Enough to Make You Sick

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."

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Michael Freedman