Pathogens and People: Reflections from Haiti
PLoS Pathogens Deputy Editor Grant McFadden reflects on his recent trip to Haiti as part of a volunteer medical team.
It is easy for those of us raised in the high-income countries to forget that a very fine line separates us from rampant infectious disease. Our relative freedom from so many of the pathogens that afflicted our forefathers is not accidental, but is entwined with advances in public health, free access to clean water and uncontaminated food, public education, widespread vaccination programs, and access to decent medical care. One only has to spend time in a place where all of these advantages are absent, or in desperately short supply, to appreciate that so many pathogens are still lurking around, and waiting for us to collectively let down our guard.
In February this year I spent a week working with a team of 20 other people in a medical clinic located in the village of Fort Liberte, on the northern shore of Haiti not that far from the much larger city of Cap-Haitien. This is the same location where the slave revolution that launched the independence of Haiti from France in 1804 began and took hold. Today, after two centuries of failed statehood and foreign interference, Fort Liberte is probably typical of most of rural Haiti, with people living in a kind of poverty that is hard to describe in the printed word. Paul Farmer does an admirable job summarizing the situation on the ground in Haiti nowadays in his recent book “Haiti after the Earthquake”.
Our volunteer medical team (organized by Lee & Gerry Platt, and based out of a church in Columbus, Ohio) stayed in the compound of the local parish priest, Pastor Andre, and spent the week running operations of the medical clinic down the street. Some of the team members were fully trained medical doctors, pharmacists and nurses, whose skills were invaluable. Others (like myself) came only with skills that had no bearing to the tasks at hand, but a desire to help and make a difference. Essentially all of the medicines the clinic needed had to be brought in by the team, and much of our supply was very nearly stolen by corrupt border guards in the Dominican Republic, our portal of entry into Haiti.
My own task turned out to be ferrying prescriptions and medicines from the pharmacist to the patients themselves, and ensuring (with the tireless help of our Creole-speaking interpreters) that every patient understood fully what the medicines were for and how to take them according to the doctor’s instructions. I shared this job with Mike Eckel, who worked in the pharmaceutical industry in Ohio, and we both figured we needed a proper job description so we called ourselves Pharmaceutical Delivery Technicians (PDTs). Finally, after all these years, I had worked my way up the food chain to become a card-carrying drug runner. It was a chance to meet literally hundreds of Haitians, and it was an experience that literally changed the way I think about life.
The first thing we noticed was the wide prevalence of so many infectious diseases: typhoid, malaria, dengue, cholera, HIV and TB cases were common. I have no doubt that other pathogens were incubating, about which we know nothing, either because the testing is inadequate or we just don’t have a clue about their identity. Memo to pathogen discovery wonks: go to Haiti.
One young dehydrated girl nearly died on the table while being examined, but the team managed to rescue her, to the relief of everyone. Not all was grim news, however, another beautiful young girl appeared who had been a cripple two years ago when she literally crawled into the clinic on her knees. She was lucky enough receive the needed foot surgery in 2010 that restored function of her foot tendons. She just walked into the clinic to say hi, and I now have her lovely picture on my iPhone. Some of the cases were more depressing, and chronic diseases like diabetes, high blood pressure and hepatitis are also sadly rampant and we could provide only short term relief for many. It was a sobering reminder of what an absence of long term health care really means to people on the ground.
But the most lasting impression wasn’t on the disease or health problems of so many afflicted patients, it was the gentleness and good spirit of the people I met, both in the clinic and outside. I saw so much true friendliness and caring in people who have so little reason to hold either emotion dear. On the Sunday we arrived, there was an all day celebration held in Pastor Andre’s church, held once a year, in which people come from all over the area to sing songs of hope and faith. I have a video clip of one group that I keep on my iPhone that makes me smile every time I hear it. Listening to their music, full of gratitude and love, I think I understand a little better what they are trying to teach us.
Grant McFadden is the Deputy Editor of PLoS Pathogens and a Professor in the Department of Molecular Genetics and Microbiology at the University of Florida. His lab focuses on the strategies that poxviruses have evolved to evade, subvert, suppress and micro-manipulate the various host defence pathways.
God, it makes me think of Calcutta, where I was born and where I lived until I was ten. My parents were Americans so we had access to the best medical help available. I went back there on my 40th birthday; to represent the family, so to speak, to go back and try to find the house I grew up in (now a block of apartments) and the places my father used to go (work, golf etc.)
I was horrified. Horrified beyond description, possibly more than Grant ever was. Bands of small children, 8 years old and under, roamed the streets, so thin they looked like rag dolls, shouting “Uncle, uncle!” with their hands outstretched. I was so horrified — I swear there was a man on the sidewalk, busy dying, while hundreds of people strolled by him — that I confined myself to my hotel room for a week and only went out to verify the landmarks I’d promised to visit.
But even more horrifying than the children and the dying man and the dozens of dead dogs that littered the highway to the airport was the signs, everywhere, advertising Internet services, electronics, cosmetics — things that were just a horrible unreachable reminder to probably more than half the population, that there were rich people walking by right next to them, everywhere, but they would die of typhus or cholera or meningitis or the measles.
Who is going to help *them*? As I sit here in my comfortable apartment in Montreal I shrink mentally when I read stories such as Grant’s.
The children of Calcutta are not alone.