In reference to my post of several days ago, my patient turned out to be most cooperative and forthcoming, despite his current house arrest. With family members by his side, we reviewed his four-drug regimen, discussed his side effects, as well as the expected course of treatment.
Deciding that it was worth broaching, I launched into a brief diatribe about how people often associate TB with poverty, and a diagnosis of TB in a poor person, a person of color, or an immigrant can often feed into stereotypes and bigotry. Looking them each in the eye, I assured them that we would do our best to make sure that this does not happen, and that any public statements made about the state of TB in our community would be worded in such a way as to circumvent xenophobic thinking.
There are many diseases that cross all racial and socioeconomic boundaries. I want my patients to feel that they will not be targeted for their diagnosis, and that they are not judged for having developed such a disease. Beyond case management, medication side effects and epidemiology, we are dealing with the feelings of human beings, and their humanity must always remain foremost in our minds as we navigate the waters of disease management and treatment.
I am off to a good start with this patient and his family. We made the human connection, and that connection will serve us well as the weeks and months go by. May I always hold my patients' humanity above all else, because if humanity is honored, the rest will naturally follow.
Showing posts with label tuberculosis. Show all posts
Showing posts with label tuberculosis. Show all posts
Tuesday, March 31, 2009
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.
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.
Tuesday, March 24, 2009
World TB Day
Today, March 24th, 2009, is World TB Day. Here is what the Centers for Disease Control and Prevention have posted on their wesbite today:
"World TB Day is observed each year on March 24 to commemorate the date in 1882 when Dr. Robert Koch announced the discovery of Mycobacterium tuberculosis, the bacterium that causes tuberculosis (TB). Worldwide, TB remains one of the leading causes of death from infectious disease. An estimated 2 billion persons are infected with M. tuberculosis. In 2006, approximately 9.2 million persons became ill from TB, and 1.7 million died from the disease. World TB Day provides an opportunity for TB programs, nongovernmental organizations, and other partners to describe problems and solutions related to the TB pandemic and to support worldwide TB control efforts. The U.S. theme for this year's observance is Partnerships for TB Elimination."
The CDC states that, following more than three decades of decline, worldwide TB cases increased by 20% from 1985 to 1992. And although concerted global efforts have attempted to stem the tide, multidrug-resistant tuberculos is on the rise, and certain ethnic and racial groups are still significantly vulnerable.
To access the CDC's Division of Tuberculosis Elimination, click here.
To visit Stop TB USA, click here.
To read several of my previous posts about XDR-TB, click here or here.
"World TB Day is observed each year on March 24 to commemorate the date in 1882 when Dr. Robert Koch announced the discovery of Mycobacterium tuberculosis, the bacterium that causes tuberculosis (TB). Worldwide, TB remains one of the leading causes of death from infectious disease. An estimated 2 billion persons are infected with M. tuberculosis. In 2006, approximately 9.2 million persons became ill from TB, and 1.7 million died from the disease. World TB Day provides an opportunity for TB programs, nongovernmental organizations, and other partners to describe problems and solutions related to the TB pandemic and to support worldwide TB control efforts. The U.S. theme for this year's observance is Partnerships for TB Elimination."
The CDC states that, following more than three decades of decline, worldwide TB cases increased by 20% from 1985 to 1992. And although concerted global efforts have attempted to stem the tide, multidrug-resistant tuberculos is on the rise, and certain ethnic and racial groups are still significantly vulnerable.
At the Stop TB Partnership Website, a myriad of informative pages are available for your perusal and edification.
To access the CDC's Division of Tuberculosis Elimination, click here.
To visit Stop TB USA, click here.
To read several of my previous posts about XDR-TB, click here or here.
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