Carol Nyirenda, a Zambian community health activist, and Vernard Green, a senior public health advisor for the Centers for Disease Control, came to the University yesterday to give several talks on the importance and challenges of controlling tuberculosis.
Both speakers have extensive experience with TB diagnoses and treatment through their work with public health organizations. But the two speakers used their different backgrounds to provide two distinct perspectives on the issue at the event, which was co-sponsored by World AIDS week and RESULTS — a grassroots citizens’ lobby aimed at ending poverty.
Nyirenda said she has been infected with both TB and HIV. She said it took doctors over six months to diagnose her with TB, after which she endured eight months of treatment. During those six months, Nyirenda said, she was a risk to her son and daughter, the latter of whom she shared a bed with.
Since her experience, she has advocated extensively to the United Nations and pharmaceutical companies for effective diagnosis and treatment programs for both diseases.
In addition, Nyirenda is a community representative on the Stop TB Partnership’s New Diagnosis Working Group and is a board member of UNITAID — an organization that represents people living with TB, HIV and malaria.
Through the Community Initiative for Tuberculosis and Malaria, Nyirenda is also involved in policy analysis for TB-related legislation, support group formation for TB patients, treatment adherence training and community outreach.
At the event, Nyirenda emphasized the importance of public health organizations reaching out to people infected with TB.
“Most of the time you don’t find hospitals going out into the community,” she said.
Once infected individuals are found, Nyrienda said it is crucial they receive Directly Observed Therapy, which requires community treatment supporters to bring medication directly to patients. The community treatment supporters are usually people with TB who have already been through treatment.
Nyirenda said the Zambian government can only afford to provide DOT for two out of the nine months of treatment for most patients, but the quality of life during those two months is significantly better than it would be without DOT.
She added that one of the ultimate goals of her advocacy is to have one place in Zambia that patients infected with TB and HIV can go to seek treatment for both diseases.
Green, the operations manager of the Detroit TB Program — a public health organization that manages TB cases in Detroit and surrounding areas — also spoke at yesterday’s event, but offered another side to the issue.
Green spoke generally about the importance of public health, saying public health organizations fight for “the greater good of all.” He added that this interest in the greater good is what distinguishes public health organizations from private health care.
Services provided by public health organizations, Green said, include patient follow-up, prevention, and education. He said they deal with the social aspects of health care, like ensuring patients have stable housing and food.
Green spoke about a patient his organization worked with in 2004, who had TB but refused to complete her treatment. About a year after not completing her treatment, the patient came down with drug resistant TB and caused an outbreak around her, but still refused to complete her treatment.
“This woman verbally abused my staff and basically assaulted one,” Green told the audience.
After more than two years of tracking down every person potentially infected by the patient, Green and his staff successfully tested and treated every one of them.
The patient will finally complete her treatment next week and Green said she now does advocacy work for the Detroit TB Program because she realizes they went above and beyond for her.
“That’s what public health for us is about,” Green said.
In addition to working with patients infected with TB, Green said his organization also deals with patients that are co-infected with TB and HIV.
“In the past four to five years,” he said, “we’ve realized that TB and HIV are partners.”
Because of the dangers of co-infection, Green said the Detroit TB Program has made HIV testing a necessary part of their evaluation for TB.