This report was filed by Shaoli Chadhuri, a junior at Duke University.
“When I told my friends about my summer plans, many were surprised to hear that tuberculosis still existed in the US, not to mention, right here in North Carolina,” writes Duke University senior Catherine Castillo in her first blog post as an intern at the Wake County Tuberculosis Program.
Castillo and senior Melanie Subramanian spent this past summer in North Carolina’s Wake County working under the direction of Dr. Jason Stout, a faculty at Duke University Medical Center and the state’s TB director. As Castillo discovered, TB cases in North Carolina are typically in the hundreds, but is concentrated in high-risk populations like the homeless, migrant farmworkers, refugees, and undocumented persons—all groups susceptible disease because of a near-absence of health care access. Castillo is a biology major and pursuing a certificate in Global Health at Duke.
Below is a Q&A with Castillo in which she describes here experiences this summer, her exposure to the realities of TB cases and research, and the efforts being made by the TB program to prevent and control it.
Q: Why did you decide to conduct summer research with a tuberculosis program?
A: I technically didn’t decide to conduct summer research when I applied for the internship. The premise was that it was a fieldwork experience, and that I would be assigned to different tasks through Dr. [Jason] Stout. Part of those tasks were assisting in research projects. There is an additional study I could point out related to TB: using overlapping geographical information about areas with high risk factors for HIV, syphilis, and TB, we [Duke Medicine’s Division of Infectious Disease] identified communities and recruited volunteers to participate in a study that provided them with a combined TB, HIV, and syphilis blood test.
The blood test makes it easier to do outreach testing because the provider has the result, and can contact the patient if it’s positive without [the patient] having to come back. For many people, especially in communities with high risk for TB, transportation is a huge issue that prevents them from getting adequate health care. The goal of this study is to determine if this test–in combination with the geographical data—can help find more active and latent cases.
Q: What about TB patients and their treatment [first] interested you?
A: I was interested in this internship because, through the Global Health Certificate, you hear a lot about health disparities around the world and the heavy burden many low-income nations face due to infectious diseases like tuberculosis. In the United States, it’s a minor health problem compared to non-communicable diseases. Yet, infectious diseases do exist in this nation—and there’s a lot of effort put into making sure it does not become a huge problem.
I spent the summer of 2009 in Uganda through DukeEngage [a summer service-learning program] working on a maternal health project, and I wanted to have a domestic experience to get a better perspective of how wealthier countries handle public health. This opportunity gave me the chance to see the reality of the situation [in] the U.S. and what measures we have in place to keep important and real, but relatively minor issues like TB out of most people’s radars.
Q: Is this the first time Duke students have worked with this specific program?
A: The internship with Dr. Jason Stout has been offered through the Duke Global Health Institute for the last three years, and other students have done similar work assisting on whatever projects he or his colleagues were working on—or small “outbreaks” that occurred during the time they spent under his mentorship.
Q: What barriers do you think remain for TB patients and for those who care for them, whether as physicians or legislators?
A: The TB control program in Wake County is particularly good…not only because the administration and staff are excellent, but because the funding has been used to ensure…essential treatment and prevention methods—[especially] where people exposed to individuals with active TB are vigorously sought after for TB testing. Treatment…is strictly enforced and made more accessible because it’s free and there are nurses assigned to do directly-observed therapy in people’s homes.
A few barriers that still exist are a lack of access to health care for migrant farmworkers, undocumented persons, low-income populations, and general lack of awareness of TB, its symptoms, and methods of transmission. There’s also a stigma against TB [within these populations] that may prevent individuals from seeking healthcare early in the disease. This not only affects them, but the people they may expose while they are symptomatic. In the case of undocumented persons, they may fear deportation and be apprehensive about seeking health care. The lack of awareness of TB in the US is another problem because funding is harder to find compared to other health issues that are more popular in the general public. [But] it is an issue that would quickly become a problem for everyone if it did get out of control.
Q: Do you plan to work with TB treatment or research in the future?
I want to pursue a career in public health, and TB treatment and research is definitely an area I could get involved in–especially since I’m a fluent native Spanish speaker and immigrants, including Latinos, are disproportionately affected by it.