Participants
Questionnaires were successfully administered to 24 paralegals. The number is relatively low from the estimated number of all paralegals LBHM has trained (81 people) because many of them have moved away or could not be contacted. There are many potential reasons why it was difficult to contact some paralegals, including simply that the time between when the training was offered and when the research was conducted was quite long, as well as potentially ineffective coordination.
An overview of the characteristics of the paralegals who participated in this research is provided in Table 1.
Table 1. Characteristics of the Study Population
Variable
|
Persons (N = 24)
|
Gender
|
|
Male
|
22
|
Female
|
2
|
Age
|
36 (22-75)
|
Occupation
|
|
Employee
|
3
|
Fisherman
|
4
|
Hospital Peer Support Staff
|
1
|
Local CHC Staff
|
2
|
Nongovernmental Organization Staff
|
2
|
Self-employed
|
2
|
Student
|
2
|
Unemployed
Other informal sectors
|
3
5
|
Year of Paralegal Training
|
|
2008
|
18
|
2011
|
1
|
2013
|
2
|
2015
|
2
|
2010
|
1
|
Not all paralegals have had experience in working on both access to justice and access to health. Some cases that are handled by paralegals do not involve health issues or problems. Based on themes that emerged from the research, findings are divided into four categories below: checking the clients’ health, raising clients’ awareness regarding the right to health, ensuring health services in detention, and seeking an alternative to imprisonment or lower sentence in legal defense.
Checking the clients’ health
Under Indonesian law, police investigators, prosecutors, and judges can place an accused in detention if the sentence for the crimes is more than 5 years, or if there is any indication that the accused will run away, destroy evidence, or commit other crimes. Therefore, detention is the most common setting where paralegals meet with their clients. It is during the meeting in detention that paralegals check their clients’ health condition. Not all of the paralegals interviewed had experience assisting clients who were detained. Thirteen paralegals had experience in assisting clients who were in police detention, while only eight had experience in assisting clients who were held in a detention center or a correctional facility. The remaining paralegals had either never met a client in person, or had handled private legal cases.
The client’s health condition was one of the first pieces of information that the paralegals sought during assessment. Sixty nine percent[1] of paralegals who had assisted clients in police custody reported having checked on a client’s health condition in police custody though not all of them did so consistently. Meanwhile, 87.5% of paralegals who had assisted clients in detention centers and correctional facilities checked on the health condition of clients who were detained in these particular settings.
[1] Calculated from those responding ‘Seldom’, ‘Sometimes’, ‘Frequently’ and ‘Always’.
Table 2. Paralegals Check on the Health Condition
Settings
|
Responses
|
Total
|
Never
|
Seldom
|
Sometimes
|
Frequently
|
Always
|
Police Detention
|
4 (31%)
|
1 (8%)
|
0 (0%)
|
3 (23%)
|
5 (38%)
|
13 (100%)
|
Detention Center
|
1 (12.5%)
|
1 (12.5%)
|
1 (12.5%)
|
2 (25%)
|
3 (37.5%)
|
8 (100%)
|
Correctional Facility
|
1 (13%)
|
1 (13%)
|
1 (13%)
|
3 (39%)
|
2 (26%)
|
8 (100%)
|
When asked what situations led to them checking on a client’s health condition, paralegals who did not always ask about the client’s health condition said that it usually depends on the case assisted and the nature of the client. For example, if paralegals know that the client is a drug user, or if there are physical signs or information that the client has experienced torture, they will ask about the health condition.
Yes, if I know my client is HIV positive, the first thing that I will advocate for is his/her right to health. Once it is fulfilled by the police, then I will advocate for the rest. But right to health always comes first. (Paralegal 4)
This priority demonstrates the familiarity of LBHM’s paralegals with problems related to health. Having themselves experienced violation of rights impacting health on a daily basis, it is understandable that a main concern is the health status of their clients. This attention to the health condition of their clients, supports them to advocate for the right to health and other health-related rights.
Raising awareness of right to health
Beyond checking clients’ health condition, paralegals also informed their clients about their right to health, and sometimes provided information related to health services available to their clients in closed settings.
The research found that twelve out of thirteen, or around 92% of the paralegals who participated in the study and had experience assisting clients who were detained in police custody gave their clients information about the right to health. Three of them always provided such information, and four of them provided such information frequently. A similarly high percentage of paralegals gave information on the right to health to clients held in a detention center or prison (87.5%).
Table 3. Paralegals Give Information about the Clients’ Right to Health
Settings
|
Responses
|
Total
|
Never
|
Seldom
|
Sometimes
|
Frequently
|
Always
|
Police Detention
|
1 (8%)
|
3 (23%)
|
2 (15%)
|
4 (31%)
|
3 (23%)
|
13 (100%)
|
Detention Center
|
1 (12.5%)
|
2 (25%)
|
1 (12.5%)
|
2 (25%)
|
2 (25%)
|
8 (100%)
|
Correctional Facility
|
1 (12.5%)
|
2 (25%)
|
1 (12.5%)
|
2 (25%)
|
2 (25%)
|
8 (100%)
|
The provision of information related to the right to health and health services available at the detention center or correctional facility was usually the next step after the paralegal asked about their client’s health condition. In a situation where the client expressed concern about their health, paralegals would provide such information on the availability of health services. In a situation where the client did not have health issues, some paralegals reminded them that they too have the right to health. There were also situations where the clients themselves proactively asked about available health services.
Usually, my client asked me what health services are available in detention center or in correctional facilities. They asked, “What if I am sick?” I told them that in some detention centers or prisons, there is a civil society organization working together with the detention center. I told them, “You can ask to be put in touch with them, if for example, you are HIV positive and need treatment. They have the medicine.” (Paralegal 2)
Ensuring health services in detention
Increasing access to health can also mean providing greater access to health facilities, goods, and services. Paralegals can take two approaches to ensure access to health services in detention centers or correctional facilities: taking the medicine directly to clients inside facilities or requesting the law enforcement agency to refer clients to health facilities.
Table 4. Paralegals Ensure Clients Have Access to Medicine
Settings
|
Responses
|
Total
|
Never
|
Seldom
|
Sometimes
|
Frequently
|
Always
|
Police Detention
|
7 (53.5%)
|
0 (0%)
|
0 (0%)
|
1 (8%)
|
5 (38.5%)
|
13 (100%)
|
Detention Center
|
4 (50%)
|
0 (0%)
|
1 (12.5%)
|
0 (0%)
|
3 (37.5%)
|
8 (100%)
|
Correctional Facility
|
4 (50%)
|
0 (0%)
|
1 (12.5%)
|
1 (12.5%)
|
2 (25%)
|
8 (100%)
|
Six paralegals said that they ensured that their clients had access to medicines in police custody, and four paralegals did this both in the detention center and in the correctional facility. Five out of the six paralegals who ensured their clients had regular access to medicine in police custody did this on all of the cases s/he assisted, while another one only did it frequently.
A. Taking Medicine Directly To Clients
Out of thirteen paralegals who had experience in assisting a case in which the client was detained in police custody, six took medicine to their clients themselves. During assistance in detention centers and correctional facilities, 50% of the paralegals stated that they had delivered medicine to their clients.
One aspect that may affect paralegals’ ability to take medicine to their client is the paralegal’s main job. In some situations, LBHM’s paralegals worked as outreach workers or in a Community Health Clinic (CHC) where their clients access methadone or antiretroviral therapy. With their position, the paralegal was able to go the extra mile to help their clients without breaking any laws.
I usually help preparing some letters from the Community Health Care for my clients. For example, if my client is on methadone therapy, I will help make the methadone letter [that confirmed the client’s status as methadone patient]... I also help clients to enroll in the national health insurance system. (Paralegal 3)
Taking medicines to clients directly was not always easy. Paralegals’ position as outreach workers or in a CHC did not always guarantee that they could successfully take medicines to their clients. It required good negotiation skills with relevant law enforcement agencies. The more frequently paralegals advocated for taking medicines directly to the clients and the more exposed law enforcement agents became to information about detainees’ right to health, the more likely it was for such advocacy to be successful.
In the past few years, it is easier to advocate for the right to health (i.e. bringing medicine to a client who is detained). Maybe because the police have experienced similar requests before. But it was once very difficult to do so, especially before 2010. (Paralegal 4)
B. Encouraging Law Enforcement Agencies to Refer Clients to Health Services
Not all LBHM’s paralegals worked as outreach workers, or in a CHC. For those who did not, taking medicines directly to their clients was impossible as they did not have access to the medicines needed. To ensure access to health services in detention, some paralegals encouraged law enforcement agents to refer their clients to treatment, either for drug dependency or mental health treatment. However, the number of paralegals who did this was substantially lower than those who took medicines to their clients.
On average, only 30% of paralegals had ever asked law enforcement agents to refer their clients to drug dependency treatment, and only one paralegal had ever asked for his/her client to be referred to mental health facilities. According to paralegals’ testimony, the decision on whether or not to ask law enforcement agents to refer their clients to health facilities depended on the client’s need to be referred.
Not all clients need to be put in health faciliies. Some clients only needed paralegals’ help in ensuring that they had access to medication while in a closed setting. For a range of different reasons, some clients rejected the idea of paralegals asking law enforcement agents to refer them to health facilities. As paralegals’ actions must be based on the client’s consent, they could only encourage the clients to consider being referred to health facilities, but they could not request this if the client did not want to be referred.
One of my clients was infected with tuberculosis after he was detained. I asked Pak Tardus, the person who works at the detention’s health clinic, to put my client in Drug Dependency Hospital instead of the Kramat Jati Police Hospital. I told him that the facility in Kramat Jati Police Hospital is not good. Pak Tardus granted my request, and referred my client to Drug Dependency Hospital. (Paralegal 4)
Despite the low number of paralegals who advocated for their client to be referred to health facilities, the success rate was relatively high, ranging from 50% to 75%. Three paralegals claimed that they succeeded in getting police officers to refer their clients to health facilities; two paralegals claimed similar success with prosecutors; while one paralegal claimed s/he succeeded in encouraging prison officers to refer their clients to health facilities.
Seeking an alternative to incarceration or lower sentence in legal defense
The right to health do not end when someone is found guilty of criminal charges. The stage when someone serves their sentence is usually longer than the pre-trial detention, and with the issue of overcapacity in prison, health risks are heightened. Here, paralegals play an important role to help clients seek an alternative to incarceration whenever possible, and permissible. Such help is given through intervention in the legal defense.
For many of LBHM’s paralegals working on drug-related cases, one of the objectives is to obtain a rehabilitation verdict for people who use drugs. The Narcotic Law allows judges to sentence people who use drugs to undergo rehabilitation services as an alternative to imprisonment.
Paralegal 4, a paralegal who specialized in drug cases said that he always tried to help obtain a rehabilitation verdict for his clients who had been proven to be involved only in drug use and not drug trafficking. He calculated that, during the many years of his paralegal work, he had helped many people to obtain rehabilitation rather than incarceration. He stated, “For rehabilitation, I can count around ten out of sixty cases that I handled so far [the client] got rehabilitation.”
One of the cases that stood out for him was a case involving Rose (not her real name), a woman who used drugs. Following her arrest for drug consumption, she kept using drugs while in detention. Due to this behavior, the lawyer who assisted Rose wanted to drop her case but the paralegal explained to the lawyer that this is precisely why Rose needed help: she had drug dependency and prison would not help her address her condition. In the court, he helped the lawyers explain Rose’s drug using behavior, and argued that Rose should have been given proper rehabilitation services. In the end, the judge sentenced her to rehabilitation facilities. Being asked about why the case was memorable for him, Paralegal 4 answered, "That case has a lesson. We find that if the convict does not receive her/his rights of rehabilitation, there will never be an assurance that s/he will not consume drugs again, due to her/his addiction.”
Another paralegal reported similar success when, in 2016, she assisted a drug user who regularly accessed methadone treatment in a local CHC. Her client was arrested for amphetamine possession. She pushed the local CHC to issue a letter about her client’s health situation as a patient there, and that he was still on treatment to cure his drug dependency when he was arrested. She then gave the letter to the judge. As a result, the client got a relatively lenient punishment of one year in prison, while the minimum sentence according to the Narcotic Law is four years. Paralegal 3 reflected on her decision: “(If he was not assisted), he could get four years. That’s the minimum of drug user. That’s why his friends are confused. How could he get one year? It’s so short.” These experiences demonstrate how paralegals’ interventions in addressing access to justice significantly impact their clients’ health.