Prison Health Is Public Health.

Project ECHO
Sep 12, 2017 · 12 min read

Which Is Why Project ECHO’s Peer Education Project Is So Important.

Behind the walls of Roswell Correctional Center, three inmates lead a training with some of their fellow inmates on how to avoid getting hepatitis C. They review the risks of needle-sharing and drug use. They talk about what happens to people who contract hepatitis C and they explain the treatment.

The two-hour-long session is interspersed with laughter and conversation. The leaders engage the other men in role-playing skits and Jeopardy-style trivia games about hep C, with time for questions and answers. Some of the men open up about their personal health challenges; the others listen and take notes.

Peer educators at the Roswell Correctional Center in Hagerman, NM

The inmates leading the class got their certification through the New Mexico Prison Peer Education Project (PEP). Launched in 2009 by Project ECHO and the New Mexico Corrections Department, PEP trains inmates to educate other prisoners on how to stay healthy by avoiding infectious diseases. They also provide information on key health issues, such as substance use and how to navigate the prison health system. To date, PEP has certified 485 peer educators, reaching more than 9,100 inmates through classes and mentorship.

“Prison health is community health,” says Karla Thornton, M.D., M.P.H., director of PEP at Project ECHO. “Ninety-five percent of people in the criminal justice system will be released back into their communities. If they unknowingly contract hepatitis C while in prison, that can spread quickly when they return home. That’s why educating inmates on disease transmission and prevention is important to everyone.”

How PEP Works

To become a peer educator, inmates must get the approval of the prison warden and complete a 40-hour training course with on-site PEP coordinators. They learn about common infectious diseases and other issues pertinent to life in prison, such as drug addiction and violence. In addition, they receive training in skills like public speaking, presentation development, and group facilitation that help them prepare for a career outside the prison after they are released back into the community.

“We are equipping inmates with real hands-on knowledge,” says Saul Hernandez, PEP’s health educator at Project ECHO. “We see inmates leaving the correctional facilities, ready for the workforce and the new challenges ahead. Their whole mindset is different.”

Continuing education is provided monthly via the Project ECHO videoconferencing model, which allows the peer educators at the nine New Mexico prisons participating in PEP to meet and interact virtually. They collaborate on their presentations, share stories, and solve problems together. They also get in-person guidance and refresher training from PEP staff at least once every two months.

The Value of PEP

For many inmates, PEP opens a door to a world of opportunity where they gain knowledge, respect, autonomy, and purpose. They become not only teachers but role models who give back to their community.

They leave prison with real accomplishments they can point to, new professional skills and a confidence in their future that many never could have imagined.

This, of course, can benefit the communities where former inmates go to resume their lives after prison. Because of their experience with PEP, they’ve learned how to take care of their own health and how to share what they’ve learned with others. Hopefully, that can contribute to reducing the spread of infectious diseases and the costs of treating them in the community.

Here, three former peer educators who are still involved with PEP share their experiences and talk about life after prison.

Carissa McGee

At 15, I had everything going for me. I was a star athlete with college scholarship offers from around the country. A year later, all that disappeared when I became one of New Mexico’s youngest female inmates.

I did something that no one will understand. I tried to kill my mother and sister, who I felt hated me and made my life intolerable.

Oddly enough, prison is where I learned how to make the most of my life. In prison, I learned empathy. I learned what it means to care about other people. Most importantly, I found my calling.

It still hurts to remember how I felt walking through those doors the first time. At 16, I faced 21 years in an adult institution. I was terrified. I had lost everything. Now I would have to grow up and figure myself out from inside a cell.

Carissa, bottom right, with members of her high school basketball team

During my third year, my caseworker asked me if I wanted to join a new “health group,” as she called it. At that point, I had a clean record and held a sought-after job working in the prison’s fire and safety department. I figured, why not try it?

That’s how I joined 14 other women to become one of the first health educators for the Prison Peer Education Project, or PEP for short. We walked into a classroom with people eager to meet us — both in person and virtually through video conference. They were people I’d never talked to before: doctors, professors, and public health experts. They treated us to donuts (a rare prison indulgence) and listened to us.

We learned a lot in the PEP sessions, not only about how to minimize the spread of diseases, but also professional skills like public speaking, presentation development, and group facilitation. During our classes, I felt like a different person because I felt valued. Plus I gained all this new knowledge.

Soon, everyone in prison recognized me as a peer educator. PEP fostered a new sense of trust and respect among the women and staff in prison.

Most importantly, PEP gave us hope.

As a peer educator, I was there for the other women. I helped them take control of their health and manage their medical conditions. Each day, I listened to their stories. Every story I heard broke me down a little. For the first time, I experienced empathy, sympathy and true sorrow — for the other women first, and then for myself.

After years of emotional isolation, I realized that I wasn’t alone. Every woman I talked to in prison was hurting just like I was hurting. I opened up to them. We talked about our lives before prison, and we built community around our health and our desire to better ourselves.

And, through PEP, I learned to use my new feelings and my voice to help these women who were becoming my friends.

After serving nine years, I finished my sentence early, and now I’m in my third year of probation. I’m studying for my associate’s degree and hope to one day become a community health worker as well as an advocate for young people like myself facing incarceration. I want to help create alternatives to putting young people in prison.

I’m still involved with PEP as a community faculty member, training new peer educators in prison through the teleECHO video clinics. I’m one of the few women educators still connected to PEP after prison. It depresses me at times to hear the inmates’ stories, because they remind me of where I used to be and how I used to feel. Sometimes I want to run away. But I would rather confront my past than ignore people who need my help. And the work keeps me grounded.

If Project ECHO and PEP hadn’t given me a chance, I don’t know where I’d be today. Instead, I’m part of a community, where I help people see how they can do better, both for themselves and for the world.

Daniel Rowan

I was 14 when I had my first run-in with the law. The cops caught me with a firearm, and they wanted to know where I got it. They put me in a room and interrogated me for five hours. They threatened me, screamed at me, cursed at me, and called me every name in the book, but I didn’t tell.

Instead, I walked away, angry and humiliated, convinced that life was about “me” versus “them.”

It took many years for me to lose that mindset, and to see myself, not as someone alone and apart, but as someone in a community.

By that time, I was in prison.

I’d been in prison about six months when I spotted a poster asking if I wanted to be a peer educator. I liked the idea. It sounded cool, and I needed an outlet.

That’s how I started working for the Prison Peer Education Project, or PEP. It put me on the road to becoming who I am today.

Being a peer educator gave purpose to my everyday life beyond serving my sentence. I couldn’t stay stuck reliving my past, because I had things to do: planning the next class, coordinating with my team, making sure I did my part. I had to think about the students in the class, what they needed to know, and how I could connect with them.

I learned a lot about myself, too. I learned how to use my voice, how to reach people where they are, and even how to mediate between people who don’t always trust or like each other. For me, this was very powerful.

And I learned that community exists everywhere — even in prison. Wherever there are people, there’s community. I realized that I could create the community that I wanted to be part of.

I started planning for life after prison before I got out. A partner and I launched a nonprofit called Best Chance, which provides peer support and re-entry services for men coming out of prison. A lot of these men have been inside a long time, and when they get out, they are kind of lost. Some of them have no friends or family on the outside. We help them find housing, food, transportation — whatever they need to get started. Sometimes it’s just someone to talk to.

I’m still involved with PEP, too. As a community faculty member, I train new peer educators in prison through the teleECHO video clinics. At some point, we’ll be cleared to go back into the prisons to do in-person trainings; currently, inmates from nine prisons in New Mexico connect with us through the teleECHOs.

I’ve been out of prison about a year and a half now, and I feel good about my life. I went through a dark period at first. I had a lot of anxiety, agonizing over whether I was doing the right thing with my life. I was tired of having to explain my prison story to people, and I wanted to put my past behind me.

And then, just before Christmas last year, a childhood friend of mine was released from prison in Florida and came to Santa Fe. He’d been back about a month when he went to one of his old drinking spots and was shot to death.

I never got to see him. And I couldn’t help thinking whether things could have turned out differently if I had.

That’s when I realized that the work I’m doing is important. My anxiety went away.

Being a peer educator for PEP has given me an opportunity to put my past to good — now and for the future. Most prison programs provide you with education, but they don’t offer you a way to put that education into action. And that’s what gives you purpose. If you can’t act — if you can’t have impact — it’s hard to find a path forward.

Working with ECHO has changed my view of myself and what I can do in the world. Now I am moving forward as part of a community that I am helping to create every day.

Barry Ore

Prison is not a place where people build their futures. Most struggle to keep from getting stuck in the past.

Yet I started making good on my dreams after I entered prison.

I was 24. I’d been addicted to heroin and contracted hepatitis C in the process. I’d been in and out of jail a few times for non-violent, drug-related offenses, and was arrested and convicted again.

Before my sentencing, I quit drugs and started to turn my life around. I got counseling and joined several sober-living and support groups.

I hoped that the judge would put me in a treatment program instead of sending me to prison, but my jail record worked against me.

Now, there I was, with hepatitis C, staring at an 8-year sentence. My future looked scary.

About six months in, I saw a poster for the Prison Peer Education Project, or PEP, as we all came to call it. The poster said that the University of New Mexico was looking for inmates willing to be trained to teach other inmates how to take better care of their health. I’d been making the best of things in prison­ — taking classes for my associate’s degree, working out, and trying to stay healthy — but I was always looking for opportunities. PEP seemed like a good one.

It proved to be so much more than that.

We learned a lot in the PEP training, including public speaking, presentation skills, group facilitation, and project management. I also learned more about my disease and treatment for it; that gave me hope of someday being cured. And I soaked up everything I could about the neuroscience and biology of addiction, which I found fascinating.

The men seemed to love the PEP health classes. We served fresh-brewed coffee, which is a big deal in prison, and the only time we ever got to do it. Most importantly, the men were engaged; not only did they ask a lot of questions about their health, but they also talked openly about themselves. We had created a safe place where people could share their stories and discuss things that mattered to them.

All this gave me a sense of purpose and meaning. In prison, you’re always afraid of losing time. But I wasn’t. Instead, I was gaining professional skills and confidence that would help me start a career — all while providing service. That gave me hope for having a life after prison.

I wound up serving about half my sentence. Once I got out, I had a lot going on. In addition to earning my associate’s degree in prison, I studied and got certified to be a personal trainer. I had a contract with Project ECHO to continue working for PEP, and I also went to work for my friend Daniel, another peer educator from prison, who was starting a nonprofit called Best Chance, which helps men released from prison get a good start.

Through Project ECHO, I got treatment for my hepatitis C. I’m cured. Completely. Even more amazing to me, my doctors and all my caregivers treated me with nothing but respect and compassion. I had never experienced that before. After my first visit, I felt so good that I almost cried.

I’m now studying for my bachelor’s degree in psychology at the University of New Mexico. My business, Roadrunner Fitness, is doing great. I’m still with Project ECHO and Best Chance, and it is all good.

I leave the house in the morning and don’t come back until 9 or 10. Normally I stay up studying until about midnight.

Yet nothing I do feels like work, because I love everything I’m doing. I take care of myself physically through my work. I provide service through my work. Doing what I love fills my life.

It all started in prison, with the PEP program and Project ECHO. They provided me with the foundation for everything I have now — the skills, the sense of purpose, the opportunities, and even my health.

I never imagined my life unfolding this way when I entered prison. But I was blessed to become involved with Project ECHO and the PEP program. My prison experience keeps me humble but it also keeps me motivated. I have faith and hope, and I’ve learned to let my passions drive my work.

The ECHO Effect

Project ECHO

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Project ECHO is a movement to touch and improve the lives of 1 billion people worldwide.

The ECHO Effect

A collection of personal stories on the many ways in which Project ECHO is working to touch one billion lives.

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