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t m c » p u l s e | a p r i l 2 0 1 7 20 Health Care Behind Bars Story by Alexandra Becker | Photography by Cody Duty A group of men gathered around a table in the geriatric wing of the Estelle Unit in Huntsville, Texas, for a game of domi- noes. Behind them, a small television flickered with the day's soaps, and beyond that, a white- washed room separated by waist-high partitions exposed rows of state-issued cots strewn with magazines, Bibles, empty cups and headphones. Here on the inside, this is high-dollar real estate. It's air-conditioned and quiet, almost peaceful, absent of the endless buzz that bounces through the main hall where the general population of this maximum-security prison resides. On clear days, natural light beams through the small win- dows here and, if you're lucky, you might catch a glimpse of the feral kittens playing outside along the towering fences. The inmates in the geriatric unit suffer from multiple medical diagnoses, which is how they gained access to this haven in the first place— a silver lining to their chronic obstructive pul- monary disease, high blood pressure or kidney failure. One man with advanced kidney disease had been paroled a few years prior after serving two decades. He was doing well on the outside, abstaining from alcohol and working for a group home in Fort Worth, cooking and cleaning and sometimes assisting with baths and overnight diapers. But he ended up back in the system because he couldn't get the dialysis he needed in the free world. At least in prison, he said, he had health care. A DIY approach The country's state prison population has grown by more than 700 percent since the 1970s, according to a report by the Vera Institute of Justice. In 1994, the Texas Correctional Managed Care program was created in response to grow- ing concerns about overcrowding and access to health services in the state's prisons. With a mission to improve care while maintaining costs, the partnership between The University of Texas Medical Branch (UTMB), the Texas Department of Criminal Justice (TDCJ) and Texas Tech University Health Sciences Center has signifi- cantly changed how health care is delivered in Texas prisons. (continued) A nurse treats a patient in the Regional Medical Facility at the Estelle Unit in Huntsville, Texas.