CDC History of Tuberculosis Control - Medical and Public Health ...

Many told us universal DOT could not be
done; a few said it should not be done. But we
continue to truly believe DOT is the best
service we can offer our patients and the
public. We believe DOT offers the surest and
best chance for a timely cure. Why should we
treat anyone with less than what we believe is
the best we can offer? Their future is our
future.
True, Mississippi has made great strides in TB
control. But we’ve made those strides not by
DOT alone.
Each and every one of those great strides was
made by everyday people: nurses, aides, clerks,
outreach workers, doctors, disease intervention
specialists, and volunteers — hard working,
dedicated, and passionately devoted
individuals who were, and are, determined to
make a difference one patient, one facility, one
community at a time.
Notable Events in TB Control
From the establishment of our sanatorium
early in the century through its demise and the
rise and continuing refinement of our outpatient
treatment delivery system, public health
nurses have made most of those great strides
possible. Usually, the nurse comforts, educates,
and gives hope to the distressed patient
who has been notified of exposure or disease.
The nurse confronts and calms the angry,
hostile, and all-too-often dangerous patient
who has given up and no longer cares about
himself or others. The public health nurse
persists through heat or snow, wind or rain,
dogs, gangs, or alligators and finds the patients
and persistently guides, cajoles, or bribes them
through treatment. If, along the way, that
means baking a few extra cookies, making an
extra trip after work to deliver a home-cooked
meal to a homeless or lonely patient, buying
an extra can of soup or a chicken for an impoverished
patient while grocery shopping, or
taking the time to put a grubby little 4-yearold
on the lap and reading a story in hope of
making the treatment seem a little more
palatable . . . that’s nothing special. That’s just
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the way DOT happens: good people doing
good things. No bells, whistles, or wreaths of
laurel — just another great stride taken in
silence and out of public view.
Public health nurses, of course, don’t work in
isolation or independently. Without a doubt,
each stride is made easier by the clerk who
greets the patient kindly and patiently, then
helps expedite the visit. Each stride is made
easier by the outreach worker who helps
ensure each dose of medication is ingested and
each appointment is kept. Physicians who take
time from their busy practice to conduct
regular clinics at the health department also
make each stride easier, more sure, and more
purposeful. And the advances in science, the
effective anti-TB drugs available, and the
emerging technology for more rapid and
accurate diagnosis have been and are unquestionably
essential to the progress we have
made.
Yes, DOT has been a vital tool for ensuring
progress and managing cost. We used it as the
fulcrum to move Mississippi from a deepening
rut and to change the direction of TB control.
But, DOT was only part of the plan. Progress
cannot be achieved by DOT alone. DOT
requires achievement goals; community support;
good legislation; adequate infrastructure
and funding; a dedicated, determined public
health field staff; and the strong support of
administration.
Baltimore at the New Millennium
by Kristina Moore, RN, and
Richard E. Chaisson, MD,
Professor of Medicine, Epidemiology,
and International Health
Johns Hopkins University
Mr. C, a Baltimore City resident, knows he
was diagnosed with active pulmonary and
lymphatic TB in May 1999. He receives his
TB treatment through the Baltimore City
Health Department (BCHD)/Eastern Chest