- Hello, Jeff - I think we could see a major outbreak of
resistant TB among the Haitian population any time now. The infected
have been unable to continue their TB medication which could put them at
risk for their TB to mutate and become resistant. When treatment is started,
then stopped and then started again, there is a big risk, especially in
HIV/Aids infected individuals with TB, of the Mycobacterium becoming
resistant to some or even ALL of the medications.
-
- There is also risk of more than normal spread of TB among
the population who are living in crowded conditions in shelters for extended
periods of time.
-
- Haitian health care has almost totally collapsed and
the population will have to depend upon Doctors without Borders, the UN
and the US and other foreign aid for all of their health care. This is
an impossible task for those care givers trying to help.
-
- Regarding TB, it is also possible that there will be
gaps in dispensing TB medications. Here again, this will cause more cases
of resistant TB. We may see MDR, XDR and XXDR TB spreading across Haiti
and into the Dominican Republic.
-
- Patty
-
-
- TUBERCULOSIS - HAITI: POST-EARTHQUAKE
-
- Date: Fri 5 Feb 2010 Source: The New York Times
http://www.nytimes.com/2010/02/06/world/americas/06tuberculosis.html?hp
-
-
- 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 2nd 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
6 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, 8 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, HIV, and other chronic or infectious
diseases have been pushed aside and no longer have access to
care.
-
- At the Champ de Mars, [a man] sat on a curb, one shoe
missing, his blue polo shirt torn, his head cupped in his hands.
"I have TB, and I am also supposed to get dialysis every
other day," he said, explaining that he was a doctor's
assistant before the earthquake and meticulous about his treatments.
"I have not had dialysis in 3 weeks, and I feel my blood
is rotting from inside." Waving his hand over a sea of tents
and tarpaulins, he added, "It is like this country."
-
- Back at the clinic, Mr Monfort struggled to fix an IV
that had missed the vein and was painfully pumping fluids under
a patient's skin. Another ghost of a man hobbled to the doorway
on crutches, moaning for help. "Please wait, please wait,"
Mr Monfort said in a tense whisper. The biggest source of stress,
Mr Monfort said, is that his 3 children and wife are living
on the street because the earthquake destroyed their home.
His wife begs him daily to stay with them. Instead, unpaid
and without a mask or gloves to wear, he walks to the sanatorium each
day at 6 am and stays until 8 p.m. when most of the patients drift to
sleep. "Why don't you just leave us to die?" asked [a patient].
Mr. Monfort looked offended by the notion. But he did not answer
and the question seemed to stick with him.
-
- The ancient Greek playwright Aeschylus once wrote that
there was a type of suffering so intense that, even in our
sleep, it bores into the heart until eventually, "in our
own despair, against our will," it taps into a terrible
wisdom. After several minutes in silence, Mr Monfort spoke
of that wisdom. He referred to it as a "strange hope"
that had sprung from the suffering of his patients and the loss and
abandonment of his fellow staff members. "These people here are dying,
but they keep me alive," he said. "I know they are hurting more
than me and not complaining. So," he said, handing another
walk-in patient a packet of pills, "I must continue."
-
- Byline: Ian Urbina
-
- _____
-
-
- Communicated by: ProMED-mail Rapporteur Mary Marshall
-
- Photo of a hospital in Haiti today http://www.donation4charity.org/blog/wp-content/uploads/haiti-earthquake.jpg
- Mod.JW
-
- Following the devastation caused by the earthquake on
12 Jan 2010 that centered about 10 miles (15 kilometers) southwest
of Haiti's capital, Port-au-Prince, the interruption of treatment
for chronic diseases (such as, TB, HIV, diabetes, end-stage
renal disease, hypertension) and loss of patient follow-up
were likely to cause significant problems. However, even before
the earthquake, tuberculosis and HIV infection were major public
health problems in Haiti. The following is extracted from USAID
report on tuberculosis in Haiti available at <http://www.usaid.gov/our_work/global_health/id/tuberculosis/countries/lac/haiti_profile.html>:
-
- Haiti has the highest per capita tuberculosis (TB) burden
in the Latin America and Caribbean region. After HIV/AIDS,
TB is the country's greatest infectious cause of mortality
in both youth and adults (6814 deaths in 2007). Haiti is among
the 8 priority countries identified by the Pan American Health
Organization (PAHO) for TB control in the region. According
to the World Health Organization's (WHO's) 2009 Global Tuberculosis
Control Report, Haiti had and estimated 29 333 new TB cases
in 2007 [incidence of 306 cases per 100 000 population]. ...The
DOTS [that is, directly observed therapy, the internationally
recommended strategy for TB case management] treatment success rate
was 82 percent in 2006, a slight increase from 78 percent in 2003.
DOTS coverage fell to 70 percent in 2007 compared with 91 percent in
2006, though it was still above the 2005 level of 55 percent. However,
in some highly dense metropolitan settings, such as areas in
Port-au-Prince, coverage can be as low as 13 percent. ...
-
- Since 1998, the Ministry of Health (MOH) has supported
the DOTS strategy in order to strengthen the national TB program,
the Programme National de Lutte contre la Tuberculose (PNLT
-- National Prtogram of the Fight Against TB), and approved
national guidelines and norms for TB control in 2002. However,
the program lacked political and financial support from the
government, and there is a lack of skilled technical human
resources at the central level of the PNLT. A major problem
in combating TB is that co-infection with HIV can run as high
as 30 percent in some urban areas. Strong stigma and cultural barriers
attached to TB also interfere with case detection and adherence to
treatment. Multidrug-resistant (MDR) TB has increased from 1.4 percent
in 2004 to 1.8 percent in 2007 [among new cases]. ...
-
- WHO has issued a public health risk assessment to facilitate
the response of those aiding the earthquake-affected population
in Haiti available at http://www.who.int/diseasecontrol_emergencies/publications/haiti_earthquake_20100118.pdf
-
- Haiti and the Dominican Republic occupy the Caribbean
island of Hispaniola in the Greater Antillean archipelago.
A HealthMap/ProMED-mail interactive map of Hispaniola can be
found at http://healthmap.org/r/00Yo. - Mod.ML
-
-
- Patricia A. Doyle DVM, PhD Bus Admin, Tropical Agricultural
Economics Univ of West Indies Please visit my "Emerging Diseases"
message board at: http://www.emergingdisease.org/phpbb/index.php Also
my new website: http://drpdoyle.tripod.com/ Zhan le Devlesa tai
sastimasa Go with God and in Good Health
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