR, fasting or post-prandial glucose or HbA1c, and lipid profile—embedded in a simple cascade that flags when a patient is overdue. Paper or digital registries, planned visits, and concise feedback loops can anchor continuity even in resource-constrained settings. Shifting testing from crisis-triggered to calendar-driven reduces silent progression and late complications, while giving clinicians a shared script for care.
2) Treat food as health care. Participants’ accounts make it plain: medication adherence is undermined when meals contradict prescriptions. For people with hypertension, sodium-dense menus blunt the effect of antihypertensives. For people with diabetes, high-glycemic plates destabilize glucose and amplify risk. Small, feasible reforms can have outsized impact: default lower-sodium cooking; measured rice portions with added vegetables and protein; scheduled fruit in place of sugared drinks; and, where possible, “therapeutic” trays for those with documented NCDs. Food service is not an add-on; it is a frontline intervention that either reinforces or erodes clinical work.
3) Guarantee medicine continuity and embed psychosocial care. Gaps in insulin or key antihypertensives translate directly into preventable harm and anxiety. A buffer-stock policy, early-warning inventory tallies, and clear escalation protocols can stabilize supply without large budgets. Alongside logistics, structured counseling and peer support should be integrated. Participants described coping through prayer, acceptance, and endurance—powerful resources—but not a substitute for guided strategies that improve self-management, reduce fear, and maintain adherence during long sentences. TB programs routinely build adherence support into treatment; NCD programs need comparable attention.
Positioning within the literature. The tension observed here—gratitude for compassionate staff coupled with frustration at structural barriers—echoes reports from other prison systems. Interpersonal care is often rated positively, while system features (timeliness, choice, specialized services, and, notably, food) lag. Community-based studies in the Philippines and elsewhere show that enabling environments—education paired with practical supports—improve blood pressure and glycemic control. Translating these principles to carceral settings means coupling brief education with environment shifts: menu changes, reliable drugs, scheduled labs, and easy-to-read patient cards. The long global focus on TB created standardized, auditable pathways; the task now is to give NCDs similar metrics, dashboards, and accountability.
Strengths and limitations. A key strength is the fine-grained, participant-centered view across three priority conditions within a large penal farm. Using descriptive phenomenology and systematic thematic analysis supported a credible synthesis that resonates with on-the-ground realities. Limitations include the single-site, male-only sample and reliance on self-report. Adding the perspectives of clinicians and administrators, together with objective indicators (serial HbA1c, lipid panels, blood-pressure logs), would enrich understanding and allow triangulation. Future work could also examine cost and feasibility: What does it take—financially and operationally—to implement therapeutic diets, maintain buffer stocks, and run calendar-based lab schedules?
SPPF care is present and often humane, but it remains fragmented where it matters most: diagnostics, diet, medicine continuity, proactive monitoring, and psychosocial support. Practical, low-cost adjustments—standard cascades, food reform, buffer stocks, structured counseling, and peer programs—can move care from reactive to reliable, narrowing the gap between principle and practice and affirming dignity for people living with chronic illness in custody.
Conclusion
Health care at SPPF is present and caring—PDLs receive medicines, TB patients complete treatment, and staff are widely perceived as kind and approachable. Yet the system is also reactive and fragmented, particularly for hypertension and diabetes: diagnostics are inconsistent, meals are misaligned with clinical advice, medicine continuity is fragile, staffing is stretched, and psychosocial needs remain largely unmet. Aligning practice with principle—equivalence of care—requires practical moves now: standardized NCD diagnostic cascades; therapeutic diet options; buffer stocks and real‑time inventory tracking (especially for insulin); expanded staffing and prevention programming; and structured counseling and peer support. These are achievable steps that would measurably improve control of chronic illness, reduce avoidable complications, and reaffirm dignity for people living with disease in custody.
References
Rogalska, A., Barański, K., Rachwaniec‑Szczecińska, Ż., Holecki, T., & Bąk‑Sosnowska, M. (2022). Assessment of satisfaction with health services among prisoners—Descriptive study. Healthcare, 10(3), 548. https://doi.org/10.3390/healthcare10030548
Villarino, R. T., Arcay, C. A., Temblor, M. C., Villarino, M. L., Bagsit, R., Ocampo, L., & Bernard, P. (2021). The effects of lifestyle intervention using the modified BASNEF model in hypertension management: Quasi‑experimental study. JMIR Cardio, 5(2), e20297. https://doi.org/10.2196/20297
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DOI 10.5281/zenodo.17204517
