Source: Seattle Times
Abstract: Behind a flimsy curtain, a doctor armed with a dozen used syringes and a single vial of penicillin works on the front line of Haiti's newest hell, a disease so lethal that it is stockpiled for biological warfare.
He's treating scores of people for anthrax - almost never seen in the developed world but passed on from sick livestock to people too poor or too hungry to destroy and burn the tainted animals.
"It is killing a lot of people here. I see as many as eight new cases a day," said Edouard Nemorin, 56, at his dirt-floored clinic in this northeast Haiti village. "Some people get badly, badly swollen, and then they die suddenly, like that." He snapped his fingers.
One hospital alone reported about a dozen deaths in the past two months, but no one is keeping count.
Anthrax is so infectious and lethal that it's stockpiled by several armies as a biological weapon. An accidental release of anthrax spores from a Soviet research center in 1979 killed hundreds; the Pentagon called it perhaps the world's most deadly biological accident.
If a person eats meat tainted with Bacillus anthracis, the bug rips through a person's digestive tract, causing grotesque bloating that can be fatal in 36 hours, doctors say. Physicians here in northern Haiti speak of faces that balloon to nearly twice their normal size and tongues that grow as long as cow's tongues.
The disease flourished in the Middle Ages but is now relatively rare.
"We thought anthrax was cured. We thought it was gone from here - and everywhere else," said Bill Clemmer, a Georgetown-trained physician who works in a northern Haiti hospital. "If there was ever two or three cases in the U.S., U.S. authorities would be up in arms. They'd send teams of investigators. Here, we have no idea of how widespread it is."
In fact, rare outbreaks of anthrax from tainted meat still occur in developing nations. Eighty died in Ghana in 1988. Five died in Haiti from 1985 to 1988. In the United States, though, the last case was reported in 1980.
The disease has been known since ancient times and is believed to be the "plague of boils" that Moses called down on the Egyptians.
Health-care workers blame the current outbreak here, about 20 miles south of Cap Haitien, on the steady deterioration of conditions over the last several years, and not just the instability wrought by the 1991 military coup against President Jean-Bertrand Aristide.
"There is a breakdown in the structure of this society," said an American doctor who asked to remain anonymous for fear of reprisals by authorities. "It's another symptom of the infrastructure collapsing in Haiti."
Preventing anthrax is simple: All goats, cattle and horses must be vaccinated. Haitian law requires those vaccinations, prohibits the slaughter of unvaccinated animals and mandates the burning of every animal suspected of having anthrax.
But who is enforcing Haitian law these days? Who is running the vaccination programs?
No one here. For several years, say villagers, the vaccination program has gradually fallen apart.
An international oil embargo against Haiti, in effect for most of the last six months, appears to have worsened all health problems, including anthrax. With the price of rice, beans and cooking oil doubling or tripling in the past few months, people are cutting back on their meals.
And even though word of the epidemic is widespread, some Haitians are slaughtering their sick animals and taking a chance on the meat, health workers say.
For many poor families, a cow is their largest investment. If the cow dies from anthrax, they have little means to feed themselves.
Animals become infected by grazing on contaminated land. The anthrax bacterium produces spores that can survive dormant for many years in soil and animal products.
The disease - malcharbone in Creole, literally "sick charcoal," because an early symptom is a black lesion on the skin - spreads with alarming ease.
It is so contagious that an infected animal can transmit the disease through spores in the air.
If anthrax spores are inhaled, a person may first get pneumonia.
If anthrax is passed by touching an infected animal, the black lesions may appear.
If anthrax is ingested through meat, the first symptoms are those of severe gastroenteritis, with fever, diarrhea and vomiting. Then the bloating starts.
Even in the worst cases, antibiotics can cure the disease - if caught early. But that's a big if here.
"People aren't coming to the hospital until they are almost dead," said Kerry Kelly, a U.S.-trained registered nurse. "They can't afford to pay for the bus."
The first anthrax cases along Haiti's northeastern coast were reported five months ago. No other part of the countryside is yet reporting cases.
In the last two months, one hospital - the director asked that it remain unidentified - has had one or two cases a day. About a dozen people have died and perhaps 100 have survived.
In the hospital, doctors treat the anthrax patients immediately, then send them home. The doctors keep no anthrax patients, out of fear that the disease will race through the hospital (Seattle Times, 1993).