THE RIGHT TO HEALTH IN PRISON: RESULTS OF A NATIONWIDE SURVEY AND REPORT 4.10 The Commission observed at the time of the survey that doctors and medical staff employed by the Prisons Department were in a situation of dual loyalty, whereby their primary obligation was towards the Prisons Department (employers) rather than their patients (prisoners), as the doctors were required to report to and receive their instructions from the Prison authorities. 4.11 Furthermore, prison health care professionals who were at the time of the survey working under the hierarchies of the prison authorities received little training in medical ethics regarding health care in prison, resulting in the prison doctors and medical staff being unable to identify potential role conflicts. 4.12 In addition to being required to adhere to the principles outlined in relevant World Medical Association, World Health Organization, United Nations, and other guidelines, health professionals who are responsible for providing health care services in prison shall act in the best interests of his or her patient at all times. 4.13 The Commission therefore recommends that the Prisons Department identify and arrange for programmes aimed at raising awareness on the principles of medical ethics as well as human rights among health care professionals in prisons and non-medical prison staff and administrators. Communication and Language Barrier 4.14 Prison authorities should implement a system that allows prisoners to communicate their health care needs in a timely and confidential manner to qualified medical professionals, who should then evaluate the situation and assess its urgency. Provision should be made for prisoners who face literacy, language, or other communication barriers to be able to communicate their health needs effectively. However, the Commission observed that the prison panel doctor at the time of the survey (Kajang Prison) was not able communicate in basic Bahasa Malaysia or English. 4.15 The Commission also observed that because of different cultural understandings of the nature and causes of illness, some prisoners were not able to understand the diagnosis and treatment options provided by the doctor. While doctors in such circumstances should make every reasonable effort to probe their patients’ understanding of their health concern and 65