Mississippi shifts gears to deal with foreign-born
Until recently, foreign-born TB patients have been relatively scarce in Mississippi, says state TB controller Michael Holcombe, MPPA, mostly because the state lies outside the routes traditionally plied by migrant workers.
That is changing. These days the state is working hard to develop profiles of its ethnic groups, train health departments, provide interpreters, and conduct contact investigations, says Risa Webb, MD, state TB consultant. The process speaks to what’s involved when a state shifts gears from working mostly with "home-grown" TB cases to handling more cases among the foreign-born — who now account for about 10% of the total number of cases overall.
The change didn’t come overnight. For years, a small community of Asian-born fishermen has plied the waters of the Gulf Coast, with fishermen going out to sea for weeks at a time, making it tough to observe therapy. In the sweet potato fields in the northeastern part of the state, the number of foreign-born laborers, many of them Hispanic, has also increased.
The state’s growing poultry industry, too, is attracting foreign-born workers. Among them, several TB cases have recently occurred.
One such case turned up in a plant where workers come from a dozen different countries in Central and Latin America. The size of the work area — a single large room — meant virtually everyone had to be skin-tested. TB controllers were surprised at how many positive reactions they found among foreign-born workers and began interpreting the results.
In some of the workers’ countries of origin, BCG vaccinations are given routinely. Investigators also found that many workers regularly travel to and from their homes, increasing their chances for recent exposure.
Eventually, the decision was made to offer preventive therapy to more than 100 workers. Four months later, about a fifth of that group has already disappeared — not a surprising event since turnover at the plant is high.
At first, TB controllers considered asking poultry-plant owners to obtain baseline skin test results from all workers at hire; but given the high turnover, they now wonder whether it would be the best use of resources. Fortunately, Mississippi has a good infrastructure capable of delivering directly observed therapy and has been able to add interpreters and offer foreign-language courses in some districts, Webb says.
What helped get the state off to a good start in coping with its foreign-born populations was a regional leadership conference held a few years ago where participants voted to survey the foreign-born populations beginning to immigrate to the state. Questionnaires went out to health district epidemiologists and chambers of commerce, and soon a picture began to emerge about who the populations were, where they lived, and where they received health care services.
The survey has proven invaluable, not just to TB control, but to other branches of the health department too, Webb adds. If commissioning such a survey proves too costly for a TB control division to undertake alone, the answer might be to get other divisions interested as well, since they stand to benefit from the same demographic information, Webb adds.
What the division needs most now is more interpreters and manpower to conduct follow-up in the poultry industry and to determine if any of the positive skin-test reactions from the contact investigation reflect other cases of active TB, which may be hidden in the communities where the workers live.
"If you have someone who speaks the language it’s easier to win people’s trust," she says.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content