Thursday, March 15, 2007
January 13th, 2007
by Dr. John A. Carroll
In clinic in Port-au-Prince on Wednesday, the girl in the photo was helped over to the wooden bench that is next to my table where I chart. Her father slowly and gently helped her sit down. She was very weak.
As I looked into her eyes, she had “the look”.
She said her name is Vita and that she is 18 years old. Vita lives in the slum with her father. She was very pleasant and focused but only spoke when I asked her questions.
Vita’s voice was very hoarse and hard to hear. She said that she had been losing weight, had afternoon fevers, a cough, was very weak, and had a skin rash that would not go away.
When I asked her if she was pregnant, her father replied that she was not pregnant but her baby died on Sunday. I quickly looked back at her and asked her if she had indeed lost a baby on Sunday. She said yes that her one month old had just died. When I asked her why, she replied that the baby had “become small”.
A quick exam of Vita revealed a very pale young lady with a lot of noise in her lungs. Her skin was covered with scabies.
I would bet my stethoscope that she has AIDS and tuberculosis. There are many teenagers and young adults in Haiti that look just like Vita. AIDS is the leading cause of death in women of reproductive age in Haiti.
In the early 1980’s Haitians were held responsible for the spread of HIV in the U.S. and other developed countries. The truth was the opposite and foreigners were bringing the disease to Haiti.
Estimates of HIV/AIDS in Haiti are 12% in urban areas and 5% rural. Once the prevalence rate in a population reaches around 5%, the virus spreads rapidly.
AIDS in Haiti and the rest of the developing world is considered a developmental disaster.
Haiti’s decrepit health care system cannot deal with it and many health care workers have the disease. The labor force in Haiti is greatly damaged with the prevalence of AIDS as most of this disease is found in the 15-50 year old age group.
Haiti is a famine stricken nation at present. Haitians have the second lowest per capita caloric intake in the world. Their babies are wasted and stunted. And when people are poor and hungry they engage in high risk behavior so that their family can eat. Then they get the virus.
All around the world, starvation and malnutrition are vying for funds with antiretroviral drugs. In other words, should funds be spent on feeding people or buying them medication to fight the virus?
Malnourished HIV/AIDS patients are six times more likely to die while using antiretrovirals. Many experts think that “health care distributors” need to be in the business of distributing food for their HIV/AIDS patients along with the antiretrovirals.
However, all is not bleak in Haiti regarding HIV/AIDS. More international money is coming in from the Global Fund, and the cost of antriretrovirals is decreasing.
Also, a New England Journal of Medicine article in December, 2005 concluded that HIV treatment in Haiti is feasible and as effective as it is in the United States—so “resource poor settings” such as Haiti, should not be denied antiretrovirals.
I told Vita that I was going to admit her to a home (for sick, dying, and abandoned adults) in Port-au-Prince run by the Missionaries of Charity. If she has tuberculosis, it can be treated there and she can be entered into an AIDS treatment program. She was very happy with this option, her only option.
The Sisters will feed Vita a couple of good warm meals each day too.
John A. Carroll, M.D.