The following is the first of a two-part feature on health and justice in a Haitian prison. Today Science Speaks looks at how a decade of work by an organization called Health through Walls has led to recognition of and responses to conditions there, with tools to diagnose tuberculosis among prisoners.
When Dr. John May arrived at Toussaint Louverture International Airport on his most recent visit to Haiti last week, he loaded the four suitcases he had brought into a truck bearing the logos Health through Walls and of USAID. He stopped at a clean airy office in town to unload supplies, and then joined by others, and carrying more supplies, went on to the penitentiary in the heart of the city, a desperate looking place even from the outside, when a line of visitors carrying bags of food stretches down the street in front of it.
Not far from here, until recently, the ruins of the capital’s National Palace, crumbled in the 2010 earthquake, dominated the landscape, until the charity started by actor Sean Penn razed the site. The prison is the biggest institutional edifice in the neighborhood now.
Its blue walls already cracked, the Prison Civile de Port au Prince largely withstood the earthquake, but with damage to its largest cell block its population of about 4,000 prisoners fled that day. With some renovations, the place is full again, on this day with a total of 3,717 men. Holding a population four times what the prison was built to accommodate, the place is chaotic.; Smells of food, sewage and garbage compete with each other. It is landscaped with puddles you want to take care not to step in, and fossilized piles of garbage. Bony prisoners, dressed in stained rags and show symptoms of an array of debilitating, infectious conditions. As May and his team arrived prisoners in the medical area lined up, plastic containers in hand, in front of a wheel barrow filled with a watery yellow slop, shadowed by a cloud of flies. It was lunchtime.
This is a place still that presents overwhelming odds against health, but as May set down the boxes of medicine he had brought, he was smiling.
Calm confidence in the face of horror comes naturally to him here, because it is everything that is wrong with the place that brought him here to begin with. A corrections physician in what he refers to as his “day job,” in the United States, he had sought settings where healthcare systems and tools can have their greatest impact, and found early on that prisons top the list of such places. Here the potential for impact is exponentially multiplied. And the conditions here, the chance to improve health here, have never been better than on this day.
In the room where May set down a box of folders, an X-ray machine now screens patients for tuberculosis. In the next room, he peeked into a well-stocked cabinet of antiretroviral medicines. A central area holds medical files — one for each prisoner, tested for HIV, screened for tuberculosis on the way in. In about a month, a GeneXpert machine, that will allow immediate and more accurate testing for tuberculosis, including among prisoners with HIV in whom the most common diagnostic tool fails, will arrive, courtesy of USAID, and staff will be trained to use it. The machine will allow health workers at the prison to quickly determine if a prisoner’s disease is resistant to the first line of treatment, as well, helping to reduce the spread of drug-resistant strains of disease. The machine will make treating patients quickly and appropriately not only possible, but imperative.
All of this is reason to smile. When May came here more than a dozen years ago, inspired by a presentation on prison conditions at the 2000 International AIDS Conference in Durban, South Africa, he was on his own.
He found malnourished prisoners wasting from untreated diseases, in crowded and filthy conditions that only ensured the spread of their illnesses. Two hours from American shores, it might as well have been on another planet.
While donors were beginning to respond to the impact of AIDS and tuberculosis epidemics around the world none of that help was penetrating prison walls. Prisoners died at a rate of one or two a week, but tools to diagnose tuberculosis and resources to treat HIV among prisoners were out of reach.
More than once over the years that he continued to return, during natural disasters and times of political upheaval, all of the prisoners got out, carrying diseases fed by neglect into the communities around them.
“You have to pay attention to what happens in jails and prisons,” he would tell anyone who would listen. He co-founded Health through Walls, with the motto “infectious diseases respect neither prison walls nor national borders.”
With volunteers and a few first donations, the group brought an X-ray machine. In the fall of 2009 a team of came for what was to be one in a series of “health blitzes” to screen prisoners. A team of HIV peer educators from a groundbreaking Florida prison program joined them and began training. A few months later, in January 2010, all of this was destroyed in the earthquake and the 4,000 prisoners incarcerated in the prison that day fled into the streets of Port au Prince.
What May saw last week had risen from the rubble since. A three-year USAID grant has provided the infrastructure — staff, office, equipment — to make it possible to show what could be done. And the next day, he would get to put it on display, to a delegation of visitors, including two United States Senators and the U.S. Ambassador to Haiti, who were coming for a first hand look at how health and justice mingle here.