XXX has the XXX largest prison population worldwide. Although national legislation guarantees full access to health care through the XXX Unified Health System (XXX), equivalent to that offered to the general population, prison health care presents specific challenges, particularly regarding the use of soft technologies to support humanized care. In this context, an undergraduate research project provided a medical student with experiential exposure to primary health care delivery within a penitentiary setting.This experience report reflects on a 2024 visit to a prison unit in XXX, XXX, conducted during an undergraduate research project.In the visited penitentiary, the primary health care team, composed of a physician and nurses, is responsible for health promotion and disease prevention actions for the incarcerated population. Constant humidity and overcrowding in the cells influence frequent complaints reported by the team, mainly dermatological, respiratory, and other infectious diseases. The role of the local health agent stands out: an incarcerated individual with good behavior, responsible for forwarding inmates’ complaints to the primary health care unit through written notes (“bilhetes”). Conflicts between incarcerated individuals and the agent may hinder the forwarding of complaints.The development of social technologies by the health team was evident in the waiting area, where inmates, required to sit facing the wall, observed their own illustrations displayed on a mural in front of the chairs. At the end of the visit, the prison newspaper was distributed - a monthly publication developed by incarcerated individuals and health staff - containing drawings, word searches, and handwritten texts. One highlighted headline read: “Using crack with steel wool: what are the health consequences?”, emphasizing the importance of individualized health promotion for effective outcomes. These practices demonstrate the potential of contextualized health education strategies within prison environments.The visit provided essential insight into health care within the context of deprivation of liberty, contributing to the student’s academic training and reinforcing the importance of primary health care and individualized health promotion strategies in prison settings.

Incarceration and its underlying conditions expose individuals to discontinuity of care and unmet health needs. These experiences are strongly associated with mental health problems, sleep disorders, and health-risk behaviours. Despite these intersecting vulnerabilities, the incarcerated population remains underrepresented in the health literature.To describe the biopsychological health characteristics of incarcerated adults in Tunisia and to identify health inequities in order to support the role of general practitioners in delivering primary care to this underserved population.We have conducted two cross-sectional studies among adult male (April 2023) and female prisoners (July 2024). Participants in this research voluntarily completed an anonymous questionnaire covering different factors using Arabic validated versions of the Rosenberg self-esteem scale, the Pittsburgh Sleep Quality Index, and the Hospital Anxiety and Depression Scale.A total of 568 prisoners answered our questionnaire. Among them, 403 were males, and 165 were females. In our sample, 53.5% of the research subjects were aged 30 and higher. The reported chronic conditions were diabetes (11.6%), hypertension (17.6%), coronary artery disease (7.0%), pulmonary disease (17.3%), liver disease (3.7%), kidney failure (9.0%), cancer (1.4%), immunodepression (15.7%), and HIV infection (2.3%). Additionally, 70.8% of the included inmates were smokers, 51.9% were alcohol consumers, 47.2% used other drugs, and 51.4% had sexual risk behaviors. Our results highlight that 37.9% of the sample had suicidal ideation, 44.7% were self-harming, 20.1% had low self-esteem and 84.5% suffer from sleep disturbance.Prison health is an integral component of primary healthcare systems. Our study highlights the high prevalence of chronic disease, mental health symptoms, sleep disturbances, and health-risk behaviors. These findings suggest that prison health services remain insufficient. Primary care physicians need to strengthen their person-centred approach to care by implementing systematic screening, early intervention, and continuity of care after discharge.Incarcerated adults in Tunisia experience overlapping biopsychological health vulnerabilities. Expanding routine screening for chronic and mental health conditions, ensuring continuity of care, and reinforcing mental health and psychosocial support are essential to leveraging primary healthcare. Keywords: Prisoners, Primary Health Care, Mental Health, Chronic Disease

Since  35  years  every  2d  year  , I do a 6 weeks’ mission abroad in  areas  where no  doctors work.Method:   The NGO  sends the  doctors and  local nurses  work  with us  in  remote  areas.  2 nurses,  1 driver and the doctor are on   “rolling  clinics”  and every  day  you  join another  village. Working  some  8  hours and  10  days continuously before 2 days break. Strengths: All  conversation is in  English ( local  languages translated ) and  40 well  chosen  drugs are available;  40  to  70  patients consulted per day;  food  is supplied for  malnourished children ; only  basic  equipment exists , but  a  mini-ultrasound helps for  better  accuracy. Limitations: no operations can be  paid; for  tuberculosis  diagnostic,  we  “try” to  convince the  patients to go for  further tests ; the  psychological  support can be  offered, but  living  conditions can`t be improved; clinical exam  in public areas is  challenging  and drugs “given free ”  for  one  family member is  often used  for all the children …..Equity  for  treatment does NOT exist  for  these  patients  and we  must  accept  such setbacks  every  day and  our housing with  the  team is  basic, so  less  is  sometimes  more!Being  in  contact with  indigenous  people , like  the  Mangyans ,  gives  you  a  unique chance  to immerse  in a  culture where oral  transmission  is  still  very  lively and  where strong family  bonds   exist .These  short “medical immersions” in different  cultures  allow  GPs  to slow  down  with  paperwork and  get so  much back from  these fraternal interactions. The   people in poor  living conditions give us  an example  of  daily  struggle with dignity  and in every  consultation, they show  us  their  ecological  working and share great feelings  with  us .   mission    immersion  dignity

Salaried practice in a suburban setting in a city of about 1 million inhabitants in XXX.This is a practice-based reflection in the form of a narrative review. The author reflects on how his identity as a GP has evolved since graduating in 1980 in XXX and completing GP training in 1987, ultimately becoming a Foundation Fellow of the XXX Chapter of Addiction Medicine, Royal XXX College of Physicians, and Life Member of the Royal XXX College of General Practitioners. The speaker was inspired as a medical undergraduate by the Existential Psychotherapy approach of Viktor E. Frankl. He chose to complete GP training rather than psychiatry. He now works as a government employee in a multidisciplinary outpatient service.Eventually I graduated and wanted to apply the existential counselling I had learned. I was offered a position in psychiatry training but opted to stay with General Practice. I found opportunities to use that knowledge to assist patients with adjustment disorders, grief, obsessive-compulsive disorder, palliative care, and problematic substance use and dependence. This approach has been applied to people who have experienced homelessness or who have been in prison, and to refugees and First Nations patients. My GP background left me comfortable managing individuals with multiple health issues, such as Hepatitis C from injecting drug use, opioid dependence and emotional instability, while also trying to assist with housing and legal issues. My salaried position allows me flexibility to make long appointments and to follow up people who do not attend.Although my initial post-graduate training was as a GP, I found work in two different university teaching hospitals in the state capital and was eventually given an academic title by the Discipline of Psychiatry at the local university, and institutes in XXX and XXX.Humanist-Existential approaches fit well in General Practice and can be applied to a range of conditions, including substance use and homelessness.

Individuals in correctional rehabilitation centers face barriers to healthcare access, discontinuous care, and substance-use–related challenges. Since 2012, Cardinal Tien Hospital has provided multiple National Health Insurance–covered on-site clinics, with family medicine delivering most services. Detainees may request evaluation as needed, and family physicians also conduct health assessments for new admissions. This practice-based reflection summarizes the main characteristics, challenges, and clinical insights from our hospital’s experience.Data were drawn from the hospital’s most recent correctional healthcare plan and the clinical experience of participating family physicians. Sources included on-site observations, service records, and referral procedures. These materials were synthesized into a reflective analysis to identify key themes and insights.On-site clinics improved healthcare accessibility and enabled earlier detection of acute conditions, while also reducing the need for escorted outside medical visits. A consistent physician enhanced trust and continuity of care; however, this is feasible only on selected clinic days, with many sessions still relying on a rotating schedule. Ongoing challenges include limited privacy, variable health literacy, insufficient nursing manpower, and restrictions on prescribing medications not covered by National Health Insurance. Future efforts should strengthen transition-of-care pathways, expand structured health programs, and increase staffing resources and professional capacity.Providing healthcare in correctional settings requires balancing security with the pursuit of health equity. Although on-site clinics are challenging to maintain, they remain essential for safeguarding detainees’ right to equitable care. As a Catholic hospital, our participation reflects a commitment to compassion and fraternity, highlighting our responsibility to serve marginalized populations.With support from Taiwan’s National Health Insurance system and family medicine principles, primary care in correctional rehabilitation centers remains both feasible and essential. Ongoing cross-system collaboration and expansion of preventive services are key to promoting liberty, equality, and fraternity in the care of incarcerated populations.