Léogâne, Haiti — On a recent weekday morning, a steady stream of patients limp their way up a metal staircase at Haiti’s Ste. Croix Hospital, down the dimly lit hallways, and through a door marked _gwo pye.
_ The term, which is Haitian Creole for “big foot,” is a euphemism for the horrors that bring people to the tiny second-floor clinic: Limbs swollen to the size of tree trunks. Ankles disappearing under giant folds of flesh. And the wartlike growths that doctors call “mossy foot,” signs of health nightmares to come.
The patients are among the tens of thousands of Haitians who suffer from lymphatic filariasis, a mosquito-borne disease that causes elephantiasis of the limbs and genitals. As many as 2 million of Haiti’s 8.3 million people are believed to be infected with the parasite that causes the disease. And at least an eighth of those — some 250,000 people — have developed the crippling symptoms.
Until recently Haitians suffering from the disease had nowhere to go for help. But in 1995, the Rev. Thomas G. Streit, then a postdoctoral fellow in biology with the U.S. Centers for Disease Control and Prevention, helped open a clinic for filariasis here in Léogâne. At the time, the impoverished sugar-growing town had the highest infection rate in the country, with more than 50 percent of residents testing positive for the parasite. The town’s ubiquitous rum factories are breeding grounds for mosquitoes, which thrive on the sugary, stagnant water used in the cooling process and on the pools of water that collect in the sugar-cane fields.
Three years later, Father Streit founded the Haiti Program at the University of Notre Dame, where he is a research assistant professor in biology. The program, which works with the Haitian Ministry of Public Health and the Centers for Disease Control, is supported largely by a $5.2-million grant from the Bill&Melinda Gates Foundation. In addition to offering treatment, including surgery for men with elephantiasis of the testicles, it is working to eradicate the disease nationwide. Father Streit spends most of his time in Haiti, where his disease-fighting work is part of his research for Notre Dame.
“I challenge people to come up with another disease so tied to poverty,” says Father Streit, 46, a Roman Catholic priest who often holds Mass in Léogâne. He walks along the dusty streets, past a park piled with rotting garbage. “You look at the world where it exists, and there is always horrible poverty.”
There is no cure for filariasis, but the disease can be kept under control by washing the affected area regularly and doing exercises to improve circulation. One of Father Streit’s biggest challenges is persuading patients of the importance of basic hygiene, since most lack running water at home.
Père Tom, as the townspeople call him, stops to chat with a woman in the congested roadside market. “Ella, where are your shoes?” he playfully scolds a middle-aged mango seller, whose left leg is the shape of an elongated watermelon. The woman is squatting barefoot in the dirt, seemingly oblivious to the ants that crawl in and out of the open sores on her ankle. She just smiles and shrugs.
With an annual per-capita income of just $425, Haiti is the poorest country in the Western Hemisphere. It also has the worst housing, education, sewage, and water-supply systems, thanks to decades of dictatorship and corruption. Health care is virtually nonexistent.
“This is a country where killer diseases” — like AIDS — “get all the attention,” says Father Streit, explaining widespread ignorance about filariasis. (Many Haitians believe it is the result of voodoo curses.) Wuchereria bancrofti, the threadlike parasite that causes the disease, clogs up the lymphatic system, forcing lymphatic fluid to accumulate in the limbs and genitals. While the consequences are ugly and painful, the disease is rarely fatal.
In 1997, when the World Health Organization named filariasis among several diseases that could be eradicated, Father Streit saw a chance to lift at least one of Haiti’s burdens. His program has set the ambitious goal of eliminating the disease here by 2012, well before the international organization’s worldwide goal of 2020. An estimated 120 million people, in some 80 countries, are infected with the parasite, most of them in Asia and Africa. Haiti is home to most of the cases in the Western Hemisphere.
The strategy in Haiti is twofold: mass distribution of the drug diethylcarbamazine (DEC), which kills the young parasites and prevents transmission, and addition of the medicine (along with iodine, which is essential for brain development in children) to the country’s salt supply. The Haiti Program, whose more than 60 members include nine physicians and scientists, expands by hundreds of volunteers during annual distributions of DEC and albendazole, a drug that fights intestinal worms. The program has reached more than one million Haitians over the past five years.
The combined strategy of drug distribution and fortified salt has worked in China, which has virtually eradicated filariasis. But employing the method in Haiti, which lacks China’s infrastructure and armies of state health-care workers, has not been easy.
“You don’t even have the most basic resources,” says Father Streit. His program recently put $150,000 into renovating an abandoned factory in the capital, Port-au-Prince, for use as a salt-fortification plant, and won a two-year contract to operate it. But the site has no electricity. And Father Streit’s team is still struggling to find enough clean salt to supply the necessary 12,000 bags per day. The country’s main salt ponds were 80 percent destroyed by Tropical Storm Jeanne, which struck Haiti in September. Most Haitian salt is so dirty that it must be rinsed before use.
“Our whole program is based on convincing people not to wash the salt, because they will wash away the iodine and DEC,” Father Streit says during a three-hour meeting at the salt program’s office, in the capital. The program’s directors also discuss more-mundane issues, such as how to keep the factory’s toilets from overflowing. (It’s the first time most of the workers have seen indoor plumbing.)
“What am I doing at a meeting like that? I’m not a management professor,” says Father Streit, laughing, as he sits in gridlocked traffic on his way back to Léogâne. The 20-mile drive can take up to three hours, thanks to chronic roadblocks and traffic accidents.
On the same day he discusses broken toilets, he and his colleagues meet with the country’s interim president, Boniface Alexandre. “It’s ridiculous. Only Haiti has this problem in the West,” Father Streit says in Creole, making a passionate case for greater government involvement in fighting filariasis. The president, a former chief justice of Haiti’s Supreme Court, listens intently. He asks his visitors for more details of the disease and possible methods of fighting it. After two hours, the professor leaves the presidential palace smiling.
The meeting is one of dozens he holds every month with Haitian and international officials to rally support in the fight against filariasis. His job has become even more difficult since Jean-Bertrand Aristide, the former president, fled the country in February 2004 amid an armed rebellion. Since then, attacks by gun-toting thugs, many of them sympathetic to Aristide, have left hundreds, perhaps thousands, dead.
Among the victims was a young administrator of the Haiti Program, Joseph Dorvil, who was shot to death in December while driving through a slum on the outskirts of the capital. Father Streit has been unsuccessful in his efforts to retrieve the body by paying bribes to local gang leaders.
“This is no way to build a career as an academic,” he says, somewhat ruefully. But professional recognition seems the last thing on his mind, as he sets off in search of patients among the dirt-floor huts of Léogâne.
There is cause for hope. Through mass drug distribution, the Haiti Program has made progress in reducing the prevalence of filariasis in Léogâne. In 1994, 3.5 percent of mosquitoes tested by Father Streit were carrying the parasite. Today that proportion has dropped to 0.7 percent, greatly reducing residents’ chances of becoming infected. At that rate, he hopes, it’s only a matter of time before the disease disappears from the country.