At the Shanghai Prison Center Hospital, 300 medical staff treat sick prisoners. Photo: Cai Xianmin/GT

The patients in this Shanghai hospital suffer from heart disease, respiratory complaints, broken limbs, cancer - all of the illnesses that ordinary people suffer. But these patients are killers, thieves, drug dealers, thugs, rapists and suspects. They need treatment however and for the 300 doctors and nurses in the Shanghai Prison Center Hospital, they are the patients they treat every day. The hospital in Pudong New Area is the only designated prison hospital in Shanghai and receives patients from prisons and detention centers all over the city.

The hospital is a large five-story white brick complex and a three-story infection ward building on Fanrong Road in Pudong New Area and it has 450 beds for prisoners, male and female, operating theaters and all of the equipment and sections of a modern hospital including an isolation ward.

But just because someone shows up at the hospital claiming they are ill does not always mean that, at this hospital especially, they really are ill. From day one here the doctors learn how to distinguish real symptoms from fake symptoms.

Dr Jiang Haitao has been working at the hospital for more than 12 years and knows that his job involves not just the skills of a doctor but often the art and expertise of a detective.

One patient arrived complaining that he had difficulty swallowing. He was given a barium meal drink and his X-ray indeed showed a shadow leading the doctors to suspect the man was suffering from a tumor in his throat.

But further tests showed that the man had tied a cotton ball to a fine thread and swallowed it secretly when the X-ray was being taken.

The 38-year-old doctor was impressed. "Faking an illness like this needed a lot of imagination."

Faking illness

Prisoners fake illness for different reasons - some to avoid work details and some aiming for a medical parole. Another patient was tested after doctors found blood in his urine. But he had no symptoms that would have resulted in this and further checks revealed that the man had worked out a way of biting his lip and dripping blood into his urine sample without the staff seeing this.

The doctors are well-acquainted with more common tricks - like the prisoners who bite their tongues and claim they are coughing up blood from their lungs. Or the prisoners who swallow knives, needle, rings, jewelry or zips from clothing to produce symptoms or just to try for time in the hospital.

More so than ordinary hospitals here the staff rigorously check every piece of equipment used. One missing thermometer means all the cells will be searched from top to bottom.

Zhu Rong is the head surgical nurse and she explained that many of the prisoners actually believed they were ill and deserved lighter sentences or freedom. "Some will swallow anything at hand to create symptoms. The doctors and nurses here have to keep their wits about them all the time - this is very different from any other type of hospital."

Unexpected twist

A government job in China has always been sought after and that was where Jiang Haitao was heading after he graduated from medical school and passed the civil service exams. But his career took an unexpected twist 12 years ago and he found himself walking through the heavy gates of the prison hospital.

He had no idea of what the new post would involve. "I thought it was just a hospital for prisoners and I presumed that it would be easier to treat prisoners than civilians because they were imprisoned and wouldn't complain. But I was wrong," Jiang said.

 "People assume there are no disagreements between the doctors and the prisoners, but that's not correct. Today prisoners know their rights and are well-informed - even better-informed than ordinary people. We have to be accurate and record everything every time we make a diagnosis or prescribe medicines."

One prisoner who arrived at the hospital for treatment of an arm injury complained to the doctors there that he had been assaulted by warders and this had caused a serious problem with his eyesight.

When he had been admitted to prison earlier, he had not undergone the detailed medical examination on his eyesight and there was no easy way to check if he had a pre-existing condition but the doctors did not completely believe his story. One of the prison doctors then began checking hospitals throughout the city and eventually discovered that the man had had an eye condition from some time before. His story was a lie.

"After the 'hide-and-seek' incident in Yunnan Province in 2009 when a prisoner's death exposed the flaws in the surveillance and management, prison rules have further tightened. Now when they accuse us of something, we have to have concrete evidence to prove them wrong," Jiang said.

Zhu Rong has been working at the prison hospital since 1991 when she graduated from university. Work in the prison hospital was a far cry from nursing at an ordinary hospital where she carried out her internship. Here some of her patients are chained to their beds.

 "When I was young and looking for a job I was excited by the prospect of wearing a police uniform. I had no idea of the risks involved in a prison hospital. The initial thrill at getting the job was soon overshadowed by the dangers I faced at work."

Nothing is more important than communication between doctors, nurses and patients. In a prison hospital, communication is much more difficult. Doctors and nurses have to talk with and examine the patients but they constantly are aware that they must keep their distance.

Safe communications

"Most of the prisoners here are men and we nurses are women. Some will have committed violent crimes. The first thing we learn is how to communicate with them safely," Zhu Rong said.

"It is impossible to examine a patient without touching them at some stage," Zhu said. "But you have to be careful. You cannot get too close to prisoners but you cannot not touch them."

Liu Yan is a nurse at the hospital. The 34-year-old had worked as a nurse in a PLA (People's Liberation Army) hospital for 12 years before transferring to the prison hospital in 2007. "All the patients in my ward are men. When I walked through the hospital for the first time, I felt all of those eyes staring at me from behind the bars, glaring with hostility. It freaked me out.

 "At first, I didn't dare look at or talk to any of the patients. I just did my work. I am more relaxed now and I talk to some of the patients but I am careful - they are criminals, not ordinary sick people. You can sit on their beds and talk to them but there are boundaries," she said.

Every inch of the prison hospital is under round-the-clock surveillance recording every movement and conversation of staff and inmates. The cameras are there not just to check on the prisoners but to ensure that the doctors and nurses were performing their duties appropriately, Zhu Rong said.

"The media has reported many cases of law enforcement officers behaving improperly or negligently. So the cameras and recorders are not only to supervise but also to provide evidence if needed. If a prisoner is dying and his relatives cannot make it here in time, the surveillance film can show that we tried our best. It is easier for relatives to accept the situation instead of having suspicions about a death," Jiang said.

When doctors at general hospitals come across a difficult case or a rare disease and are uncertain about treatment, they can send the patient to see a specialist in a leading hospital. It's not so easy when the patient is a prisoner. And for different reasons, public hospitals are not willing to admit these patients.

"When you treat the patients here, you have to do your own research or consult specialists from elsewhere. We have to be prepared for difficulties and we try to give the best treatment possible under the circumstances," Jiang said.

Xie Xufeng is a surgeon at the prison hospital. The 39-year-old has been working there since 2004. "Patients infected with HIV/AIDS are not given surgery at ordinary hospitals. But surgery on HIV/AIDS patients is routine work here."

It is a principle here that prisoners should not die accidentally in the hospital. Sometimes there are bizarre outcomes as this principle is enforced. One man who was seriously ill and dying had been sentenced to death. When it was discovered he might die in the hospital, the death penalty appeal procedure was hastened so that the man was executed rather than being allowed to die in the hospital.

"Death is unavoidable in a hospital. But in a prison hospital, death is always prohibited," said Xie.

Devoted to the work

In today's society, sexually transmitted diseases, hepatitis, tuberculosis and HIV/AIDS, are increasing. The risks of exposure to these diseases are also increasing for doctors and nurses, especially in the prison hospital, but the staff do not take their concerns home and rarely confide in their families. 

"With ongoing education and good management, the doctors and nurses here devote themselves to their work, although they probably do not get the same respect and financial rewards as their counterparts at ordinary hospitals," noted Shen Xiaodong, the deputy director of the hospital.

"After many years of working at the prison hospital, I know now the prisoners are just human beings with feelings. Sometimes they are depressed at being both imprisoned and sick. They are deprived of their freedom but they should not be deprived of their health. They have the right to be treated," Jiang said.

He has been conflicted about his work here. Once he treated a criminal who had specialized in stealing gold and jewelry from old and weak women. "I was disgusted by this man. He had a serious kidney disease. But he was a human being. He had harmed other people but we could not harm him in return. So I gave him the best treatment possible."