The priest and the parasite

by Marion Lloyd

In a country where nearly everything’s broken, one American is trying to eliminate a disease that sickens millions

LEOGANE, Haiti — The Rev. Thomas G. Streit shook his head in exasperation as he surveyed the mountains of dirty, grayish salt piled in a sweltering warehouse.

The salt factory, inaugurated in March in the Haitian capital, is the latest weapon in Streit’s decadelong battle against lymphatic filariasis, a mosquito-borne parasitic disease that causes grotesque ballooning of the limbs and genitals.

By providing clean, medicated salt that prevents the parasites from reproducing, Streit is working to expand nationwide the eradication program he began in the impoverished sugar-cane-growing town of Leogane. He hopes to wipe out the last traces of the disease from this Caribbean nation in the next seven years.

But, once again, the chaos and total absence of infrastructure that complicates even the most basic tasks in Haiti threw up road blocks.

‘’You don’t even have the most basic resources," said Streit, a Roman Catholic priest and biologist at the University of Notre Dame in Indiana.

There was no electricity at the abandoned factory he had paid $150,000 to renovate. The workers, who had never seen flush toilets, left them clogged and overflowing. And the only salt available locally was so dirty that Streit worried that consumers would wash it before use — a common practice in Haiti — rinsing away the medications that Streit was struggling to provide.

But Streit, who spends most of his time in Haiti, is not easily discouraged.

He quickly started an education campaign to convince consumers that the salt should not be washed. And he is working with local producers to help them provide cleaner salt.

So goes Streit’s tireless battle against a disease that, while rarely fatal, has devastating consequences.

An estimated 120 million people in some 80 countries worldwide are infected with the parasite that causes the illness. As many as a quarter of Haiti’s 8.3 million people carry the parasitic disease, and hundreds of thousands will develop its crippling symptoms, which occur when the threadlike Wuchereria bancrofti parasite clogs up the lymphatic system, forcing fluid to collect in the limbs and genitals.

While on a postdoctoral fellowship in Haiti in 1995, Streit helped open the first clinic to treat filariasis patients in Leogane, 20 miles west of the Haitian capital. Four years later, he founded the Haiti Program at Notre Dame, which is supported by a $5.2 million grant from the Bill&Melinda Gates Foundation.

The program has been working to eradicate the disease nationwide through mass distribution of the drug diethylcarbamazine, or DEC, which kills the young parasites and prevents transmission.

The Haiti Program is working together with Haiti’s health ministry and the Atlanta-based Centers for Disease Control and Prevention. But Streit, 46, is clearly the main force behind the efforts to eradicate the disease in Haiti — as well as the public face of the campaign.

Streit said his commitment to fighting filariasis is rooted in his belief in social justice.

‘’I challenge people to come up with another disease so tied to poverty," he said as he walked past a park piled with rotting garbage in Leogane. ’’You look at the world where it exists and there is always horrible poverty."

With an annual per-capita income of $425, Haiti is the poorest country in the Western Hemisphere. It also has the worst housing, education, sewage, and water-supply systems because of to decades of dictatorship and corruption. Health care is virtually nonexistent.

But, in 1997, when the World Health Organization named filariasis among several diseases able to be eradicated, Streit saw a chance to help lift one of Haiti’s burdens. He set the goal of eliminating the disease in Haiti by 2012, eight years ahead of the global organization’s worldwide target.

The combined strategy of drug distribution and fortified salt has worked in China, which has virtually eradicated filariasis. Employing the method in Haiti, which lacks China’s infrastructure and armies of state healthcare workers, has not been easy.

But it is starting to make a difference. The impact of mass drug distribution can be felt in Leogane, which once had the highest rate of filariasis in Haiti. The town’s ubiquitous rum factories are ideal breeding grounds for the mosquitoes, which thrive on the sugary water used in the cooling process, as well as the stagnant pools that collect outside the town’s wooden shacks.

The percent of residents testing positive for the young parasites has plunged from 30 percent in 1999 to about 5 percent today, said Dr. David Addiss, a medical epidemiologist with the Centers for Disease Control who helped coordinate a five-year campaign in the town.

The Haiti Program has sought to replicate that success nationwide, treating more than 1 million people with DEC and albendazole, a drug that fights intestinal worms. It is also providing treatment at clinics in Leogane and in the northern town of Milot.

While there is no cure for filariasis, the clinics’ doctors teach patients to prevent further swelling in the limbs by practicing basic hygiene and doing exercises to improve circulation. The program, which includes a staff of about 60 people, also provides surgery for men with elephantiasis of the testicles, enabling the men to resume normal lives.

But the program’s main focus is on preventing more people from contracting the disease. Its success will depend largely on the salt fortification project, which involves medicating the salt with DEC, as well as iodine to combat the separate problem of iodine deficiency. (Haiti is the only country in the hemisphere that does not fortify its salt with iodine, a mineral critical to proper brain development in children.)

Another challenge is the widespread ignorance about filariasis. Many Haitians believe it is the result of voodoo curses. Streit’s team is working to increase awareness through nationwide publicity campaigns, which include showing videos of infected people in other countries.

‘’People are shocked because they thought it was caused by voodoo," Streit said with a laugh. ’’Now, they trust us more because they saw we were right that it wasn’t a mystical disease."

Many doctors also are unaware that the disease is so prevalent. The majority of the worst cases are among poor Haitians, who are unlikely to visit a doctor. Others are too ashamed to appear in public.

‘’Haitians are very proud, so they hide their disease," said Dr. Madsen Beaude Rochars, the physician in charge of coordinating treatment efforts for the Haiti Program. By the time many patients seek help, they are already suffering from advanced stages of the disease — triggered when people with the parasite get bacterial infections, which cause dramatically increased swelling in the affected areas. Once the disease has reached this advanced stage, it’s harder to reverse the damage.

While always daunting, Streit’s job has become even more difficult since former President Jean-Bertrand Aristide 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 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. Though he has paid bribes to local gang leaders, Streit still has not been able to retrieve the body.

’’This is no way to build a career as an academic," he said, somewhat ruefully.

But professional recognition seemed far from his mind, as he spotted a prospective patient hobbling down the dusty streets of Leogane one recent sweltering afternoon.

’’Imagine your life like that," Streit said, shaking his head in indignation.

* Rev. Thomas Streit is a Research Assistant Professor of Biological Sciences at the University of Notre Dame. *

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