Toussaint Louverture International Airport in Port-au-Prince, Haiti

My name is John May. I'm a physician of internal medicine, practicing for more than 15 years in the field of correctional health care.

I'm the chief medical officer for a company in Maimi — That's my full time job.

My other life is volunteer service,

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.

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 norm.

I flew into Haiti this morning to continue our work at the prison, I've been

brought 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 study improvements in the system there.

The prison officially is designed for about 1,050 persons.

Today's population is 3,054 inmates.

This is the titanic building.

It was built just a few years ago with international funding.

But it never had any provision for plumming.

They thought at the time 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, you know, 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 deficate you put it in a plastic bag and toss it out.

This is the focus of the intervention now.

[Doctor May] Ask them how many are in here.

[in French] How many are in there?

47, 47 people

The intention was that the inmates would be able to leave the cell areas and go to the latrines

or to an outdoor area where they've got some pits

and access water that way, but because of the crowding and 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 a 20 by 20 room designed for, you know, 12 people and some have 50 and 60 and 70 persons all crowded into them.

And these rooms. Ask how many people are in this one.

[in French] How many people are in there?

67

There's no running water, no plumming.

They're allowed out maybe an hour a day to shower or get some exercise...

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

and 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 first if you're in the back, I was afraid they were going to start little riots because everyone clambers for it.

It's a sad thing to see the...the frustration

and intensity with which they want to get just a simple bar of soap.

I don't think we'll cause riots with the soap and we haven't.

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, and when you can provide something small as a bar of soap,

it gives someone some hope.

We're not sure what he has...

He started with Beriberi. You can find it in the literature in WWII camps. Prisoners would get Beriberi.

It started emerging here a few years ago. A simple thiamine pill or injection could cure it.

But I don't think he got the replacement quickly enough and that's why he's got the swelling in his leg now.

I think the opportunity was missed to reverse it. It could have been cured easily with just a vitamin of thiamine.

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.

When was your last test, day you said you had it? A year ago.

A year ago. Here or in the States?

Ok. What was the result then? Negative. Ok.

These are rapid tests and so they're a preliminary. It's not a final.

But it's concerning me.

That the preliminary test was positive.

But we have to do more tests with the samples...

Tuberculosis, HIV, sexually transmitted diseases are things that if they're not properly managed

within a medical setting, they can develop drug resistance, they certainly will spread to others.

And most of these inmates are going to go out into the community.

And if we're not addressing the problems here, we're actually incubating and creating a worse problem

and it will flourish and we're going to spread this to the community.

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."

Produced by the Pulitzer Center on Crisis Reporting and Azimuth Media

Reported by Antigone Barton and Stephen Sapienza

Videography by Stephen Sapienza

Translators Ana Valdes, Daphne Duret, Danielle Barav

Additional footage provided by Pan American Health Organization and United Nations Film & Video Library

Funding provided by MAC AIDS Fund