Megan Coffee, M.D.

Early on the afternoon of January 12, 2010, Dr. Megan Coffee, 33, was working at a computer on the University of California, Berkeley campus modeling the spread of infectious diseases, research she does for that university and the U. S. Veterans Administration. In the midst of her work, she received an email from a friend in Haiti before the news even broke, informing her that a huge earthquake had struck Port-au-Prince. An infectious disease Fellow at the University of San Francisco Medical School, Dr. Coffee had studied infectious disease in Haiti and intended to come to the country, using her saved vacation time, in May. The earthquake changed her plans.

Megan Coffee talks with a TB patient being sent home from the hospital.

Cat Laine, who works with the Appropriate Infrastructure Development Group (AIDG) (www.aidg.org) , an NGO in Haiti, contacted Dr. Coffee not long after the earthquake and asked her if she could come down to help with the infectious disease situation. Almost all of the local infectious disease specialists were missing for one reason or another, and very few foreign doctors with this specialty had come, as initially the need was for surgeons and other trauma care specialists. Dr. Coffee arrived in Haiti, via the Dominican Republic and bringing as much medication as she could manage, two weeks after the earthquake struck.

Once on the ground, Dr. Coffee was approached by a relative of a Haitian-American doctor and asked to work at the Hopital l’Universite d’Etat d’Haiti, the General Hospital in downtown Port-au-Prince. She met with one of the few Haitian infectious disease specialists remaining there and realized immediately that tuberculosis, TB, was the most significant infectious disease affecting the post-earthquake population. However, in many cases the TB was complicated by the patient also being HIV positive. Together with Mulhouse Charles, a Haitian nurse who recruited other nurses to come to work at the hospital, Dr. Coffee established an approach for addressing this dual threat.

“Actually, living and working in San Francisco was excellent training for Haiti. It’s probably the only place in the U.S. with a higher HIV infection rate, among men anyway, than here.”

Megan Coffee studies a TB patient's x-ray.

Due to their weakened immune systems, HIV positive individuals tend to get worse cases of TB than those who are HIV negative. They are also more likely to contract new strains of TB from other patients in the hospital. TB, for its part, further stresses the already weakened immune system, making the development of AIDS more likely. To break this vicious circle, Dr. Coffee decided to simply treat all HIV positive TB patients for both conditions.

HIV treatment has now developed to the point that a patient only requires one pill a day. For TB, the regime is a bit more onerous. TB treatment requires the patient, depending on weight, to take between two and five pills, each of which contains four medicines, each day. The patient should also take one multivitamin each day to prevent nerve damage that causes foot pain.

“People taking their meds makes a huge difference. It not only helps the individual, but reduces illness in the general population as well.”

The TB/HIV ward, a large tent on the grounds of the hospital, opened January 1, 2011. Dr. Coffee now has a staff of sixteen Haitian and one American nurses. She depends on a variety of NGO’s, International Medical Corps (www.internationalmedicalcorps.org), (See International Medical Corps), Partners in Health (PIH) (www.pih.org), (See Guerrier Carmen and Kerline Jean Louis, June, 2010) and Operation Blessing International (www.ob.org) among them, as well as the Haitian government and the kindness of strangers, to supply the means to continue her work.

A patient in the TB/HIV ward

“It’s amazing. People just show up with stuff. A woman came by the other day with a carload of diapers. I don’t question it.”

As for the future, Dr. Coffee plans to stay in Haiti at least until July. Her one year leave of absence from her UCSF infectious disease fellowship is up July 11. Nevertheless, she’s frankly undecided about what she will do. Obviously, it’s not easy to leave possibly the most rewarding job you’ll ever have.

Postscript

Using the phone number Brillant got from her sister Rosemante, International Medical Corps located the woman in the Acra Sur tent camp who had been wasting away from an undiagnosed illness for a year or more  (See Acra Sur Tent Camp).  An International Medical Corps team transported her to the Hopital l’Universite d’Etat d’Haiti (General Hospital), where Dr. Coffee examined her and determined that she is suffering from TB.  The woman is now receiving treatment at the hospital and her condition is improving.

To see more pictures, go to  www.vichinterlang.com.