Haiti makes solid progress in reducing TB

On World Tuberculosis Day, a personal account from the frontline, Haiti, which has the highest reported rates of TB in the western hemisphere.

There is a certain poetic symmetry to my return to Haiti this year as tuberculosis (TB) advisor. It was exactly 10 years ago that I first set foot on Haitian soil as a doctor. The little boy who left the little town of Deschapelles in Haiti’s Artibonite Valley years ago, was back, and now able to give back to his people.

There’s nowhere else I’d rather be right now and no other job I’d rather do. Sadly, expertise in TB is badly needed here in Haiti, which is very poor, has relatively high rates of HIV, a weak health infrastructure, and the highest reported TB prevalence rates in the western hemisphere – 300 cases per 100,000 people. The Dominican Republic, with which Haiti shares the Caribbean island of Hispaniola, has just half the number of cases. 

So the situation here is of obvious concern in global health security terms. As Dr. Frieden and others stressed at the mid-February launch of the Global Health Security Agenda, the frontline is wherever diseases break out. Disease knows no borders, and we live in an age of increased mobility. But more specifically, Haiti is known to be one of the top ten contributors of TB cases to the United States. To combat TB in the U.S., we have to fight it abroad, especially in countries like Haiti where multidrug-resistant (MDR) TB has emerged as a particular concern since the earthquake struck in 2010.

The quake damaged TB hospitals, displaced 1.5 million people and forced them to crowd into cramped quarters – a classic situation conducive to the transmission of an infectious disease. I was here in Port au Prince the whole of 2010. At the main (and, at the time, only functioning) field TB hospital in the Haitian capital, we were seeing twice as many TB patients as before the quake. We were seeing many more children with TB. Most of the new TB cases were HIV-negative. CDC helped reinforce surveillance in crowded camps in Port au Prince in the months after the earthquake.

Four years on, we’re making solid progress in the battle to reduce TB prevalence 25% by 2015. This is an important public health goal for the U.S. government, Haiti’s Ministry of Public Health and Population (MSPP), and other partners. CDC is contributing to this by working on better diagnostics, better treatment, and better surveillance – the holy trinity of TB diagnosis and treatment. We’re providing support to two TB hospitals badly damaged by the quake – SanaPaP, as it’s colloquially called, in Port au Prince and Sigueneau in Gressier in the Ouest department – . We’re also working with the National Laboratory and the National TB Program to implement a country-wide surveillance program.

On the last day of February, I attended the launch of a pilot scheme for MDR TB surveillance in the Ouest department, where a third of all cases are concentrated. As I stood there, I thought back to my childhood and the Albert Schweitzer Hospital in Deschapelles, where I got all my shots and which was one of the first hospitals in the world to run a hugely successful community care program for TB patients.

If Haiti could do that back then, I thought, it can do even more today.