Few people who are not part of the Cuban penitentiary system have been allowed to visit the inside of Combinado del Este, the men's prison located 20 km outside Havana.

Nor are the doors normally open to journalists or international observers at the National Hospital for Prisoners, inside the fenced compound. The hospital receives the infirm from several other prisons in Cuba.

"We treat all of the patients equally. All we know is the name and the details on the clinical record. Nothing more. Nothing about where they come from, their sentences, or the crime committed," said doctor Aurelio Gonz�lez, director of the hospital.

As for medications and other hospital supplies and equipment, he told IPS that the institution faces "the same limitations as in the rest of the country: no more, no less."

Gonz�lez received a group of more than 40 members of the foreign press on Thursday who were invited on a tour of the compound, along with delegates to the First Cuban Congress on Penitentiary Medicine.

The forum organised by the Ministry of Interior, which met Mar. 29-30 in parallel to meetings on nursing and natural and traditional medicine in Cuban prisons, was also open to the national and foreign press.

This unusual open-door attitude comes just weeks before the vote by the 53-member United Nations Commission on Human Rights on a resolution critical of the socialist-run island's record.

The resolution condemns the Cuban government's crackdown on dissidents in March and April 2003. After swift trials, 75 human rights activists and journalists were handed long prison sentences.

Responding to complaints from some of those inmates' families, Cuban Foreign Minister Felipe P�rez Roque said on Mar. 25, "It is false that they are victims of cruel, inhumane or degrading treatment."

But the families and human rights groups like Amnesty International insist that prisoners are mistreated and humiliated, and receive poor nutrition and little medical attention.

The last prison visit by the accredited foreign press in Cuba was 14 years ago. The objective of that tour was to observe the conditions in which several dissidents were being held.

This time, reporters were not allowed to speak with any of the dissident inmates, but did have access to other prisoners in a hospital ward, and to 20 more who were participating in a training course for nurses offered by the prison.

"It's a good profession. We are barely getting started and already I feel different," nursing student Joel Perez, 26, told IPS. He is serving a 15-year sentence for armed robbery.

When he completes the programme, he will receive a diploma like anyone graduating in the Cuban education system. He will be able to work as a nurse in the National Hospital for Prisoners and, once he is released, he will be qualified to apply for a nursing job in any hospital.

The Cuban government's initiative to "turn prisons into schools" entails several types of training courses for inmates. The stated aim is to ensure their reinsertion into society when they have served out their sentences.

In addition to nursing, there are courses in physical education and in technical areas. The inmates who work in the prisons receive wages.

"The problem is not getting in (to the prison). The problem is knowing how to be out," Nereida Pacios, one of the penitentiary medicine congress delegates, told IPS.

If it weren't for the bars that separate the rooms from the hallways, the guards, the silence and the overwhelming solitude of the long corridors, the prison could be any other hospital in Cuba.

The equipment in the prison's three operating rooms and in the anaesthesiology area are the latest models available.

"The volume of people arriving here has declined because now all of the units (prisons) have their own medical posts. We are seeing 15 to 20 patients per day," said doctor Carlos Alberto Espinosa.

Hernias are the most common reason for surgery in the prison, and pneumonia is the most frequent infection, according to the medical staff.

The Cuban prison system has 15 health programmes under way, including testing for tuberculosis and sexually transmitted diseases, and providing immunisations and nutritional counselling.

Infection with HIV, the precursor to AIDS, is not a serious problem amongst the prison population. Inmates who test positive for the virus are transferred to special facilities.

According to lieutenant colonel Juan Pe�a, who is also a physician, there are three health institutions in Cuba for prisoners who are HIV positive. "The capacity of the one in Havana is 200 people, but I don't know how many are there now," he said.

Some 40 km from Combinado del Este is the Western Prison for Women. There, the medical personnel are training inmates as nurse assistants.

In the prison's medical unit and in the maternity ward, also open to the foreign press for a visit of about two hours, two or three assistants could be seen working alongside every nurse or physician.

The number of pregnant women who gave birth in the prison grew from 18 in 2000 to 48 in 2003. The babies live with their mothers in the prison's maternity block until they reach their first birthday.

"Here, the children are born into good hands," said Yaima Leal, one of the 15 mothers living in the unit along with nine pregnant women.

All of the births take place at institutions of the national health system. No maternal or infant deaths have been reported. The average birth weight is 3.5 kilos. The mothers are encouraged to nurse their newborns for the first six months.

The data made available during the First Congress on Penitentiary Medicine indicate that there is one doctor for every 200 inmates and one nurse for every 100.

The government does not publish statistics on the Cuban penal population, but the opposition Cuban Commission for Human Rights and National Reconciliation (CCDHRN) estimates it to be in the "tens of thousands", which is relatively high for a country of 11.2 million people.

Although none of the experts consulted by IPS offered numbers, it is widely held that there has been a notable increase in the prison population since the Cuban Penal Code was modified in the late 1990s.

A study of prison systems by researchers Elsa Azaola and Marcelo Bergman estimates that the Latin American prison population grew 56.4 percent between 1992 and 1999. Only Venezuela was excluded from the investigation.

They found that Brazil had the worst prison overcrowding in Latin America. For Cuba, prisons are estimated to be 75 percent over capacity, which experts consider moderate compared to the prisons in other countries.

"The conditions are improving somewhat in the prisons. Treatment is more human. We are gathering data about the situation. There is an effort to improve treatment," Elizardo S�nchez, president of CCDHRN, told IPS.

At the same time, the rights activist -- who has spent time behind bars himself -- considered the visit organised for the foreign media "a propaganda manoeuvre" of the government with an eye to the vote on Cuba by the U.N. Commission on Human Rights in the next few weeks.

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