Tuberculosis is becoming a world-wide problem. Three million people die of TB each year, and over 22,000 cases are reported each year in the United States. There are also an estimated 10 to 15 million people in the U.S. who are infected with the TB germs with potential to develop TB disease in the future (Huglas, February 1998). The modern era of tuberculosis began in the mid 1980s. At that time it was realized that tuberculosis had not only ceased to decline in many developed countries, notably the U.S.A., but was actually increasing. It is estimated that deaths from tuberculosis will increase from 3 million a year currently to 5 million by the year 2050 (Tilson, 1998).
Tuberculosis spreads through coughing and sneezing and it is highly contagious. Someone in the world is newly infected with TB each second. One-third of the world s population is now infected with TB bacilli (World Health Organization). There is virtually nothing anyone can do to protect himself or himself from TB. You could get into a taxicab and if somebody who was there three hours before had been coughing, those particles will remain suspended in the air for a few hours. Although effective and affordable treatment have been available since 1950, the drugs generally must be taken for 6 to 8 months. Many patients stop taking them as soon as they begin to feel better because of a lack of education. Premature cessation of the treatment will result in a relapse and possibly the emergence of a drug resistant strain (Hugles, February 1998).
Tuberculosis is out of control in many developing countries of the world. Within the developed world, immigration is the greatest factor contributing to the increase in cases. Current events suggest that the situation will deteriorate further before the international community provides sufficient resources to regain the upper hand in the war against tuberculosis (World Health Organization). The practical solution must concentrate on the completed and correct treatment of the great majority of those suffering from tuberculosis, particularly those that are sputum smear positive. Since TB is easily transmissible between people, the increase in TB in any segment of the population represents threat to all segments of the population. The first level of prevention is education.
I am working as an interpreter-translator in a medical setting for the Russian and Ukrainian community and I realize that many people do not know the facts about TB. This means that it is important to institute and maintain appropriate public health measures, including teaching, screening, vaccination, and treatment. This issue is very important to me, because 1 out 20 of Ukrainian-Russian people have been infected with TB germs. People should know that treatment at this point could prevent TB germs from causing TB disease. The problem is noncompliance with the treatment because of a lack of knowledge. If we will decrease TB in any segment of the population, we will decrease the threat to all segments of the population.
The first medical place where the Russian immigrants come to is Health Department. People are screening there for TB by the TB skin test. A positive reaction usually means that person has TB infection. Many people who have TB infection never develop TB disease. But some people who have TB infection are more likely to develop TB disease than others. These people are at high risk for TB disease. They include:
+ people with HIV infection
+ people in close contact with a person who has infectious TB
+ people who became infected with TB bacteria in the last 2 years
+ babies and young children
+ people who inject drugs
+ people who are sick with other diseases that weaken the immune system
+ elderly people
If someone has TB infection (a positive skin test reaction) and he or she is in one
of these high-risk groups, he or she needs to take medicine to keep from developing TB disease. This kind of treatment is called preventive therapy. Also, if the patient is younger than 35 and he or she has TB infection, he or she may benefit from preventive therapy, even if he or she is not in a high-risk group. People who have TB infection but do not receive preventive therapy need to know the symptoms of TB. If they develop the symptoms of TB disease later on, they should see a doctor right away.
How can we educate Russian-speaking community if all the information such as brochures and pamphlets is written in English? To answer this question, I developed a strategic plan that can help educate people in order to prevent tuberculosis in Clark County. My plan is to interview the nurse who works at the Health Department and teaches the community, including Russian immigrants, about prevention and treatment of tuberculosis. The interview will include questions that reflect experiences with immigrants and their compliance with the TB treatment. I would like to bring my plan to the attention of the nurse to stimulate positive, constructive discussion and action to increase the public s level of awareness of tuberculosis. I expect that the nurse will support my decision about distribution of the TB information to the Russian immigrants that is written in their own language. Russian people who are infected with TB germs do not have enough information about the process of the disease. Unless alternative actions are taken, people will continue to be incompliant with the medication regimen. In order to understand the course and prevention of the disease, brochures must be written in simple language. The goal of this plan is to educate the population about the consequences of non-compliance with treatment. I will review all the Information and brochures that are available at the Health Department that is related to tuberculosis. I will choose information that is best related to disease prevention. I will translate it from English into the Russian language. I would like to distribute the brochures written in Russian among the Russian community, and the brochures written in English among American people in order to increase awareness of TB facts. The goal is to provide the community, including the Russian population, with information that is necessary for understanding tuberculosis.
In order to evaluate my project, I will interview the nurse from the Health Department, and I will ask the following questions:
+ How many brochures were distributed?
+ How did the distribution of the brochures increase compliance with the treatment? (It can be evaluated by subjective data).
+ What additional information should be translated for better understanding of TB?
I believe that my contribution will increase awareness of the TB facts and will decrease the noncompliance with the treatment.