Haitian prison an incubator for disease, but treatment for multidrug-resistant TB remains out of reach

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Dr. John P. May, founder of the U.S.-based Health through Walls, in the yard of Haiti's National Penitentiary after the January 2010 earthquake

When the January 2010 earthquake cracked the walls of Haiti’s National Penitentiary, the roughly 4,500 prisoners caged inside fled into the streets of Port Au Prince. They left a place built to hold about 1,000 men that had gotten so crowded that prisoners shared sheets turned into hammocks, and window ledges for beds, while others, crammed 60 at a time into cells meant to hold a dozen, stood so long their feet and legs grew swollen.

Dr. Patrice Joseph of GHESKIO, says he’s pretty sure at least 50 of them had active tuberculosis (TB), but the number could easily be more than three to four times that number. Uncounted numbers may have had multidrug-resistant (MDR) strains of active TB. There was no way to determine that, at least at that prison, then. Joseph had been working  with the United States-based Health through Walls, a nonprofit to help screen patients for tuberculosis. The nonprofit, founded by a American corrections physician Dr. John P. May, had been working to improve and systematize infectious disease responses at the prison since 2001. The working relationship had been formalized just the year before. In the months before the earthquake, about a quarter of the prisoners had been screened.

Dr. Joseph spoke at the Health through Walls and AIDS Foundation East West networking zone, the first for prisoner’s issues, in the Global Village of AIDS2012 in Washington this morning.

Dr. Patrice Joseph, Project Coordinator at Haiti's GHESKIO Centers, works with the U.S.-based Health Through Walls to screen prisoners at the National Penitentiary for tuberculosis

In the months after the earthquake, Health through Walls was able to screen for infectious diseases every prisoner  who entered the prison, as the place began to fill again. Within the year, the prison once again grossly overcrowded, had progress disrupted in a riot during which a donated x-ray machine was destroyed.

A new machine was donated last January. Of 141 abnormal chest x-rays taken since, Dr. Joseph said, 52 inmates have been confirmed to have active tuberculosis. He doesn’t know how many have MDR-TB, although, he added, a GeneXpert rapid TB diagnostic test could take care of that.

“It’s not a matter of identifying people, it’s a matter of what to do when you identify people,” he said.

A prison, where most inmates are behind walls for years — even while awaiting trial — and where a staff could be trained to offer directly observed therapy, would seem to offer at least some compelling reasons to treat the diseases that have spread behind its walls and that require two years of grueling treatment.  But, said Dr. Joseph, drugs to treat MDR-TB aren’t available to the prisoners. A place to isolate and treat patients with drug-resistant disease doesn’t exist.

The results of GeneXpert testing could propel a push to fund and address those deficits, he said.

But, he added,”I don’t know what to do, if it doesn’t.”

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