Tuberculosis in Haiti
Pediatric Blog
As a young boy, the only things I recollect about TB were Christmas seals, which supported the care of individuals with the disease, and Sanatoriums, where those infected were isolated from the communities at large.
As a young man, I learned that many of my favorite authors (Robert Louis Stevenson, Charlotte Bronte, DH Lawrence, John Keats, Robert Burns, Anton Chekhov, George Orwell, Robert Heinlein, Sir Walter Scott) suffered from Consumption, which is what the disease was called, because the illness eventually consumed the individual.
During medical school and my early hospital years, TB was not a common problem in my clinical world and this continued until the HIV era, which resulted in a resurgence of the infection. With HIV so prevalent in Haiti, TB became a real problem for the population, and the infection is now the leading cause of death in those Haitians infected with HIV.
TB is spread in the air when an infected person coughs or sneezes, and the crowded unsanitary living conditions in Haiti are a perfect setting to transmit the infection. Haiti has the highest prevalence of TB in the Western Hemisphere. About 3 individuals in a thousand in Haiti are known to have TB and experts believe that half as many again have unrecognized TB.
Partners in Health (PIH) and GHESKIO offer TB prevention and treatment programs in Haiti. Recently, courtesy of support by the Center for Disease Control and other organizations, the ability to diagnose and treat TB has improved in Haiti. New Light Emitting Diode fluorescent microscopes are present in 10 health facilities and allow superior diagnostic accuracy compared to conventional microscopes. A new TB laboratory opened in October 2011 and offers TB culture and drug sensitivity testing. A cutting edge rapid diagnostic test for diagnosis and identification of Rifampin resistance is available.
Treatment requires a long course of therapy (typically at least 6 months) with multiple antibiotics. Failure to complete the recommended course increases the risk of Multidrug-resistant (MDR) TB and this is a growing problem in Haiti. MDR TB increased from 1.4% in 2004, to 1.8% in 2007, to 2.9% in a recent study in Port-au-Prince. Directly Observed Treatment (DOT) programs minimize the risk of MDR TB. Careful follow up with repeat sputum tests are essential to pick up individuals with MDR TB.
Next month in Haiti I will have my clinical eyes open for children with a wet cough, blood-tinged sputum, fever, chills, and night sweats. I'll also keep a look out for scrofula (TB lymphadenitis) and Pott's Disease (spinal TB). My N95 particulate respirator masks are already packed.
DISCLAIMER: This blog was originally posted on Helping Children in Haiti and Nicaragua. Please note, Dr Robson is not accepting donations at this time. However, he would greatly appreciate your comments and suggestions in support of his efforts.
