Port-Au-Prince, Haiti: At a fly-infested clinic hastily erected alongside the rubble of the only tuberculosis sanatorium in this country, Pierre-Louis Monfort is a lonely man in a crowded room.
Haiti has the highest tuberculosis rate in the Americas, and health experts say it is about to drastically increase.
But amid the ramshackle remains of the hospital where the country’s most infected patients used to live, Mr. Monfort runs the clinic alone, facing a vastness of unmet need that is as clear as the desperation on the faces around the room.
“I’m drowning,” said Mr. Monfort, 52, flanked by a line of people waiting for pills as he emptied a bedpan full of blood. All of the hospital’s 50 other nurses and 20 doctors died in the earthquake or have refused to return to work out of fear for the building’s safety or preoccupation with their own problems, he said. Mr. Monfort joked that the earthquake had earned him a promotion from a staff nurse at the sanatorium to its new executive director.
In normal times, Haiti sees about 30,000 new cases of tuberculosis each year. Among infectious diseases, it is the country’s second most common killer, after AIDS, according to the World Health Organization.
The situation has gone from bad to worse because the earthquake set off a dangerous diaspora. Most of the sanatorium’s several hundred surviving patients fled and are now living in the densely packed tent cities where experts say they are probably spreading the disease. Most of these patients have also stopped taking their daily regimen of pills, thereby heightening the chance that there will be an outbreak of a strain resistant to treatment, experts say.
At the city’s General Hospital, Dr. Megan Coffee said, “This right here is what is going to be devastating in six months,” and she pointed to several tuberculosis patients thought to have a resistant strain of the disease who were quarantined in a fenced-off blue tent. “Someone needs to go and help Monfort, or we are all going to be in big trouble.”
A further complication is that definitively diagnosing tuberculosis takes weeks. So doctors are instead left to rely on conspicuous symptoms like night sweats, severe coughing and weight loss. “But look around,” Dr. Coffee said. “Everyone is thin, everyone is coughing from the dust and everyone is sweating from the heat.”
Dr. Richar D’Meza, the coordinator for tuberculosis for the Haitian Ministry of Health, said his office and the World Health Organization had begun stockpiling tuberculosis medicines. “We are very concerned about a resistant strain, but we are also getting ready,” he said, adding that he is assembling medical teams to begin entering tent camps to survey for the disease.
“This will begin soon,” he said. “We will get help to these people soon.”
For Mr. Monfort, it is not soon enough. He scavenges the rubble daily for medicines and needles. He sterilizes needles using bleach and then reuses the bleach to clean the floors.
In his cramped clinic, eight of the sickest and most contagious patients lay on brown- and red-stained beds. He said he had lost count of how many more were sleeping in other pockets alongside the hospital. Hundreds come daily to pick up medicine.
Outside the clinic, the air is thick with the sickening smell of rotting bodies. Occasionally a breeze carried a waft of char from small cooking fires nearby, offering a respite from the stench and the flies.
Mr. Monfort began to explain that his biggest problem was a lack of food. Suddenly a huge crash shook the clinic. A patient screamed. Everyone stood still, eyes darting. A man outside yelled that another section of the hospital had collapsed. People looking for materials to build huts had pulled wood pilings from a section of the hospital roof, which then fell as the scavengers leapt to safety, the man said.
Mr. Monfort looked to the ground silently as if the weight of his lonely responsibility had just come crashing down.
“These people are dying and in pain here,” he said. “And no one seems to care.”
The dire scene at Mr. Monfort’s clinic speaks to a larger concern: as hospitals and medical staff are overrun by people with acute conditions, patients who were previously getting treatment for cancer, H.I.V. and other chronic or infectious diseases have been pushed aside and no longer have access to care.
First Published: Saturday, February 06, 2010, 08:52