As an infectious disease research fellow at the UC Berkeley
Center for Infectious Disease and Emergency Readiness (CIDER)
and at UCSF, I conduct research using computer models to
better predict and control infectious diseases. However,
since late January, I have been working at Hôpital de
l’Université d’état d’Haiti, the public university hospital
in Port-au-Prince and the largest hospital in Haiti.
Much of my day is spent caring for TB patients. I provide care in a tent where the temperature is usually 90 to 100 degrees Fahrenheit. Many patients arrive critically ill, with longstanding TB and oxygen saturations in the 60s and 70s, which is much lower than one would ever see in a chronically ill patient in the United States. Managing these patients has been challenging. There is some laboratory capacity, but most decisions are made solely based on clinical evaluation. Sometimes my job is simply to make sure I have managed my patients’ fluid status and avoided heat stroke. I also make sure they have enough food and water, which is difficult as the hospital can run out of food for up to a day at a time. The resources are intermittent. We have dialysis, but usually
This raises substantial concerns about the long-term effects of this disaster on the public health infrastructure. Haiti faced the largest per capita burden of TB before the earthquake. Now there is the risk for increased spread without the infrastructure to manage daily treatment, the follow-up for sputum clearance (an indicator of infectiousness), and the management of TB medications to avoid the spread of anti-TB drug resistance.
At the moment, Haiti has very little general antibiotic drug resistance overall. So I have been encouraging doctors to use medicines which we think of as “weak” in the United States, but which are actually more powerful when the bacteria are not resistant. So we can use penicillins and cephalosporins, and we do not need Vanco or expensive broad-spectrum antibiotics commonly used in the United States.
With my background in infectious disease mathematical modeling, I keep thinking of how the density of the populations in tent cities creates the perfect kindling for transmission and disease outbreaks. I also begin wondering how the selection pressure of the antibiotics brought by expatriate doctors will affect the development and spread of drug resistance long term. This would be one legacy we do not want to leave behind.