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House Call in Hell
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A Divine Mission
Overcrowding, poor sanitation, and a general lack of funding in Haiti's National Penitentiary have caused it to become one of the worst in the Western Hemisphere. Reporter Antigone Barton and videographer Stephen Sapienza take a first-hand look at these conditions and an American doctor working to correct them.
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Produced by Stephen Sapienza.

Find out more about the Pulitzer Center on Crisis Reporting.

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Segment 1

TITLE
Toussaint Louverture International Airport, Port-au-Prince, Haiti
DR. JOHN MAY [PHYSICIAN]
My name is John May; I'm a physician in internal medicine. I've been practicing for more than 15 years in the field of correctional healthcare. I'm the chief medical officer for a company in Miami, that's my full-time job. My other life is volunteer service. I'm looking at how we can bring some of the skills and systems that we have in place, that are effective and functional in the United States, to developing countries.
TITLE
In the wake of a massive crackdown on organized crime and urban gangs, Haiti's National Penitentiary is a dangerously overcrowded powder keg. Poor physical conditions contribute to cases of physical and sexual abuse, and the rates of tuberculosis and HIV are far higher than the national norm.
DR. JOHN MAY
We flew into Haiti this morning to continue our work at the prison. I go to the National Penitentiary every two months or so, sometimes more frequently than that, to follow up on some patients and try to deliver care and make steady improvements in the system there. The prison is officially designed for about 1,050 persons; today's population is 3,054 inmates.
DR. JOHN MAY
This is the Titanic Building, it was built just a few years ago with international funding, but it never had any provision for plumbing. The thought at the time was that people could leave their cell areas and go out and use the toilets, but it's so crowded now they have to keep it locked down almost all the time. So you'll see the waste all over the floor and the water as they hose down the areas, but the smell will be obvious. To urinate you have to go through the bars, to defecate you have to put it in a plastic bag and toss it out. This will be the focus of the intervention now.
DR. JOHN MAY
Ask him how many are in here now.
MAN 1
Forty-seven.
DR. JOHN MAY
The intention was that the inmates would be able to leave the cell areas and go to the latrines, go to an outdoor area where they've got some pits and access water that way. But because of the crowding and the fact that there are very few staff persons to maintain a safe environment, they're locked down in these rooms and the rooms are mostly all small, different sizes maybe, 20 by 20 room designed for twelve people and some have 50, and 60 and 70 persons all crowded into them.
DR. JOHN MAY
These rooms -- ask how many people are in this one.
MAN 1
Sixty-seven.
DR. JOHN MAY
There's no running water, no plumbing, they're allowed out maybe an hour a day to shower or maybe get some exercise.
DR. JOHN MAY
Soap is very important; it's a commodity that the inmates really need and appreciate. Unfortunately soap is heavy but we at least bring one suitcase full of soap. I always, before the trips, run to the flea market or a discount store and fill a suitcase with soap that we can distribute. Walking into the prison with the soap can be really overwhelming, and at first it threw me back, I was afraid we were going to start little riots because everyone clambers for it. It's a sad thing to see the frustration and the intensity with which they want just a simple bar of soap. I don't think we'll cause riots with the soap, and we haven't, and I've come to appreciate that somehow this place has not blown up. It seems like it's really on the teeter to explode. How all these people can be cramped in such a space under such conditions, and still there's stability there, it's a fascinating thing to study and figure out. They're still clinging on to hope. When you can provide something as small as a bar of soap, it gives someone some hope.
DR. JOHN MAY
We're not sure what he has. He started with Beriberi. You can find it in the literature in World War II, in the camps prisoners would get Beriberi. It started emerging here a few years ago, and a simple thiamine pill or injection could cure it, but I don't think he got the replacement quickly enough, that's why he has the swelling in his feet now. I think the opportunity was missed to reverse it. It could have been cured easily with just a vitamin, a thiamine.
DR. JOHN MAY
Infectious diseases are a huge concern in the prison. Many come in with infectious diseases, and then crowded in these tight areas the diseases can flourish. Mostly we're talking about tuberculosis, scabies. We had an enormous problem with scabies. Certainly sexually transmitted infections and HIV are prevalent throughout the prison.
DR. JOHN MAY
When was your last test, when did you say you had it? A year ago? Here, or in the States? What was the result then? It was negative? Okay. These are rapid tests, they are preliminary, it's not a final, but it's concerning me that the preliminary test is positive. But we have to do more tests with the samples that I took.
DR. JOHN MAY
Tuberculosis, HIV, sexually transmitted diseases, are things that if not properly managed within a medical setting can develop drug resistance, they certainly will spread to others, and most of these inmates are going to go out into the community. If we're not addressing the problems, then we're actually incubating and creating a worse problem, and it will flourish and we'll spread this to the community.
TITLE
In August 2007, a private donor gave $25,000 to Dr. May's organization to launch a cleanliness initiative at the prison called "Titanic Plus."