Haiti Hospital’s Fight Against TB Falls to One Man
By IAN URBINA
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
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
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.
“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
“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