Monday, March 30, 2009

Tuberculosis Rears Its Head

So, my learning curve continues to veer upwards as different aspects of my job ebb and flow. This week, it's tuberculosis case management.

According to our state Department of Public Health, every patient with active or latent TB who lives in the community must have a nurse case manager, and the local Public Health Nurse (if there happens to be one, that is) usually fits the bill. Thus my work is cut out for me.

Things have been pretty quiet on the TB front in my little town for the last few months, with a few patients finishing treatment and sent on their merry way. Now, without divulging any important details, I will say that a new case has emerged that involves complicated and multiple social contacts, a language barrier, sensitive cultural issues, and the potential for a media and public backlash due to the frequency of tuberculosis among immigrants from outside the United States.

When a new case of TB comes to light and is reported by a medical provider to the state, a great epidemiological and bureaucratic machine is set in motion. There are contacts to investigate, families and friends to test for TB, complicated medication regimens to dispense, and an investigation that can easily consume the time of an erstwhile Public Health Nurse who has many other duties with which to contend. Tuberculosis is serious business, and it is taken very seriously by state and federal agencies that seek to contain it wherever it surfaces. And surface it does.

In these days of global air travel, an individual with undetected (and untreated) tuberculosis can sit on a transatlantic flight for many hours as nearby passengers breathe in the recirculated air carrying the potential for infection. While not everyone on a plane may be at great risk, close contacts who have shared the same air space for a number of hours are indeed suspect, and testing and close monitoring are crucial in order to catch new infections. If the infected individual attends school, works in a restaurant or hospital, or lives in a dormitory in close proximity with others, contact investigations are key to ascertaining who is at greatest risk of infection.

My TB case load has been light these last months of winter, and for that I'm very grateful. Now, an interesting and compelling case begins to draw my attention, and I will be put to the test as I summon my communication skills, cultural sensitivity, and ability to tease out the details of what may be a complex investigation.
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