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ANTH265 Group 1

on 28 April 2014

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Transcript of Tuberculosis

TB Screening & Treatment
Screening Processes
Cultural Understanding

Tuberculosis: a Global Problem Explained within the United States
U.S. Structural Vulnerabilities of TB
Majority of the TB threat resides in urban areas that comprise of 15% of the U.S.’ population (Oren et al., 2011, p. 1256).

Living conditions, population density, lack of available healthcare (Oren et al., 2011).
Urban Areas
Jails & Prisons
“...up to 17 times the TB prevalence in the U.S. population; prison inmates have approximately four times the U.S. prevalence” (Roberts et al., 2006, p. 125)
Homeless Shelters
6.5 percent of all cases in the U.S. in 1997 were from the homeless (Curtis et al., 2000, 308).

Ventilation is an issue (Curtis et al., 2000, 311).

Preventative measures: screening upon arrival, chest radiograph testing for those TST (Tuberculin Skin Test) positive and creating separate sections for TB patients. (Curtis et al., 2000, 311).

Medical history and physical examination

Chest radiography and determination of immune response
Skin testing - tuberculin inserted into forearm and swelling/hardened reaction is measured
Interferon gamma release assay - blood test and measure of infected white blood cells
Sputum testing - phlegm test for germs

Depending on where the applicant is from, different tests looked at based on WHO estimated regions of risk

Initial Phase (first 2 months): Main drugs in the form of pills are administered

Second Phase
usually administered for 4 months
administered for 7 months for patients with cavitary pulmonary tuberculosis and other special cases

Directly Observed Therapy (DOT) - health care professional is present for each dose to make sure it is consumed, standards for immigrant applicants
What is Tuberculosis?
Global Overview
One third of the world's population is infected with TB (WHO)

People with HIV are 20-30 times more likely to develop active TB

TB can become multidrug-resistant to standard treatments

This is a particular problem in the United States due to lack of cultural understanding and structural vulnerability.

Primarily caused by
Mycobacterium tuberculosis--
thrive in areas of the body with blood and oxygen

Airborne bacteria known as droplet nuclei spread through sneezing and coughing down into the throat into the alveoli
Bad cough lasting at least 3 weeks

Chest pain

Coughing up blood or sputum


Weight loss and loss of appetite



Sweating at night
Works Cited
Centers for Disease Control and Prevention. (2012). Reported Tuberculosis in the United States, 2011.
Atlanta, GA: U.S. Department of Health and Human Services. Retrieved from http://www.cdc.gov/tb/statistics/reports/2011/pdf/report2011.pdf
Centers for Disease Control and Prevention. (2008). Promoting Cultural Sensitivity: A Practical Guide for
Tuberculosis Programs That Provide Services to Persons from China. Atlanta, GA: U.S. Department of Health and Human Services, 9-10. Retrieved from http://www.cdc.gov/tb/publications/guidestoolkits/EthnographicGuides/China/chapters/china.pdf
Curtis, B., Novick, F., Driscoll, J., Blair, D., Oxtoby, M., McGarry, M., Hiscox, B., Faulkner, C.,
Taber, H., Valway, S., & Onorato, M. (2000). Analysis of Mycobacterium tuberculosis
transmission patterns in a homeless shelter outbreak. The International Journal of
Tuberculosis and Lung Disease, 4(4), 308-313. Retrieved from
National Research Council. (2000). Ending Neglect: The Elimination of Tuberculosis in the United
States. Retrieved from http://www.nap.edu/openbook.php?record_id=9837&page=1
Oren, E., Winston, C., Pratt, R., Robison, V., & Narita, M. (2011). Epidemiology of Urban
Tuberculosis in the United States, 2000-2007. Am J Public Health, 101(7), 1256-1263. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3110232/#__ffn_sectitle
Roberts, C., Lobato, M., Bazerman, L., Kling, R., Reichard, A., & Hammett, T. (2006). Tuberculosis
Prevention and Control in Large Jails: A Challenge to Tuberculosis
Elimination. American Journal of Preventive Medicine, 30(2), 125-130. Retrieved from

“...but also of rising concern was the specter of multidrug-resistant tuberculosis...” (National Research Council, 2000.)

Strong association with HIV: 82 percent of TB patients reported having HIV in 2011 (CDC, 2012, p. 3).
Urban Areas (cont.)
Image References
(1) http://indianapublicmedia.org/eartheats/antibiotic-resistance-catastrophic-global-health-threat/
(2) http://www.frontpagemag.com/2013/dgreenfield/is-new-york-city-the-next-detroit/
(3) http://en.wikipedia.org/wiki/New_York_City
(4) http://www.toledoblade.com/frontpage/2006/09/25/Jails-prisons-test-to-prevent-outbreak-of-tuberculosis.html
(5) http://www.sptimes.com/2008/03/11/Hillsborough/Hillsborough_jail_abu.shtml
(6) http://www.prlog.org/11770707-bed-bugs-get-homeless-shelters-running-out-of-budget-bedbugsprayreviews-suggests-cheaper-green-sub.html


Have qualified interpreters available

Allow patients to be honest and do not discount beliefs that are not held by Western medicine

Do not make assumptions on a race based on stereotypes, turn all supposed “facts” into questions-- open, accepting attitude.

Important to maintain respect between patient and doctor by:
listening to patient and asking questions
reaching compromise
blend of traditional and Western medicine
promoting confidentiality

David Pilachowski, Sari Dorn, Dana Parker, Melissa Morella, Cam Rogers & Nathalia Cibotti
Source: CNN News
TB scare on U.S. flight-- overreaction? Centers for Disease Control and Prevention thought so.
Outreach activities are the first step in educating anyone who needs awareness because people who are informed of the significance of TB are more likely to contribute

There are many places from which to gather funds such as federal, state and local government or foundations through thoe Fundation Center.

Donations for organizations such as Project HOPE in Malawi help give professionals a means with which to work towards treatment of patients
Full transcript