Infections and Inequalities

Anthrax. The word conjures images of germ warfare, which is pretty ridiculous when you discover that we're not really sure anthrax has ever been used in this fashion. Germ warfare is certainly not what came to mind when a six-year-old girl showed up in our clinic with half of her face puffed up like a balloon, her right eye swollen shut (Figure 1). We were in rural Haiti, where a very different sort of germ warfare is the rule. So what came to mind that day was the word epidemic, and sure enough a young woman from the same village was also diagnosed with cutaneous anthrax—called charbon in Haiti, "malignant pustule" in the older textbooks—on her right chest wall. Soon after their arrival, both were receiving intravenous penicillin; they would recover completely. Later that night, the clinic's medical staff held a meeting. Another anthrax case had been diagnosed a few days earlier, and the patient was from the same area. It seemed increasingly likely that we were dealing with an epidemic. By morning, we learned that a young man from the village had just died of charbon. Why? "Because he didn't have enough money to get here." It costs no more than four dollars to take a truck from their village to our clinic. It was an epidemic, all right, and it had already taken a life.