Rocky Mountain states ponder forming group
When crisis hits, networking proves critical
Representatives from state TB programs from the far-flung northern Rocky Mountain states were set to meet as a group for the first time late last month in Jackson Hole, WY.
The meeting, intended as an exploratory look at forming a new regional group, was called by Alex Bowler, MPH, TB control officer for Wyoming. On the invitation list were Montana, Colorado, Utah, Idaho, Nebraska, North and South Dakota, and Wyoming.
The invitees all have plenty in common, which makes a regional group a good idea for them, Bowler maintains. "We all have widely scattered populations, except for metropolitan Denver, and we’re all low-incidence states," he says. When Bowler says "low-incidence," he’s not kidding, either: Wyoming’s rate last year was a mere flyspeck of 0.8/100,000. "That can make it hard to keep an edge," he adds. All the states also have Indian reservations, where TB can pose a problem, Bowler notes.
Regionalization is one issue Bowler was definitely planning to kick around at the first meeting. The recommendation that states like Bowler’s regionalize some of their services (one of the suggestions contained in last year’s Institute of Medicine report on TB elimination) is hardly a popular subject in Wyoming.
"When you say regionalize,’ if you’re talking about education or highly specific laboratory services like DNA fingerprinting, then I’d say that’s all right, " says Bowler. "If you mean forced regionalization of essential services, I’d have to say no." When it comes to laboratory services, "regionalization" suggests slow turnaround time and losing control of isolates, he explains. "You can’t enforce your states’ reporting requirements in another state," he points out. Wyoming already contracts with
one TB lab on the East Coast, and Bowler is less than satisfied with that arrangement.
On the positive side, states so far from everywhere else on earth relish the prospect of having someone with whom to network. In Colorado, where rural TB controllers are just now emerging from a trial-by-fire ordeal involving two multidrug-resistant TB cases, one of Bowler’s colleagues says she likes the idea a lot.
"These MDR-TB cases are always going to be a crisis in a low-incidence state like ours," says Gayle Schack, RN, public-health nursing consultant for the state’s TB program. "The most important thing when something like this happens is to work together and not fly off the handle when the tension gets high."
Good cross-state teamwork helped save the day in both MDR-TB cases, Schack believes. First, TB experts called in to consult by teleconference concluded that some of the cases’ 80-plus contacts had probably been previously infected; others seemed likely to have been infected by the source case.
Two separate regimens for treating contacts were duly devised, and Schack got the word out to neighboring states where contacts were located. Things were just settling down, she sighs, when a nearby state sent Colorado yet another MDR-TB case.
Rock-bottom case rates like Wyoming’s notwithstanding, Schack adds that she’s seeing other low-incidence states get hit with occasional four-alarm fires like hers and is watching her own state’s case totals climb, thanks to a spurt in population and an influx of foreign-born residents.
"We’ve got to work together so we can have a voice," she says. "That way, maybe we can keep from being forgotten."
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