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

intravenous drug users, residents in long-term
care facilities such as correctional facilities, and
the homeless. Active tuberculosis with subsequent
spread of infection to contacts poses a
significant threat to the community. Practicing
physicians, for the most part, focus on the
individual patient, and to some extent on the
family; public health officials focus on patients
as a group, on families, and on the community.
So, in controlling TB, who are the real
heroes? Who, on a daily basis, deals with the
patients, their families, and the health care
providers? Who does the leg work required to
ensure patients are monitored through
completion of treatment, and that contacts are
Nurse crossing roofs to visit patients
identified and evaluated? Public health field
workers are the real heroes in the fight against
tuberculosis.
Historically, in the United States, community
outreach workers have played an important
role in waging a successful battle in the war
against tuberculosis. Hermann Biggs, in 1896,
called for health inspectors to visit homes of
TB patients and educate their families on how
to deal with those suffering with the disease
and how to prevent future cases. In the 1920s
and 1930s visiting nurses were climbing and
jumping over New York City tenement roof
tops to visit TB patients who were being given
Notable Events in TB Control
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the “fresh air treatment.”
In the 1950s, federal public health advisors
were assigned to local health departments to
provide technical assistance and treatment
guidelines and to assist local health departments
with TB surveillance and control activities.
In the 1960s New York City hired “lay
tuberculosis investigators” to track down
noncompliant patients. The workers would
visit patients’ homes, and as needed, track
them to unsavory locations, such as local bars,
clubs, and hangouts. Since then, most state
and local health departments have hired and
trained lay persons and nurses to carry out
similar functions and activities. Who are these
people that have played an important role in
the fight against tuberculosis and why is it that
we hear so little about them? They are the
backbone of the TB control program, the foot
soldiers who are willing to place their lives on
the frontline each day in order to do battle
against the common enemy - tuberculosis.
TB control programs have used public health
field workers with different backgrounds and
expertise to monitor patients and assist them
in adhering to and completing the recommended
course of treatment. Responsibilities
assigned to these workers vary by area and
degree of complexity. Some workers conduct
surveillance activities by visiting hospitals,
laboratories, and infection control officials;
others provide services out in the field such as
conducting home visits or providing DOT,
which can put them in risky situations. And
even under difficult circumstances, field
workers continue doing their work. Field
reports document clients and patients directing
violent threats and hostile incidents to public
health workers. Field workers survive by
learning conflict resolution and field safety
and by using precautionary measures when
conducting their activities. The threat of
violence that field public health workers
experience while in the line of duty cannot be
controlled by detection devices used in office