In Black America; Tuberculosis Among African Americans

See you next time… From the Longhorn Radio Network, the University of Texas at Austin, this is In Black America. We don't hear a lot about tuberculosis and as the old adage, the squeaking wheel gets the grease.

I think we need to squeak a little bit more so we can get a little more of the grease to spread around. Local and state health department TB programs are primarily funded from federal dollars. Texas is very lucky. Texas is one of the few states that commits a large amount of state funds to tuberculosis treatments. So you're very fortunate here in Texas, but in a lot of other states, you primarily are dealing with federal funding and we are just not at the federal level getting the monies that we would like to get. So we can dispense more to the states to fight tuberculosis. Miss Phyllis E. Cruz, tuberculosis control division, the Texas Department of Health, tuberculosis is an infectious disease, primarily affecting a person's lungs and may spread to other organs calling severe complications or death. The disease is both preventable and curable if patients comply with the physician's instructions and taking the prescribed medication. The federal Centers for Disease Control's strategy plan for the elimination of tuberculosis

in this nation has a goal of 99% reduction in tuberculosis by the year 2010. Although the occurrence of TB in this country has declined during the past 35 years, today TB among non-Hispanic whites is predominantly a disease of the elderly. Among one or two it is primarily concentrated in young adults. I'm Johnny O. Hanson Jr. and welcome to another edition of In Black America. This week fighting tuberculosis in the African-American community in Black America. That person should go to the local health department. The state of Texas provides medications through the local health department and private physicians to care for tuberculosis patients. There won't be any cost for medication for treatment of this patient, not by the patient.

I think the first thing you do is to seek out your local health department and let them know why you're there and let them assess your sufferers as need and let them take care of providing that need because we provide to the local health department the kind of tools they need to take care of that patient. A person whose income is moderate to zero can receive care and evaluation on tuberculosis in most counties and most county health departments at no charge. I realize that in some areas there may be an initial fee, some health departments have an initial fee for admission into that system, but so far it's care for that patient. To tuberculosis medications, evaluation, there is no charge. Mr. Charles Wallace, assistant division director tuberculosis control, the Texas Department of Health. Before tuberculosis can be treated or cured, it must first be recognized. Years ago when TV was a leading cause of death in this country, the disease was often suspect in patients. Today, physicians and nurses in experience with tuberculosis may overlook the disease. In 1987, the medium age for non-Hispanic wife with tuberculosis was 62 years.

For minority patients, the medium age was 39 years. Although tuberculosis infects many persons, those who developed the disease symptoms sometimes fail to seek health care. Health officials attribute the fact to a lack of understanding about how serious untreated tuberculosis can be. I hope this program will give you a better understanding of tuberculosis. Recently I spoke with three experts on the subject of TB. They are Phyllis A. Cruz, Joyce, Colin, and Charles Wallace, all with the Texas Department of Health. One thing we can say is that tuberculosis is a micro-bacterium and that's not breaking it down from a non-scientific base, but it's a germ that's spread through the air primary to individuals who, in a situation or condition, where they can receive that particular infected air into their system. I think it's important to mention that the process of spreading tuberculosis is primary again through air that's breathed in. It's infected by someone who has this particular germ of bacteria. As a result of having it spread it through coughing, sneezing, singing, and many other ways

that it can be transmitted through to the air. What type of effect does this disease have on the body? I would assume that since you breathe it in, it has a devastating effect on your lungs. That's correct. I think the primary area of concern, when we look at this particular disease, is its impact on the lungs. And most times when we see a person, we think of their particular disease after diagnosis and evaluation as being pulmonary. Although it can occur in other parts of the body, we most often see this particular disease occurring within the lung system. So it's important to know that many of the things we see, the coughing, the sneezing, many of the other kinds of things that go along with pulmonary infection can be a result in fact of that particular tuberculosis infection in the lungs. Is there any relationship or correlation with the disease, or tribute to urban areas or areas in which there is a large smoke stack industry? Does that come into play with tuberculosis?

We don't see that so much as a relationship or interrelationship to large metropolitan areas that have a high industrial settings. But we do see quite a bit of this particular infection in metropolitan areas. And I think by and large, the reason we see it occurring in large metropolitan areas is because of the kind of population composition we have in these areas. If you recall from readings in one have you that most metropolitan areas have a fairly large concentration of minorities, individuals who fall into our risk groups, individuals who are homeless, large percentage of those individuals who are elderly and what have you. So if you look at a large metropolitan area, you can think of that areas containing many of our risk groups or groups that risk for having tuberculosis. But not in relationship to a point of the industrial setting of that particular community, but in fact the population composition, if you will. You mentioned part of the next question I was going to ask, those are in the high risk for infection of this disease. Is there any particular reasons why these particular minority groups other than living in a concentrated area where they would become such a high risk group than other nationalities?

Well, I think you really kind of hit the answer on the head there when you said constant traded areas. Many of our minority populations in this day in time find themselves in situations where the economic setting is not as good as they would like to have it, not as good as we like to have it. And as a result, that's quite a bit of gathering together in home housing settings to better use the income that comes in. I think you also have to consider that because of the lack of access to good medical care, that we often find this particular segment and other segments that risk for tuberculosis in this particular arena, also being impacted by this particular disease. So the coming together of people sharing conditions that will make their life easier as a result of not having enough money. And other reasons are really the reasons we consider for this disease being so rapid in minorities and other adverse populations. Particularly here in Texas, but in other parts of the country, when did our state and federal health agencies realize that we are embarking on an epidemic, particularly for minorities

with tuberculosis in this country? Well, I think in the state of Texas, we really gave the idea that minorities were being impacted by this disease serious thought about a year and a half ago. We had looked at the data, but not seriously studied the data as carefully as we should have. As a result of looking even closer at the data to see where our high risk target populations were located, we were able to see that roughly 73% of the TB cases we had in 1989 did occur in minorities, primarily blacks and Hispanics. Those cases again occurred primarily in our large metropolitan areas, Houston, Dallas, San Antonio, Fort Worth, and other areas. And it kind of sprung a whole new concentration on this population. We realized before then, of course, that the Centers for Disease Control on a National Focus were looking at all possible risk groups, and that their data had generated a fairly decent concentration of disease cases within the minority populations.

But we in Texas really began to study the issue of where this disease was occurring in the state, and what populations were being most impacted roughly about two years ago. And we were kind of surprised by the kind of information we saw coming out of that particular study, that the rates were fairly high, extremely high when it came to minorities. The rates were fairly high when it came to the homeless population. When we look at HIV, AIDS cases, the numbers were fairly high. And elderly, which has constantly been a group of concern, the rates continue to be high. When the data was being tabulated or put together, where the information coming from physicians as a preventive care mechanism, or were these persons already contracted disease and they were being treated at the time. I think, in our case, most of the conditions we see, most of the cases we see are those conditions or cases that are already on the treatment. Of course, as a part of the investigative surveillance control process, when an individual

is diagnosed as a case, it becomes a part of the public health effort to then go out and try to find out who the contacts have been to this particular individual. So as a result of that, the gathering of contacts that would surround this particular case, other cases and other persons who had come in contact with this case and other cases, and at that time, infected was infected, also brought into the whole process of surveillance. So the cases we see in our office, the information we receive on cases in our office, are generally cases that have been diagnosed, either in public health settings or by private physicians. So that's the kind of information we receive, that's the kind of information we study and try to generate the activity around. The U.S. Department of Health and Human Services is saying a goal for TV elimination that is less than one case per million by the year 2010. Do you all believe that this goal is attainable, and if so, what needs to happen concerning technological advances and social logic over caution in order to reach this particular

goal of one case per million by the year 2010? It is a reachable goal, but each area will have to assess whether or not their particular state or city can reach this goal. It depends a lot on some of the major areas that we have to deal with when we're talking about tuberculosis. Our address populations, which Mr. Wallace has discussed already, and technological changes so we need to work on improving our treatment to be takes a long time to treat. And one of our goals now is short-term treatment. We have to focus on increasing the numbers of cases that we find out in the early stages of the disease, increasing the people that are on preventive treatment. So we can keep these people from coming to the disease state. We need to increase the amount of record keeping that goes on around a case, get people started investigating these cases faster.

Oftentimes, people have infected large numbers of people before we even know they've been a case of disease, so the investigative process is delayed, and we can't get to these people in time to stop other people from getting disease. Tuberculosis is a very interesting disease because you've got two main stages with tuberculosis. You have the infected stage where the person has come in contact with the organism, it has come into their bodies, but it hasn't created any problems for them at that time. They don't feel sick. They are not able to transmit the infection to anyone else, and then you have what's called the active phase of the disease. This is when they are sick. This is when they're symptomatic, when they're coughing, when they have a fever, when they've got weight loss, no appetite, and these are usually the times when they're able to infect other people. So when we can get a handle on that first stage and keep them from getting into the second stage, then we can begin to meet that goal. Some go ahead, Charles. I just added a couple of things.

I really like what Philip said there. I think it's critical, and if I can say reinforces our reasons for being here at this time, is that many people still believe and feel very strongly that tuberculosis is no longer in existence. That kind of myth about tuberculosis has led to many complications when it comes to getting a word out to people who are in most need of education or awareness. Hopefully through this program and other programs we can stimulate a greater interest in educating and receiving information by the general public on tuberculosis and that disease is complications. The other thing that Phyllis mentioned that I like to tie it to is the difficult problem we have with getting patients to be compliant and taking that medication. The process of treatment of tuberculosis up into a few months ago was a fairly long process of steadily taking medication. A physician may put a patient on treatment for nine to 12 months, daily treatment. We have been able to get that period of treatment down to six months for those individuals who are infected with tuberculosis, and in some cases when the patient is compliant, a six-month regimen of treatment could also be applied to a case, a person who has the disease.

Because of these changes, I like to think that the whole process of caring for tuberculosis patient has been improved, and that improvement should lead to a better turnout on a patient's care. But people need to be aware that this disease is still very much with us in the year 1990, and we'll continue to be with us, hopefully decreasing along the way, but we'll continue to be with us for a long time unless people become aware of educating on how to prevent it, spread and transmission, and do things to enhance the communities awareness of the disease, the countries awareness of the disease, and how we can survive this particular disease. I like to call the whole process that we go through right now that we're going through as a process of declaring war on tuberculosis. tuberculosis has been with this country, this world of very, very long time, several thousand years, and we have the tools that are necessary to bring it to a very close in elimination, but those tools must be applied, must be utilized by physicians and other healthcare workers, and those individuals who come in contact with this particular disease need to adhere to

what the treatments are and be compliant to the treatment in order to prevent themselves from becoming a case of disease and transmitting a disease to others. So our position has been, you determine what's best for your area, and some areas would almost be required because the number of TB cases seen in that particular area are staggering, so you want to make sure that everybody gets tested, but in some other areas doing mass screening would not be profitable at all. Could I say one other thing if I can about the numbers? In the state of Texas, we have noticed that black males between ages of 24 and 44, 25 and 44 seem to have a fairly high rate of tuberculosis. We have questioned in our study why that is as it is. Some would say that that's occurring because that's also fairly much the age group where age cases are occurring. Others would say this is a group that's very much at risk for IV drug use, and a number of other hypotheses have been proposed, but that's a risk group where young men in particular, young black males in this state should be concerned, but what of a reason?

And skin testing may be very much a valid process for that particular age group. Our parents enlighten to the point where there are wear of certain high risk or danger signs that their children can contract on a day-to-day basis while they're in school playing around the home on vacation of actually being aware of some of the pitfalls that children can fall into as far as their health is concerned. This forest to UB is concerned probably not, because again, one of the things that really hurts tuberculosis is the fact that people think of it as an old disease. No one has it anymore. You don't have to be concerned about it. And then we have a lot of young parent now who have no concept of TB. They've never been exposed to any one to their knowledge that had tuberculosis, so it's not as it was in the 50s when a significant number of the population either had been exposed

or had a grandparent or a parent who had had tuberculosis. Nowadays TB is not the usual disease that people think of when you've got a kid that has a cough that won't go away or it doesn't go away in a short amount of time or you've got a kid that's running a fever for no reason that you can determine. You just don't think about TB. You think about flu and you may see a doctor. You may not see a doctor. Sometimes if the kid is that age where measles or whatever is going around, you may think the kid has the measles and you start looking for symptoms for measles and when nothing happens, you think, oh well, maybe he was just a cold and he's okay now. He's one of the things about TB is the symptoms don't continue all the time. You'll feel this for a while and then it'll kind of like go away for a little time but it doesn't mean the disease isn't still working on your body because it really is but you're just not having those same symptoms at that time. So parents, I think strongly that parents are not aware and it's really not their fault. We're working on getting that message out to them more and more through programs like

this and other outreach that we're doing within the community at this time. In reading the background information for this interview, it is to say to these very depressing. Are our lawmakers and legislators aware of the severity of the health problem that is confronting this country at the present time? I think what a national scale the health officials have taken a very close look at minority health issues and tuberculosis is certainly one of those that they're looking at. I'm not and probably going out on a limb here saying it's overly impressed with what we've done on the state level. I think there's more that can be done. I would have liked to have seen perhaps a bit more discussion about minority health issues in the governor's race and in some other the other campaign efforts that take place in our state because certainly minorities, black, Hispanics, Asians and American Indians are suffering a tremendous blunt from their health issues either because of access or because of whatever reasons there may be.

I think it behooves our entire community, political, non-political, the citizens of the state of Texas to be overly concerned about what happens to the health care process of those individuals of the state because certainly if the health conditions of Texans do not improve across time, the whole state suffers. Someone has to pay the bills of health care. It's much easier to take a TV patient and get him taken care of preventively than it is to hospitalize that patient for a period of time to take care of his condition. It's much better to prevent the spread of AIDS, if you will, to prevent it means than to try to take care of an AIDS patient over the course of their time with the disease. These things can only be done if attention is pulled to or directed toward the issues of better health care conditions for all Texans and unless we do that from a political arena, unless we do that from a public health and a community arena, the issues and problems will not change. They will simply get worse. Now I may have gone out on limb saying that I'm not trying to make up a political statement by any means, but I think the issue needs to be brought to the front and discussed openly.

Do you believe tuberculosis screening will become a part of a physical, a young person or a middle-aged person with automatically received if he or she goes in for a physical, a semi-annual physical? It is something that you are trying to drum home to physicians and health care or delivery systems. As part of the federal elimination plan, that is one of the recommendations that every person has a documented record of having had a tuberculosis skin test as part of their medical record. They also recommend that when children are getting their immunizations at early ages, nine months or whatever, that they get a tuberculosis skin test at that point in time when they enter the schools get a tuberculosis test at that point in time. In some areas like Texas, where you have a lot of disease, Texas, California, Florida, they strongly push this through their state systems that these things be done because

those are the areas where we have a significant numbers of people, not only minorities, but all people who have tuberculosis. Now Texas rates number three in the country for disease, for tuberculosis, so it is a major focus here in Texas. From listening to this program and they may wonder if they themselves may have tuberculosis or someone in their immediate family, what can he or she do to put their mind at ease? I would like to recommend that they first of all, if they feel that way, contact their local health department and get more information from the tuberculosis program and most, if not all, state health departments, local health departments in the state of Texas do have TB programs, so have information on tuberculosis. Once they have sorted information out, they may also seek out a determined if they need a tuberculosis skin test. I would like to say about the skin testing if I can, that anyone who is at risk of HIV infection or following to that particular risk group should seek out a tuberculosis skin

test. Tuberculosis, and this is getting a little far from what you are saying, is the one disease that AIDS patients with HIV infection do have this treatable. We can treat that person the duration of time required and cure them, so that is one condition we know we can prevent them from having. But for sure, contact your local health department in the city of Austin, we know what the Austin Travis County Health Department, 469-2000, and ask for the tuberculosis control division, and in other parts of the state, just call your local health department and tell them you would like to have additional information about tuberculosis and they will put you in touch with the right person. You mentioned treating the disease, how long is the treatment process, and the reason why most people do not complete the therapy or the treatment for the disease. Well, I think, again, you are going to find a variance. We are recommending that persons who have tuberculosis infection, that is none disease, be treated for a six-month period.

If that person is compliant, if they take their medication according to the schedule, they don't miss taking pills, if they don't drop off and come back. If someone who has got disease, a physician can also determine that they should be treated for a six-month period as well. Some physicians are not following their particular regimen. Some physicians would recommend that the person be treated for a nine-month period, and in some cases, we've seen it even longer than that. That's with disease, but the prescribed and recommended therapy is a six-month regimen of treatment for an individual who has got disease and infection. If they are compliant, you must take the medication to receive that short-term treatment. One, if a person knows he or she has a disease and somewhat refused to comply with the physician's recommendation, how does that person put their people in this immediate vicinity in jeopardy if that person refuses to comply with the medication? I bet you joyous can give you some responses to that. She sees all those records.

Well, if you've got tuberculosis and you don't take your medication, then anyone who is in your household, like if you're the husband, you can infect your whole family. If you carpool, you can infect your carpool people. If you have a job that has a small room situation, if you work in an office, for instance, the air space is very important as to the bacteria in the air can be just distributed this coughing and sneezing, which you usually will do if you've got pulmonary tuberculosis. So you're putting everybody at risk, excuse me, that is working around you or playing around you. But it has to be in a smaller air space, you don't get it playing football with somebody or basketball in a gymnasium. But anyone in your household, you're putting them all at risk, especially the children. Could this be something employers will look at in the near future, particularly those

populations who are at risk with contracting the disease? Well, normally employers don't get involved unless an active case has been diagnosed in the work environment. And in that case, it's like with most communicable diseases, everything is confidential. We don't give out people's name. We may go to that work site and tell the people in charge that someone that worked here or has worked here has been diagnosed with active tuberculosis. And as a result of this, we're going to need to screen, do skin testing on the other people that work here. But we don't give out any names as to who wouldn't win, you know, that kind of thing, because we do respect that person's confidentiality. So you don't have to be afraid that all your friends are going to know that you've got tuberculosis when someone from the Public Health Department comes and talks to you about it. It is very important that you take your medicine.

And one of the drawbacks with compliance, that means with people remaining on the treatment until they finish, is the fact that if you've got disease, you're talking about two or more drugs that you have to take two times a day every day. And that can be a real problem for people. And when you're talking about six months taking two or more drugs two times a day, it gets very involved. And people find that it's difficult to maintain that. And that's why people often do not complete their treatment. But again, when you're diagnosed with disease, it is really important that you do complete that medicine. Or if you're on preventive treatment, meaning you have a positive skin test, but you don't show signs of illness at this time when you're only on that one drug, it's very important that you finish that medication. Because if you don't, you run the risk of developing active disease. And then putting your family, your friends at risk. My guest on this program has been Phyllis E. Cruz, Joyce Collins, and Charles Wallace, all with the Texas Department of Health.

If you need more information concerning tuberculosis, contact your local health agency or your physician. If you have a question or comment about this program, write us. Remember views and opinions expressed on this program are not necessarily those of this station or the University of Texas at Austin. For a production assistant, Richard Childs, and Heidi Cordell, and in Black America's technical producer Cliff Hargrove, I'm John L. Hansen, Jr. Have a safe New Year's Eve and join us again next year and next week. Cassette copies of this program are available and may be purchased by writing in Black America cassettes, Longhorn Radio Network, Communication Building V, UT Austin, Austin, Texas, 78712, that's in Black America cassettes, Longhorn Radio Network, Communication Building V, UT Austin, Austin, Texas, 78712.

From the Center for Telecommunication Services, the University of Texas at Austin, this is the Longhorn Radio Network. I'm John L. Hansen, Jr. Join me this week on in Black America. If they are infected and have tuberculosis disease and they are not compliant with treatment or if they start treatment and they back off and stop and start again and back off and stop again, that they can develop a drug-resistant tuberculosis. Fighting tuberculosis in the Black community this week on in Black America.