Shortly after I entered state prison, at age 15, I received my first Pap smear, a cervical screening for cancer. Pennsylvania state law mandates that minors in adult facilities be directly supervised and escorted by a corrections officer at all times. The officer tasked with my supervision notified me that I had to go to see medical staff, but didn’t mention why or for what.
After an hour of waiting, I was brought into a room where medical providers saw patients. The first thing I noticed about the room was how dated it was. The exam table seemed new, and the tissue paper covering it was clean. But the rest of the room looked how I imagined hospitals would have looked 50 years past. Random pill bottles, blister packs and medical instruments lay scattered haphazardly across every available surface.
The medical provider, an older woman, put on latex gloves as she told me that I would be receiving a Pap smear. She did not explain what a Pap smear was or what the exam would consist of. I felt scared and confused.
The provider instructed me to lie back on the exam table and put my feet in the stirrups. I complied, bracing myself. As a victim of sexual assault, I immediately tensed at the thought of someone probing my body. I was not given the option to refuse, and to my knowledge parental consent was not required.
This was my first dehumanizing experience with prison medical care, a master class in how this place disregards and degrades our bodies, and how it impedes our ability to make informed decisions about our health.
Incarcerated people are commonly misdiagnosed and given improper or inadequate care. Individuals who are mentally ill are shuffled through the system with little regard for their unique health conditions. We don’t have access to verifiable information or to second opinions from other medical professionals. All of this makes us especially vulnerable to exploitation by doctors and other staff members.
Alone in pain
From open conversations I have here, I find that traumatic and dehumanizing experiences like mine are not uncommon. At the State Correctional Institution at Muncy, several women in my facility have discussed enduring symptoms that were ignored or dismissed by medical staff.
One woman told me she suffered long and painful periods for years before an ultrasound revealed that she had fibroid uterine tumors. The doctor recommended a hysterectomy since she was a “lifer” and therefore would not be having more children. She ultimately decided to proceed with this permanent and life-changing procedure. But she is still waiting to be scheduled and her pain is unmitigated.
Another woman I am incarcerated with said she started experiencing excruciating lower abdominal pain and constipation in 2017. All together, she submitted five sick calls — written requests to be seen by medical staff — and endured more than three years of pain before she was seen by a medical provider. The woman told me that when the prison gynecologist read through her file, he became outraged that it had taken her so long to be referred to him.
As an adult, it is painful for me to reflect on my early experiences of incarceration. Even though the state determined otherwise, I was still only a child. Learning how to navigate the bureaucracy of prison on my own was isolating, confusing and often frightening.
On the exam table all those years ago, awaiting the Pap smear, I felt utterly alone, trapped in a body that felt alien. I had been incarcerated less than a month after I turned 15. I was deprived of caring adults to help me understand both the changes my body was undergoing and the unfeeling system I would have to grow up in.
I remember staring up into the harsh fluorescent lights overhead. I felt the same way I had when my rape kit was being conducted: violated, judged and afraid. The Pap smear was extremely painful. I expected it to be uncomfortable, but nothing could have prepared me for that searing, excruciating pain. Choking back tears, my face flushed with shame as I pretended not to notice the ever-watchful gaze of the corrections officer standing near.
Months after the exam, medical staff had not shared the results with me so I had to make a request to see my own records. The request was granted, and I learned that my Pap smear results were normal — a relief. But I also learned that my uterus is tilted forward at my cervix; that is why the test had been so painful.
‘I had to keep my mouth shut’
Since my first Pap smear, I have received one almost every year. My most recent experience was also degrading and humiliating.
I was examined by a male doctor with a female nurse present. The exam took place in the same room where I received my first exam years ago. The room’s appearance didn’t seem to have changed much — I recognized the same disorderly presentation of prescriptions and medical devices. The doctor began the exam by asking me if I liked coffee, and offered me a sip of his. I declined. He read my psychological diagnoses aloud: “major depression, generalized anxiety disorder, PTSD and bulimia nervosa. They got your number, girl.” All I could do at that moment was laugh nervously, mumbling my agreement.
As the doctor was preparing for the exam, I advised him that I have a tilted uterus, which makes the exam more painful, but I could position myself in a specific way to assuage the pain. He dismissed my concerns, saying, “Don’t worry, girl, I know what I’m doing.” During the exam, he inappropriately described parts of my anatomy to the nurse.
After the exam, I stumbled out of the room in a daze. I knew what had just occurred had been wrong and unprofessional. But I also knew I had to keep my mouth shut. I had seen so many accusations against prison staff backfire. I decided I couldn’t afford retaliation, that the nurse would deny the doctor’s comments, and that it was not worth it to say anything to anyone who could help me.
In prison, my agency is constantly clouded by forces beyond my control. In every decision I make, I factor in the sentence that looms over me. I have to consider how my actions may be perceived by prison staff, the courts and the board of pardons to which I will eventually appeal.
Even though incarcerated people, especially girls and women, are ensnared in a system that treats us as dispensable, we are not. Our pain is considered irrelevant, but our bodies experience pain and change with the same unpredictability that free women contend with.
Locking up human beings for years without addressing their physical and mental health is counterproductive, as most incarcerated people will eventually return to society. Our communities will be safer when prisons offer meaningful care to those whom they confine.