LA BRILLERE, Haiti -- Behind a flimsy curtain, a doctor armed with a dozen used syringes and a single vial of penicillin works on the front line of Haiti's newest hell, a disease so lethal that it is stockpiled for biological warfare.
He's treating scores of people for anthrax -- almost never seen in the developed world but passed on from sick livestock to people too poor or too hungry to destroy and burn the tainted animals.
"It is killing a lot of people here. I see as many as eight new cases a day," said Edouard Nemorin, 56, at his dirt-floored clinic in this northeast Haiti village. "Some people get badly, badly swollen, and then they die suddenly, like that." He snapped his fingers.
One hospital alone reported about a dozen deaths in the past two months, but no one is keeping count.
Anthrax is so infectious and lethal that it's stockpiled by several armies as a biological weapon. An accidental release of anthrax spores from a Soviet research center in 1979 killed hundreds; the Pentagon called it perhaps the world's most deadly biological accident.
If ingested by eating bad meat, the Bacillus anthracis rips through a person's digestive tract, causing grotesque bloating that can be fatal in 36 hours, doctors say. Physicians here in northern Haiti speak of faces that balloon to nearly twice their normal size and tongues that grow as long as cows' tongues.
The disease flourished in the Middle Ages but is now relatively rare.
"We thought anthrax was cured. We thought it was gone from here -- and everywhere else," said Bill Clemmer, a Georgetown-trained physician who works in a northern Haiti hospital. "If there was ever two or three cases in the United States, U.S. authorities would be up in arms. They'd send teams of investigators. Here, we have no idea of how widespread it is."
In fact, rare outbreaks of anthrax from tainted meat still occur in developing nations. Eighty died in Ghana in 1988. Five died in Haiti from 1985 to 1988. In the United States, the last case was reported in 1980.
Health care workers blame the current outbreak here, about 20 miles south of Cap Haitien, on the steady deterioration of conditions over the last several years, and not just the instability wrought by the military coup against President Jean-Bertrand Aristide in 1991.
Preventing anthrax is simple: You vaccinate all goats, cattle and horses. Haitian law requires those vaccinations, prohibits the slaughter of unvaccinated animals and mandates the burning of every animal suspected of having anthrax.
But who is enforcing Haitian law these days? Who is running the vaccination programs?
No one, here. For several years, say villagers, the vaccination program has gradually fallen apart.
And even though word of the epidemic is widespread, some Haitians are slaughtering their sick animals and taking a chance on the meat, health workers say. For many poor families, a cow is their largest investment. If the cow dies from anthrax, they have little means to earn enough money to feed themselves.
Animals become infected by grazing on contaminated land. The anthrax bug produces spores that can survive dormant for many years in soil and animal products.
Anthrax is so contagious that an infected animal can transmit the disease through spores in the air. Even in the worst cases, antibiotics can cure the disease -- if caught early.