Argueta Marilynn Argueta HSCI 367

Tuberculosis Tuberculosis (TB) was once the leading cause of death in the U.S, yet since the decrease in deaths, it seems as many have forgotten the severity of this problem. Although it is true, TB death rates have decreased, it is important to know that TB still exists and that its a serious illness that kills many. Despite the fact Tuberculosis is treatable and preventable, millions still seem to be dying from this infectious disease worldwide. The reason for its high contagious rates is due to the fact that TB is spread from person to person through the air. When people with lung TB cough, sneeze or spit, they propel the TB bacterium called Mycobacterium tuberculosis, into the air. A person needs to inhale only a few of these germs to become infected. In order to know the severity of TB, one must become acquainted with the different types of TB. Many believe that receiving a positive test in TB, will result in illness, thus resulting in death; yet this is not the case. The reason for this misunderstanding is due to two TB-related existing conditions: latent TB infection and TB disease. According to the CDC, latent TB bacteria can live in the body without making you sick. In most people who breathe in TB bacteria and become infected, the body is able to fight the bacteria to stop them from growing. Individuals with latent TB infection do not feel sick and do not have any symptoms. People with latent TB infection are not infectious and cannot spread TB bacteria to others. However, if TB bacteria become active in the body and multiply, the person will go from having latent TB infection to being sick with TB disease. If the immune system is not capable of using its

Argueta defenses against the TB bacterium, it then becomes active. When TB bacteria are active (multiplying in your body), this is called TB disease. Therefore, TB disease is definitely taken more seriously, since without any medication, it can quickly spread and result in death.

TB, whether its latent or disease, works different for each and every person. This bacterium attacks the hosts immune system. Furthermore, it depends on the host immune system to either conquer the illness or have the illness conquer the host. Although TB is no longer the leading cause of death in the U.S, it is still one of the worlds deadliest diseases (CDC). In the article, Tuberculosis: A Call for Papers, the authors, Catherine DeAngelis and Anette Flanagin write, with more than 90% of infections and deaths occurring in low- and middle-income countries. In 2000, an estimated 8.7 million new cases of TB were reported, and approximately 2% to 3% were multidrug-resistant (DeAngelis and Flanagin, 1). In addition, the CDC states that TB is the leading cause of morbidity and mortality among individuals infected with the human immunodeficiency virus (HIV), who have a greater risk of developing the disease. With these dramatic statistics, it is proven that the TB nightmare isnt over. TB has been trying to wipe out the human race for the past 3000 years. With that proven, what is the United States doing, in order to cure and prevent its people? Many health issues are involved with TB. It is not just a problem dealt within the lungs, neither is it a severe cough as many may believe. TB results in severe chest pain, weakness, fatigue, as well as weight loss. There are many more health issues a part from the ones mentioned above. Despite the fact of the existent physical issues of TB, one must also understand that there are hidden effects caused by it too. As for example,

Argueta Partners In Healths Sister Project, in Peru, Socios En Salud (SES), organized an event aimed to demystify mental health-related conditions especially those affecting patients receiving care for tuberculosis (TB). In one of their blogs, titled, Surviving the mental health impact of tuberculosis and HIV/AIDS, one of the staff members of the project shares a quote from a patient who participated in this event. The patients says, In my

home they didnt understand me they didnt know what it was to live with this disease (pih.org, 1). It is obvious that TB affects one physically, as well as emotionally. It is constantly mentioned from public health educators that the main reason for being infected by TB bacterium is due to the weakness of ones immune system, as well as the negligence of ones actions to either protect oneself from acquiring this, or to take ones prescribed medication to cure TB. And although this holds much truth, one must also understand that there are environmental factors that definitely add onto the severity of this disease or even the onset. Not only is the environment around us a contributing factor to TB, yet it may also be the answer to the cure for it. In the book Infectious and Inequalities, the author, Paul Farmer, stresses the idea on poverty and inequalities being the reason for high rates of TB in rural Haiti. Farmer writes, There is nothing wrong with underlining personal agency, but there is something unfair about using personal responsibility as a basis for assigning blame while simultaneously denying those who are being blamed the opportunity to exert agency in their lives (Farmer, ). Farmer believes that its not entirely ones fault at acquiring or caring for his or her TB illness, yet its the environment around one that contributes mostly to the result of the TB. Supporting Farmers thoughts, poverty is a big contributor to the onset and outcome of TB. When one has no opportunity to be seen by doctors, transportation to make it to the clinic or

Argueta most importantly the money to buy the medication, what is an individual to do in this situation? Adding onto Farmers point of view, it seems like one of the main organizations affecting the degree of TB is the pharmaceutical companies, insurance companies, and even medical doctors. Due to their medical authority, these companies and individuals see the need to prescribe and provide medication to the individuals, for they have the authority to do so with their degrees, certificates, education and positions, but they seem

to lack on viewing the important reasons, such as to why an individual may not be able to seek the help needed. Pharmaceutical companies and medical doctors not only hold control over TB medication, yet they hold control over every medication exists in the world. They set the rules, as well as the prices. TB can be cured, it can even be prevented, and still TB has killed one third of the worlds population (CDC). And although this statistic is known among our government, why havent pharmaceutical companies donated the medications needed in order to control or prevent this serious disease? Would they rather let those who cant afford it die? There may be contributing factors to why pharmaceutical, insurance companies, and doctors blame the individual for his or her lack of responsibility towards their disease. For example, it may be that when doctors are first being trained throughout medical school, they become apart of a medical culture that requires rules and regulations to follow. Since they are taught in specific ways, perhaps they tend to lose the understanding of the patients point of view. Doctors are good at prescribing the medications, thats what they learn to do but being trained in medical school does not teach the basis of other cultural beliefs. Therefore, ethnocentrism, the belief that ones

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own culture is the right and best one, interferes with the understanding of an individuals choices and outcomes. The is due to the fact that some cultures dont hold the same necessities and beliefs other cultures do. In the book, The Spirit Catches You and You Fall Down, the author, Anne Fadiman, writes about the struggle of Hmong immigrants whose cultural differences and medical illiteracy cause them to lose custody of their sick daughter, as well as losing their daughter to epilepsy. Being medically illiterate, in other words, not understanding the medical terms of a health professional, can result in losing ones life. Fadiman writes about the struggle among the Hmong medical illiteracy; she writes, I had come to Merced, California, where they lived, because I had heard that there were some strange misunderstandings going on at the county hospital between its Hmong patients and its medical staff ( Fadiman, pg. 8). Pharmaceutical companies seem to not see things in the victims point of you. Why should they, right? Could it be that they see things in this way, The patient is in need of our help, we arent in need of theirs.? Or is there some corruption involved within this so-called medical industry. In the article, New Federal Guidelines For PhysicianPharmaceutical Industry Relations: The Politics Of Policy Formation, the authors, Susan Chimonas and David J. Rothman, write, the legality of many arrangements heretofore left to the discretion of physicians and drug companies, including industry-funded educational and research grants, consultancies, and gifts (Chimonas and Rothman, pg. 940). As one can see, companies, like the pharmaceutical company, mentioned above, doesnt seem to show empathy for its customer. It is more involved with the benefits it can receive by giving to its own industry.

Argueta Despite the fact on the lack of cultural understanding and cultural relativity to ones culture, there is a program that should be considered for applauding. The DOTS

treatment program has been a program created by the World Health Organization. DOTS recommend control strategies for individuals who are Tb infected. One of the most effective strategies this program offers is the following: a trained health care worker or other designated individual (excluding a family member) provides the prescribed TB drugs to the patient and watches the patient swallow every dose, in order to ensure that the patient is taking all of his or her prescribed medication (who.int). According to WHO, DOTS can successfully and permanently cure more than nine in every 10 TB patients who complete the treatment, which means cure rates of 95 percent even in the poorest countries (who.int). In conclusion, it is important to understand the importance of an individuals culture, in order to see what advantages and disadvantages an individual has at hand. As health professionals, one is able to make a difference by offering the help needed, with respect to improve the life span of the patient. As one can see, programs such as, DOTS, has cured and improved the some of the lives of those individuals affected by TB. Perhaps there are more ideas or programs in the making to help solve this issue. In the past Tb was decreased, now its time to prevent it. Understanding and listening to the concerns of others with different cultural backgrounds, can make the difference. In addition, creating a relationship with the patient, in order to improve the medical literacy, can also increase the amount of lives saved from TB. These are the answers to improving the life of others and ending the deadly TB disease.

Argueta Catherine D.DeAngelis, MD, MPH; Annette Flanagin, RN, MA JAMA. 2004;292(15):1889. doi:10.1001/jama.292.15.1889. CDC | TB | Basic TB Facts." Centers for Disease Control and Prevention. N.p., n.d. Web. 2 June 2013. <http://www.cdc.gov/tb/topic/basics/default. Chimonas, Susan, and David J. Rothman. "New Federal Guidelines for Physicians- Pharmaceutical Industry Relations: The Politics of Policy Formation ." Health Affairs 10.no.4 (2005): 949-960. Health Affairs. Web. 26 May 2013. Fadiman, Anne. The spirit catches you and you fall down: a Hmong child, her American doctors, and the collision of two cultures. New York: Farrar, Straus, and Giroux, 1997. Print. Farmer, Paul. Infections and inequalities: the modern plagues. Berkeley, Calif.: University of California Press, 1999. Print. "Surviving the mental health impact of tuberculosis and HIV/AIDS | Partners In Health." Partners In Health. N.p., n.d. Web. 3 June 2013. <http://www.pih.org/blog/surviving-the-mental-health-impact-oftuberculosis-and-hiv-aids>. "Surviving the mental health impact of tuberculosis and HIV/AIDS | Partners In Health." Partners In Health. N.p., n.d. Web. 3 June 2013. <http://www.pih.org/blog/surviving-the-mental-health-impact-oftuberculosis-and-hiv-aids>.