“You have tuberculosis.” There are places in the world where these words are tantamount to a death sentence. In the Philippines, 75 people die daily from the disease. In China, tuberculosis has been the number one cause of death from infectious disease in adults. And authorities in Winnipeg, Canada take the disease so seriously, they have jailed a woman who refused treatment so officials can administer the medicine that will make her better.
“There is a cure. You’re going to be OK.” In Hamilton County, these words bring relief to people who have the disease. Their lives will change for the short term, but not end.
Tuberculosis is a contagious bacterial infection that attacks the lungs, but can spread to other organs. It’s passed through the air when someone with TB coughs, sneezes, speaks, or sings, and nearby people breathe in the bacteria. TB can live in a person without making him or her sick. Moreover, people with latent LTB infection (LTBI) do not have any symptoms, and are not contagious. These individuals typically learn of their condition when they submit to a skin test administered to at-risk people, such as individuals with weakened immune systems and individuals in frequent contact with people who have TB. Treatment for LTBI includes antibiotics.
While many people with LTBI never develop TB disease, the bacteria can become active if a person’s immune system is unable to stop them from growing. When this happens, the person becomes contagious and can begin to experience symptoms, such as a persistent, blood-tinged cough, a loss of appetite, chest pain, and chills, fever, and night sweats.
Hamilton County patients with TB disease receive treatment through the health department. However, the medicine they receive is only part of a larger plan to restore their wellbeing. The other part involves the compassionate care of the doctors, nurses, and other workers who become a part of their lives the moment they learn they have full-blown TB.
Rajaa Ali, a registered nurse, has been a part of the diagnosis and treatment program at the Hamilton County Health Department for 15 years. During that time, she’s come to see the importance of having the right people on hand to treat patients.
“When someone is diagnosed with tuberculosis, it changes their life, which is scary. It helps to have someone who is patient and compassionate explain the disease process to them. We let our patients know we will be with them from the beginning to the end of their therapy,” Ali says. One of the first things Ali does to alleviate the fear her patients feel is explain the difference between LTBI and TB disease. “A lot of the patients that have a positive skin test think they have TB disease, but that’s rarely the case. You can see a sense of relief come over a person when you tell them they are not a threat to themselves or to anyone else,” Ali says.
Ali also lets her patients know TB disease is treatable. It takes anywhere from six months to two years to cure a person who has tuberculosis, and although the treatment can be intrusive, it’s necessary to keep the bacteria contained. Patients speak with a doctor, are started on a regimen of medications, and are placed on DOT, which stands for directly observed therapy. “According to CDC guidelines, we can’t give a patient a bag of medicines and then send them on their way. We have public health representatives who go into their homes and watch them take their medicine,” Ali says.
Patients are also required to stay home for a few weeks while the medication takes root in their system, but do not have to remain isolated for the duration of their therapy.
Ali says there’s up to a 10percent chance that someone with LTBI will develop TB disease. When a person does contract the disease, the Hamilton County Health Department acts as their one-stop shop for treatment. Also, in the interest of the wider population, the health department provides all TB care and medication at no cost to its patients.
TB is less prevalent in the U.S. than in other parts of the world. In 2010, the Hamilton County Health Department diagnosed 319 cases of LTBI and treated seven people with TB disease.
Ali says each case is unique, which makes treating patients a challenge. “When someone is diagnosed with TB, it changes their lives physically, emotionally, and socially. So we’re dealing not just with the disease, but also with people who have different lifestyles and personalities. And we have to set boundaries and limit their activities. That’s not easy.”
But it is important, so Ali and her colleagues at the health department diligently work to contain a disease that’s tantamount to a death sentence elsewhere in the world.
For more information, visit health.hamiltontn.org.