There but for the Grace of God........

Haiti Hospital’s Fight Against TB
 Falls to One Man
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Fred R. Conrad/The New York Times
Published: February 5, 2010
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Sommervil Webert, 24, is a tuberculosis patient in the makeshift clinic in Port-au-Prince. Other patients must sleep outside

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  lonely man in a crowded room.
Clervil Orange, a patient at what remains of Haiti's only TB hospital, getting a haircut this week. “Why don't you just leave us to die?” he asked the lone nurse there.
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.”

Amid the rubble of the sanatorium in Port-au-Prince, Pierre-Louis Monfort struggles to meet patients’ needs.

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.
At the Champ de Mars, Jean-Baptiste Renauld 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 three 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 three 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 a.m. and stays until 8 p.m. when most of the patients drift to sleep.

Clervil Orange, a patient at what remains of Haiti's only TB hospital, getting a haircut this week. “Why don't you just leave us to die?” he asked the lone nurse there.

“Why don’t you just leave us to die?” asked Clervil Orange, 39. 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.”

Whenever in the future I start to feel overwhelmed by my own circumstances, of what I must personally endure from day to day or how hopeless our own community's situation might seem, I will remember this article, and the troubles of the people of Haiti.