The Greenpoint Men’s Shelter for the homeless is as grim as its name suggests: a crumbling yellow-brick pile in a desolate corner of northwest Brooklyn. Even in normal times its residents hate being here, with robbery, assault, and abuse their everyday companions. But one day last winter they had something worse to worry about than poverty, homelessness, and the squalor of the city’s stark and overburdened institutional charity. They were terrorized by a 32-year-old fellow resident whom we’ll call Walter.
Walter wasn’t violent; he was ambling placidly around the premises brandishing a can of soda, apparently harmless, even companionable. According to Gregory Usenbor, a courtly and soft-spoken man who works for New York City’s public health agency,
Walter triggered the alarm by appearing at the shelter bizarrely swathed in a surgical mask. But, Usenbor recalled, every time he wanted a sip of soda he’d pull the mask down. Everywhere he went the shelter clients--even the caseworkers--were running away from him. They were running from that lowered mask and the legendary killer it was releasing into the room: Walter’s highly contagious case of tuberculosis.
TB is back, and with a vengeance. And as Walter’s case illustrates, its return is a mirror of everything that went wrong in American health care during the 1980s. Walter has been homeless for the last five years. He is an IV drug user with a history of multiple sexual partners. He also has AIDS, a predisposing cause of TB, and a factor, Usenbor estimates, in 30 to 40 percent of the TB cases he sees. Damage to Walter’s immune system by the human immunodeficiency virus probably paved the way for the TB he already had when he first came to the attention of the city’s Bureau of Tuberculosis Control, a year before his masked appearance at the Greenpoint shelter.
