THE public doesn't know much about China's prison system and its hardworking professional staff. Shanghai Daily reporter Zhao Wen received rare permission to interview at surgeon at Shanghai Prison Central Hospital.

Surgeon Lu (his full name is withheld) wears a standard white physician's coat and looks like any other doctor, except for a dark navy uniform under his coat and a shiny number ID badge.

Dr Lu is a prison surgeon as well as a policeman and, he hopes, someone who not only saves lives but also helps "save souls" and put inmates on the right path.

A bespectacled man of medium build in his 40s, Dr Lu is head of the Department of Surgery at Shanghai Prison Central Hospital, the system's only prison hospital. It handles major cases from throughout the 13-facility system, including two in Anhui Province. Each prison has a clinic for routine cases.

In his 20 years with the Chinese prison system, Lu has performed thousands of surgeries, both major and minor. Stitching up wounds from prison fights is common.

"Being a prison doctor is a hard and risky job, with lots of pressure, witnessing conflicts that ordinary people can hardly imagine," Dr Lu told Shanghai Daily in an interview in a meeting room in the white, modern hospital. Anatomy charts cover the walls.

Lu introduces himself as both a doctor and a policeman, a dual identity shared by all doctors and nurses in the prison system.

"What we do is not only cure the patient's pains but also give them hope for life and rebuild their confidence so they can go on living like everyone else," Lu said.

Lu cites good examples of ex-inmates who became successful entrepreneurs, good workers, husbands and fathers. He tells them they will also become one of these people and live normal lives.

"You can see the goodness in the inmates' eyes while they are listening to these stories. They long for freedom, for family reunion and for a clean identity as a citizen," Lu said.

Lu says he agreed to an interview because he wants people outside the prison system - who know very little about it - to get some idea of the work that medical staff do.

Doctors are well qualified, very experienced and extremely busy; surgeons especially do a lot of work, honing their skills almost daily. These are not doctors with lots of titles, whose walls are covered with academic degrees and who only occasionally perform surgery - with the incentive of a red envelope of cash.

Providing moral guidance

Prison doctors do everything other doctors and nurses do in public and private hospitals. They also try to provide some moral guidance.

Doctors frequently talk with patients, learning about their backgrounds, personal lives and expectations for the future when they complete their sentence. Inmates frequently discuss anxieties about the future and difficulties in getting along with their families.

Some physicians are also certified psychologists and counselors.

Doctors receive a flat salary, like other civil servants, and must first pass the national civil service exam. Authorities do not disclose physicians' salaries.

Dr Lu is not rewarded based on the number of patients he sees, surgeries he performs, or medications he prescribes.

The pay scale is that same as that of civil servants in judicial and police departments.

It's not every day that Dr Lu gets to share the details of his little-known and under-appreciated working life, and he was eager to discuss his work.

He's right. People outside prisons know even less about prison staff than about inmates. Many people don't know there is a major hospital and think injured and ailing inmates are treated in city hospitals. If true, that would be dangerous, but it's not.

Lu, a native of Anhui Province, was assigned to the prison system after he graduated from Anhui Medical University in 1993. In those days there wasn't much choice for medical graduates like Lu since China was shifting from a planned economy to a socialist market economy offering more choices.

He first worked at an Anhui prison until he was transferred in 1994 to Shanghai Prison Central Hospital, then at 147 Changyang Road inside Shanghai Tilanqiao Prison. It was built by the British colonist in 1903 to house Chinese criminals.

When Dr Lu was first assigned to the old Central Hospital, it had only 100 beds and a medical staff of 150; equipment and resources were very limited.

In 2007 the hospital was relocated to an independent site on Fanrong Road in the Pudong New Area. It is next to but independent of Shanghai Nanhui Prison, which houses mostly elderly and disabled inmates, who frequently need doctors. The hospital also receives serious cases from other prisons, including heart patients, surgery patients and cases of infectious disease.

The medical staff, including doctors, nurses and nurses' assistants, numbers around 300.

Treating AIDS patients

Most patients return to their assigned prisons after treatment here, but AIDS and HIV-positive patients are required to serve their prison terms in the main hospital, Dr Lu said.

"Some doctors in other hospitals refuse to perform surgery on AIDS or HIV-positive patients because they are afraid of infection," the doctor said. "But in a prison hospital, we have no choice but to operate because it is our job and our duty to save every inmate."

Lu said doctors should never reveal to AIDS patients their own fear and reluctance to treat them.

"These patients are very sensitive and have low self-esteem. They are likely to hurt themselves or try to commit suicide if they feel abandoned by everyone," Dr Lu said.

"That is a risk in being a prison doctor," Lu said. "But no one complains, because they know that is their job."

The most common blood-born diseases are HIV/AIDS, hepatitis B, hepatitis C and syphilis, which can be contracted through blood contact.

"Many people think all criminals are bad and we are often asked why we save the lives of criminals," Dr Lu said. "They also don't understand why criminals receive free medical treatment covered by the central government."

China's Prison Law requires prisons and policemen to treat criminals and keep them healthy, however, many low-income people resent this since they themselves have trouble paying for medical care, Dr Lu said.

"This public attitude is a difficult part of our job since we need to feel respected for our work and achievements," he said.

The doctor sees many familiar faces, some who stay in the hospital for long periods because of chronic disease, some who keep injuring themselves so they can get medical parole and avoid reform through labor.

"It is sad and frustrating when you see the wound you sewed up last time was opened on purpose. You have to keep convincing yourself that your work is meaningful," Dr Lu said.

Lu doesn't give up and says he is inspired by a role model, Dr Chen (his full name is withheld), president of the prison hospital and former head of the department of surgery.

In 2000, Dr Chen was the first doctor who operated on AIDS patients. He organized what some called a "death squad" to perform surgery on an AIDS inmate, who later recovered. All went well; no one was infected. Since then, the team has perfected its techniques and carries out multiple surgeries, both major and minor, on AIDS and HIV-positive inmates every year.

"Dr Chen's bravery really impressed me," Lu said. "I still remember his words: 'If none of you dare to perform the surgery, I will do it'."

Inspired by Dr Chen's caring, Lu seeks his own value through his work.

Once he treated and cured an inmate imprisoned for theft; the man had been troubled by a painful anal fistula for 10 years and surgery was necessary.

"I told myself that if he was cured here, he might be thankful to the hospital and the government and would not commit crimes any more," Lu said.

The inmate's condition was very serious and Lu invited a famous specialist from a local hospital to perform the surgery, in which he and others assisted. Afterward, Lu insisted on personally changing the inmate's dressings for six months until he recovered. They spoke a lot.

The man was deeply moved.

"I never saw him again. I hope he is living a normal life," Lu said.

Giving hope

Lu also persuaded an inmate in the late stages of colon cancer to continue treatment after the man had refused chemotherapy. The man was desperate after the diagnosis and wrote a document stating he would bear all consequences and not hold the hospital liable for withholding treatment.

Lu talked to the man daily, eventually persuading him that it was better to try therapy to extend his life.

"Our job is to relieve the pains in inmates' bodies. We don't know if our treatment can also build a sense of gratitude toward society," Dr Lu said. "What we do is give them hope for life with a healthy body."

As a prison law enforcement officer as well as a surgeon, Lu has been trained in police work, including training in self defense and how to subdue a violent patient.

"So far, I haven't been attacked, but it's important to move fast when I see an inmate who wants to hurt himself right in front of my eyes," Lu said.

Throughout the prison system, every inmate receives an annual checkup at their prison clinic. If serious problems are diagnosed, they are transferred to the main hospital. Hospital food is better than general prison fare. Diabetics receive special prescribed diets. Costs are covered by the government.

Hospital Vice President Shen (full name withheld) told Shanghai Daily that because the hospital is nonprofit, doctor's don't get commissions for prescribing drugs and ordering medical procedures. Accounts are strictly monitored by the central government, Shen said.

Around the country, disputes over patient care and death often arise between patients' families and hospital staff. Prison hospitals are not immune and the number of conflicts is on the rise, said Dr Lu.

"As a doctor, I want to tell every family that what we most want is to see every inmate walk out of the high walls in good health. That moment shows the value of our work."

So far, all conflicts have been resolved satisfactorily without litigation, he said.