Enough to Make You Sick

The CDC is trying to determine what the residents of downtown Belle Glade already know -- that poverty, drugs, and prostitution are bad for your health

In an empty lot littered with bits of broken glass and fast-food refuse, a man hunches over and pulls apart the weeds as if searching for a lost contact lens. Standing around him are half a dozen men, talking and drinking out of bottles in brown paper bags. Making halfhearted attempts to help out, they kick the dirt, peer over his shoulder, and point at places where he might want to look next.

A young girl hears the men's voices and casually peeks over the second-story railing of a boarding house. Reggae music blares from the Jamaican music store across the street. Above the store, on a fire escape rattling from the force of the music, stands Rosailious Hughley, a downtown Belle Glade resident of more than 50 years who has seen this kind of behavior before.

Bending his arthritic knee, he leans against the rusted-out railing. When "the boys," otherwise known as the Belle Glade police, drive down the main drag, the men in the lot toss their crack vials in the dirt, so that there's no evidence of a crime, Hughley explains, gently stroking his gray goatee. Once the boys have passed, the men retrieve their vials. One unlucky soul didn't take notice of where his vial had landed.

"Everybody's doing it," Hughley said earlier in the day, referring to drug use. "I mean, they're smoking crack, they're smoking marijuana. They're smoking crack and marijuana. It's just a way of life. See now, people want to try and escape reality, and they have to get something to block it. People don't want to see the daylight, because they're scared of it."

Those people are Hughley's downtown neighbors -- immigrants and migrant workers from Jamaica and Haiti and African-Americans who either grew up or eventually settled in downtown Belle Glade. A city of 17,000 residents in western Palm Beach County, Belle Glade is more than twenty miles from the nearest urban area in West Palm Beach. It is bordered by Lake Okeechobee, several smaller towns, and seemingly endless stretches of fertile farmland so flat that, from certain vantage points, they appear to drop suddenly off the edge of the Earth.

As remote as the city of Belle Glade is, the downtown section, where Hughley lives in a boarding-house room, is a pocket so socially and economically isolated that it's referred to by Belle Glade police as "the war zone." In this neighborhood substance abuse is the norm, housing is inadequate, and most workers don't earn enough to pay for the most basic needs, such as food, clothing and health care. Eighteen percent of Belle Glade's residents live below the poverty line (defined as an annual income of $7890 per person in 1997), and most of the impoverished live downtown. All of these conditions, community leaders begrudgingly admit, have paved the way for lifestyles that contribute to the spread of communicable diseases, tuberculosis (TB) included.

With that in mind, the Centers for Disease Control (CDC) has set up camp in Belle Glade to conduct a two-year study. At a cost of $900,000, the federally funded project will determine the prevalence of airborne diseases such as TB and Mycobacterial Avium Complex (MAC) in western Palm Beach County. Both are linked to HIV, which weakens the immune system, making it vulnerable to such diseases. One of the CDC's goals is to study the relationships among the diseases and to develop medicines to combat them.

But the question is: Why Belle Glade? Health professionals claim that the rates for some communicable diseases in the Glades region, which is home to 35,000 people, are extremely high. Between 1985 and 1997, 1175 AIDS cases were reported, 748 of which ended in death, according to the Palm Beach Health Center. In 1997 more than 23 cases of active TB were reported in the Glades region. That compares to 115 cases in all of Palm Beach County, which has a population of one million, according to the Florida Department of Health.

Even more interesting is the fact that the CDC has been in the region for a while. It first conducted tests there in 1986, and since then the Atlanta-based federal agency has pumped $4 million into prevention and intervention programs in the Glades region, but still the high rates persist. It's been a month since the new study began, and CDC officials refuse to dwell on the past.

"The best way for us to start is to carefully define the problems. Then we can talk about how to tackle them," says Dr. Tedd Ellerbrock, who's been working, off and on, in western Palm Beach County since the '80s. "I'm very familiar with how long the problems have been here. They are here, and I don't know how to deal with them."

While Belle Glade is not the exclusive focus of the study, CDC researchers have referred to it as "ground zero," a term that some of the city's inhabitants -- mostly politicians and residents in the middle-class sections of the region -- may not be comfortable with. But the fact is Belle Glade has a history of problems, some of which refuse to go away.

"The whole thing about public health is poverty and the conditions of poverty," Dr. Ellerbrock says. "There's an old maxim that if you want to improve public health, you make everyone middle-class. That hasn't happened out there."

Hughley couldn't agree more. He describes the downtown situation this way: "Down in the colored section, there ain't no jobs. There ain't enough jobs for the amount of people. That's how it is. Everybody's trying to make a dollar off of everybody else. You've got the drug man trying to make a dollar off the poor man. The poor man, he ain't got no job. He's got to get by the best way he can. Some of them rob. Some steal. The younger ones, they rob everybody. It's just bad, any way you look at it."

Hughley is 58 years old, unemployed, and HIV-positive. He is a tall man with thin arms and legs and a potbelly. He doesn't know exactly how he picked up the virus, but he has led a sexually active life. With seven different women, he's fathered a total of seventeen children. He has also had sex with prostitutes, for which he does not apologize. He generally keeps to himself, sleeps during the day, drinks beer in the evenings, and occasionally smokes crack cocaine. On Sundays he goes to church.

Hughley's nighttime hangout is the Blue Bell Bar just across the street from his boarding house. Painted day-glo orange and blue, the building looks like one of those exaggerated movie versions of a backwater juke joint. In the late afternoon, a group of elderly men sit on the curb by the door and chat. Some are older than Hughley, and like him they've been worn down by years of picking vegetables in the farm fields just outside of town.

For at least forty years, western Palm Beach County has been one of the country's biggest providers of sugar cane and vegetables such as beans, lettuce, and sweet corn. A sign welcoming visitors to Belle Glade reads: "Her Soil Is Her Fortune." Historically this fortune has been provided by the labor of migrant workers -- Americans and immigrants from South America, Mexico, and the West Indies. During the fall and winter, the workers would move into Florida, make a few dollars a day picking vegetables, then move north at the end of the spring harvest. In 1960 a worker picking green beans for ten hours would earn about a dollar. And he or she wasn't guaranteed work every day, thanks to the weather.

Low wages, erratic employment, and tough working conditions led to a host of problems. Health care was either unavailable or unaffordable. While their parents worked, preschool-age kids were left unattended in filthy and disease-ridden labor camps. Children who attended local schools were often whisked away in May, the end of most of the farms' season, so that their parents could find work up north. Other kids dropped out of school to work in the fields and help with the family expenses.

At least superficially, conditions have improved. Because an average worker today makes between $7000 and $13,000 a year, parents can afford to remain in Belle Glade past the end of the season, allowing their kids to finish up the school year. But not everyone downtown works, and even those who do have only enough money to afford inadequate housing, where ventilation is sometimes poor and allows airborne diseases to spread, especially in overcrowded rooms and apartments. People living in these conditions turn to drugs for comfort, and drug addiction, along with unemployment, leads residents to rely on other means of earning an income, such as exchanging sex or drugs for goods and money.

As daylight dwindles on a recent Friday afternoon and workers return home from the vegetable fields, reggae music mixes with the clamor of voices, some of them coming from the "jitterbugs," as Hughley calls them, young men either still in or barely out of high school who hang out on the streets all day, selling dope, drinking beer, or both. Most of them still live at home with their parents, and, with the help of drug money, they enjoy an easygoing lifestyle. What they don't realize, Hughley says, is that that lifestyle won't get them out of Belle Glade.

The same goes for some well-laid plans. When Hughley was growing up, he was an exceptional athlete who believed he might someday play professional football. When he was eleven years old, he visited his mother's family in Cleveland for three months. He liked it there so much that he realized for the first time just how bad his hometown was. "I told my mama, 'I don't want to go back to Belle Glade,'" he recalls. "I said, 'Let's stay up here in Cleveland.' I said, 'I can make it good up here.' But she said, 'We got to go back to Belle Glade.'"

"But this ain't shit," he grumbles, seated inside his cramped room. "You can't get nothing down here in Belle Glade, nothing but put in jail. I was eleven years old. I knew what I was coming back to when I was eleven years old."

In 1952, a year after Hughley returned from his trip to Cleveland, a health official, testifying at a U.S. Senate subcommittee hearing on labor relations, reported that he saw 180 people living in a 60-room Belle Glade migrant labor camp with only one toilet. In another camp he found 48 babies stacked atop one another on two beds while their parents worked in the fields. At the same hearing, the director of the Palm Beach County Health Department testified that many of Belle Glade's migrant shelters weren't fit for cattle.

Those reports were neither new nor unusual. A decade earlier a state report noted that in the Belle Glade area, open-pit toilets were located next to or within the only water supply. A child's meal consisted of a cold corn cob, tomato, dried prunes, and beer. A Palm Beach County health officer reported that the board of health knew about and ignored 21 sick children with dysentery living together in a boarding camp. By the time Hughley started school, Everglades historian Marjory Stoneman Douglas had described his neighborhood as "a human jungle."

Open-pit toilets are no longer the norm, but in Hughley's building the hallways, filled with puddles of stagnant rainwater, reek of mold and mildew. Earlier this month he arrived home from the Blue Bell at 4 a.m. to find a young woman standing alone outside his doorway, smoking crack. It wasn't the first time. "I just tell them to get that dope out of this hall and take it with them," he says coolly. "Smoke it anywhere but here." Sometimes the drug users give him a hard time, but the girl didn't say anything as she descended the concrete steps into the darkness.

Hughley is better off than some. The homeless and many drug addicts dwell in the more than 80 abandoned buildings in the city. Some spend their late-afternoon and early-evening hours playing dominoes in empty lots. The city has cited dozens of buildings for code violations and bought dozens more to be renovated, according to Mayor Steve Weeks, a lifetime resident of the city. But he offers a number of reasons why the city is unable to do more.

Problem one: Many downtown buildings are so old that it is nearly impossible to bring them up to code. Landlords would rather demolish the dirty, poorly ventilated buildings than spend the money to renovate them. The results would be a loss of tax revenue and an increase in homelessness. Problem two: Some downtown residents, particularly those on crack cocaine, simply will not change their lifestyles. Problem three: With its constant demand for cheap labor, Belle Glade continually attracts migrant workers who may be carrying diseases and are willing to live in substandard housing.

"Our biggest problem is unemployment," Weeks says. "We have an unemployment rate of 30-plus percent. We have poverty of 18 percent. When you have these numbers and growth at 2 percent a year, we have to work within a framework of a dwindling tax base."

The migrant workers to whom Weeks refers are up well before the sun. Most of them are Haitians, and in Belle Glade they gather in a downtown parking lot referred to as "the loading ramp." When they arrive, they climb aboard school buses provided by various agribusiness conglomerates, including A. Duda & Sons, one of the nation's largest fresh-vegetable companies. Once on the bus, they're told what the day's wages will be, and if it doesn't sound like enough, or if someone has heard that another farm is offering more, they'll exit the bus and try another one. If that bus is full, however, a worker may be shut out for the day. When the buses are full, they head for the farms, some of them carrying workers who have been guaranteed work for an entire season.

Thirty years ago Hughley would have been down at the loading ramp every morning. If you ask him about honest labor, he talks about the days he spent in a pool hall racking balls, the time he spent working in a laundromat, his years at a packing plant or picking corn and throwing hundred-pound crates of vegetables into a pile for nine hours a day to bring home a $50 paycheck. If he was lucky. Steady work was hard to come by, because a farm owner's needs were always changing, as was the weather. And the work was physically demanding, Hughley says. That part of it got old really quick.

He began his hand-to-mouth existence when his bid for a college football scholarship got sideswiped by a case of mistaken identity. Hughley was charged with murder just before beginning his last semester of high school. "Some guy said he saw me and this dude fighting," he explains as he sits down in a Burger King for his first decent meal in days. "He made that statement, but he had me wrong. It wasn't me. It was someone else. I was home in bed." Eventually the judge dismissed the case, and the police found the actual killer. But by the time Hughley's name was cleared, he'd missed his final semester of high school.

So, rather than go to college, he went to work in the fields with many of his former classmates. All were destined, he says, for a lifetime of either terrible jobs or the alternative: crime and possibly time in jail. When he was in his twenties, Hughley was so desperate that he and the mother of one of his kids struck up a deal: She'd become a prostitute, and he would be her pimp. That was his full-time job for seven years.

In downtown Belle Glade, trading sex for basic necessities such as food and money for bills, is a common practice, according to Dale Stratford, an anthropologist at the University of Florida. For years Stratford has been studying high-risk sexual behavior in the Glades.

"You find that, in people's lives, certain pressures loom pretty large -- like their economic situation -- that come to bear on decisions people make," she says from her office in Gainesville. "Patterns of behavior become established in the community."

Hughley was diagnosed with HIV six years ago. Weakened by the virus and suffering from an arthritic leg, he hasn't been able to work much. He's also been told that he's ineligible for any sort of federal disability payment, so he relies instead on food stamps, prayer, and an arrangement with his landlord, who allows him to clean the toilets and the hallways of his building in exchange for a room. His room, which normally goes for $40 a week, stinks of urine. Whenever it's raining outside, a stream of dirty water trickles down the wall and toward his pillow, like some kind of water torture. The room is barely big enough for Hughley's bed, a decades-old refrigerator, a TV, and a bureau. Hanging on the door is a picture of John F. Kennedy, and attached to the picture, in the upper left-hand corner, is a much smaller photograph of Martin Luther King, Jr. Near the TV is a copy of the Bible, and on the bureau is a crinkled picture in a heart-shaped frame of a baby girl. Her name is Shameka, and she's one of Hughley's seventeen children.

Outside Hughley's door, residents and drifters smoke crack and spit on the cold hallway floor. "See, it's so easy for people to do wrong," Hughley mutters. "You can't tell them nothing, because you tell them to do something, and they think you're crazy."

On the other side of town, several miles from Hughley's residence, is the CDC headquarters, otherwise known as the Glades Health Survey. Over the next two years, CDC scientists will attempt to determine the extent of the communicable-disease problem in Belle Glade and the nearby towns of South Bay, Pahokee, and Canal Point. What the CDC will do with the results is still up in the air. "I don't think the study itself will do a whole bunch," says Sandra Chamblee, the survey's administrator. "But I think the more publicity that is given to these diseases, that will help. Maybe people will think, 'Hmm, I haven't had a skin test [for tuberculosis].'"

For the study the CDC will randomly choose 800 western Palm Beach County addresses and ask one member of each household to participate. Participants will report to the Glades Health Survey building, which is within walking distance of downtown, and submit to blood and skin tests. Test results will be kept confidential, and each participant will be given $50. Anyone who has lived in western Palm Beach County for at least one month is eligible.

Results of the first CDC study, conducted in the mid-'80s, showed that the AIDS rate in the Glades region was 295 cases per 100,000, according to a 1986 article in Science magazine. Manhattan's rate, meanwhile, was 270 per 100,000, San Francisco's 316 per 100,000. Since that first study, CDC officials have helped both local and state health officials establish HIV prevention programs, according to the CDC's Dr. Ellerbrock. Despite these efforts, AIDS and, lately, TB rates are still higher in the Glades than elsewhere in the nation. Spencer Lieb, an epidemiologist with the Florida Department of Health, says that in western Palm Beach County, more than 80 AIDS cases were reported in 1997 alone.

Those numbers and the CDC's presence are cause for concern for some Glades residents. After the CDC's study in the '80s, Belle Glade's reputation was tainted. A series of newspaper and magazine articles described parts of Belle Glade as "fetid." Discover magazine labeled the city "the unofficial AIDS capital of the world," describing it as a "squalid, mosquito-infested shantytown." Chamblee says the resulting notoriety destroyed the local economy. Travelers on their way through town refused to stop, high school football teams didn't want to compete in the city, and tourists stopped fishing in nearby Lake Okeechobee. The ownership of a local motor lodge changed hands three times. Checks from Belle Glade banks would no longer be cashed on "the coast," the generic term for the rest of Palm Beach County.

Because of the negative publicity generated by the last study, Chamblee says many residents were reluctant to permit Ellerbrock and the CDC to conduct yet another study. But after more than a year of vigorous debate in town and civic group meetings, politicians, activists, and community leaders decided that moving forward with the study was necessary. Only this time they demanded that the CDC work in tandem with the community. With that in mind, Chamblee, a community activist, was hired as the project's administrator, and a board was put together from various segments of the community to maintain fiscal and administrative control. The board also hired a public relations director and insisted that only certain members would be allowed to discuss the research publicly. All of this, they hope, will allow the Glades to get the help it needs without also acquiring the stigma.

"Do you know how many people I've heard say, 'The Glades is a dirty place?'" asks Mary Piper Kannel, the interim client services director of the Comprehensive AIDS Program (CAP), a countywide AIDS and HIV case-management program. "And I say, 'When was the last time you've been there? And they say, 'Oh, I've never been there.'"

In fact, she is quick to point out, there are a number of AIDS prevention and education programs that work in conjunction with community leaders and volunteers. Programs exist throughout the city to distribute condoms, to educate students about drug use and safe sex, and to help low-income residents find adequate health and prenatal care in western Palm Beach County. Kannel, who is on the health survey board and does not live in the Glades, says it is impossible to determine the success of these programs. She notes, however, that CAP provides counseling to 300 Glades clients and helps them get treatment for HIV and related illnesses. Without programs such as CAP, she says, the problems would be much worse.

While this may be true, the health problems in the Glades region have deep historical roots. As early as 1917, when an epidemic of typhoid fever nearly destroyed the entire population of Moore Haven, a nearby town in Glades County, residents thought first of their reputation, and second of solving health problems. "Some of the sick folks were taken care of here, but most of them were sent to the nearest hospital, which was in far off Tampa," Belle Glade icon Lawrence Will wrote of the epidemic in his 1964 book, Lawrence Will's Cracker History of Okeechobee. "Nobody died, but the health authorities quarantined the town and tried to have it declared unfit for human habitation, and that didn't help this town's reputation much."

More than 40 years later, as the migrant worker became a permanent fixture in western Palm Beach County, the health problems still had not been addressed. In the classic CBS news documentary Harvest of Shame (1960), which chronicles the plight of the migrant worker, nine-year-old Jerome King leans against his bed in a Belle Glade labor camp. One of his feet is scabbed and rank-looking, as if infected. He explains that his mother simply poured alcohol over the wound to wash it. Later in the film, Jerome's mother, Allean, tells the reporter that, even after picking beans for as much as ten hours a day, she doesn't make nearly enough to support her fourteen children.

Today, Jerome King lives with one of his sisters and several of their respective children in nearby South Bay in an old A-frame house. Desperately in need of repair, the house sits precariously on a series of crumbling pillars. The two cars in the driveway have flat tires. Although many Belle Glade residents and politicians claimed Harvest of Shame was way too sensational at the time, King says he found it to be completely accurate in its portrayal. Like his parents before him, King is a day laborer in the fields, picking beans and sweet corn.

The city's history notwithstanding, politicians are as short on answers now as they were when Harvest of Shame was first broadcast. When Weeks was asked why the city has done so little for so long when it comes to health problems, he said: "Beats the heck out of me."

Others involved in the community outreach effort offer more revealing responses: "OK, bottom line, there was prejudice," acknowledges Kannel. "You know what? There probably still is." Middle-class residents who did not have to go downtown simply ignored the problems because they were not in their back yard, she notes.

But some community leaders and doctors claim that attitudes have changed.
"I think the previous times the people here have had the knowledge, but they didn't have the political will," offers Dr. C. Robert Horsburgh of the CDC. The makeup of the Glades Survey board represents all segments of the community, an indication, he says, that this time the will to make some serious changes exists.

For his part Hughley is a lot less optimistic. He says that, in the last 50 years, the health problems have only gotten worse. Thirty-one years ago tuberculosis killed his father, who was a migrant worker laboring in the vegetable fields. The way Hughley remembers it, his father lived and worked for seven years with only one lung. That lung eventually collapsed from the strain. Six years ago his only brother died of pneumonia. His mother died the same year. Of what, he's not sure; he just knows that he found her lying in her bed one day, a trail of dried blood trickling from her nose. The Hughley family members' illnesses may very well have been treatable, but he says they couldn't afford adequate health care. Already diagnosed with HIV at the time of his mother's death, Hughley moved out of his mother's house that year and into a tiny room downtown.

"When I got back here, I got stuck," he says, remembering that return trip from Cleveland more than 40 years ago. He laughs at the thought, and soon the laughter turns into a phlegmy cough. He doesn't have tuberculosis, he claims, because he gets tested for it as part of his HIV treatment. He simply has a cold.

"You really get stuck in this place," he resumes. "You get where you have no money, no job, no clothes. It really got bad here.

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