Coffee's infectious disease clinic occupies two small temporary buildings and a tent on a corner in the middle of a still-collapsing University Hospital in Port-au-Prince, Haiti. Here, 45 patients who would normally require medical regimens running many thousands of dollars in the United States are saved with a simple regimen of inexpensive, antibiotics administered over a six to eight month period in combination with food supplements and when necessary, HIV medications. Coffee's work load is overwhelming. Just muscling an oxygen tank from storage to the clinic is a physical challenge.

Tuberculosis in Haiti is both rampant and undiagnosed. Horrendous living conditions, such as this open cesspool beside the tin roofed hovels in the La Saline section of Cite Soleil, the worst slum in Port-au-Prince, serve as breeding and transmission grounds. Under such circumstances, tuberculosis spreads rapidly through contact with friends and family members unknowingly infected with the bacteria.

Meet Timoun, or Ti poul, little chicken or chickie in English. She is eleven years old, illiterate, and an orphan. Her aunt lacks the money to send her to school. Ti poul is on oxygen and is being given tuberculosis medicines. She has the bloated stomach, stick-like limbs, and reddish brown hair of a Ckwashiorkor (a starving person) that is common among so many tuberculosis victims. After months in the clinic, Ti poul is on the road to recovery, although her long-term prognosis is uncertain. "She requires oxygen, from a machine, at all times." (Dr. Coffee)

Surrounded by poverty in the crowded Brooklyn section of Cite Soleil, malnourished children are especially susceptible to tuberculosis bacteria. Often mistaken for the flu or malaria or some other disease, the illness goes undetected until a patient arrives at Dr. Coffee’s tuberculosis ward, is tested, and diagnosed. TB vividly illustrates the massive gap between rich and poor. Improperly treated, or untreated, TB is a dreadful, deadly disease that eats away at lungs and often other organs of the body, including bones. About two billion people -- roughly one third of the world’s population -- have TB bacilli in their bodies.

TB kills more adult Haitians than any other disease. One way it kills is by suppressing appetite. Tuberculosis patients can stop eating and starve to death. This mother is using a large plastic syringe to force feed her son a kind of high-protein slurpy. For many days he had refused food. Dr. Coffee and family members shamed him into eating. They explained that, if he died, it would bankrupt the family, which would expend all of its money on his funeral, to be left penniless.

Death surrounds the tuberculosis ward. Just down the road is the hospital morgue. Every day coffins are carried past the clinic. Coffin makers do a thriving business in Port-au-Prince. Gunshots are still heard nearby on Champs de Mars. In the weeks after the earthquake, the TB ward was little more than a fly-infested shell hastily erected alongside the rubble of the demolished sanatorium that provided the only TB care in Haiti.

The man on the right is a prisoner. His foot is shackled to the bed. Convicted of fraud, he was about to finish his sentence. He describes Haitian prisons as worse than hell: hot, crowded, dark, dirty, and dangerous. He had sent six months with thirty other prisoners in an unlit cell reeking of shit, urine, body odors. He ate maggot infested food. His prison had served as a prime incubation and transmission cite for TB. His time in the tuberculosis unit had transformed him. Once a hardened criminal, he soon became one of the sweetest and most vocal advocates, and a friend to other patients, whom he comforted

May day street protest near the National Palace demanding food and better health care.

Many in Dr. Coffee’s clinic are orphans or without family. Most are young, in their twenties, but some under ten years of age. Many lack sufficient resources to purchase additional food to gain weight. The woman on the right is deaf. Many are homeless. Dr. Coffee does not release patients until they have some place to stay. She works her contacts until she finds shelter, even if it is just a tent.

School children pass a crippled man living on the street outside the main hospital.

Dr. Coffee reviews the X-ray of a new patient admitted with advanced tuberculosis and malnutrition. The X-ray shows the outlines of encysted cavities, full of TB bacilli, their infiltrates appearing as white splotches and smears, almost like cirrus clouds in a black sky. She points to a spot where the lobe of one lung had been eaten by TB. She will place the patient on oxygen, and initiate a regimen of antibiotic treatment supplemented by Ensure, a high nutrition food supplement. Many of her patients turn out to be HIV infected, and tend to have worse cases of TB because of their weakened immune systems. They are also very likely to contact new strains of TB from other patients. TB stresses the already weakened immune system, making AIDS more likely. Coffee attacks this cycle by treating HIV positive patients for both conditions.

TB thrives in circumstances like those percolating in the crowded shelters and open sewers on the edge of La Saline where it abuts the bay in Port-au-Prince.

A nurse swabs the floor in the clinic at the end of the day. "Oui. oui," chirps Dr. Coffee, poking her head inside the ward. "Oui, oui, "says the nurse. "Ou-i-i-i-i," says Dr. Coffee. "Okay".

Homeless woman begs outside the main hospital

One day I followed Dr. Coffee from the moment she arrived early in the morning, the first of several such tag-alongs. She moved quickly from e-mail, to a conference with her nurses, through consultation with a Google technician Neal Sidhwaney donating time to simplify and computerizing medical files, to an examining table which was little more than a bench beside a wall. At the entrance to the clinic a crowd of patients waited for her on numbered chairs outside a tent that serves as a consultation office. They were also waiting there on May 31, her 34th birthday, with balloons, a basket of fruit, and a bottle of champagne. The party was organized and financed with pennies surreptitiously collected over many months by one of her patients, Lynsa Mathieu, who had lost a mother, sister, cousin, and one-year-old son in the earthquake. "Dr. Coffee made me smile again," she told a reporter. "I never thought I'd smile again."

Outside the hospital, Haitians carry on amid collapsing rubble.

Dr. Coffee consults with outpatients near the Port-a-Potties. She survives on donations of medicine and supplies from various Non-Governmental Organizations (NGOs), and money raised through her Twitter account as DokteCoffee, the Haiti Mission Project (www.haitimissionproject.org) , Real Hope for Haiti, International Medical Corps (www.internationalmedicalcorps), Partners in Health (www.pih.org), and Operation Blessing International (www.ob.org). But people who have heard about her work often just stop by and deliver materials. "People just show up with stuff," she says. " A woman came by the other day with a carload of diapers."

Joyous TB patient who once performed in the clubs of Port-au-Prince and Paytonville sings to the photographer after a thoracentesis relieved his pain. He had been unable to stand, and had arrived in a wheel chair

Dr. Coffee performs her sixth thoracentesis of the day by lantern light. She performs so many of these procedures that she has a standing request for thoracentesis kits, which hospitals in the United States seldom use.

Dr. Coffee reviews an X-ray at the end of a typical 12-hour day. She has not eaten a full meal. She devoted her lunch break to teaching English to a group of Haitian nurses and doctors in a building across the street from the hospital.

Dr. Coffee tends to a patient on her outdoor examining bench beside the showers by lantern light at the end of a 12-hour day.