CITC Newsletter — Fall/Winter 2014
An electronic newsletter from the Curry International Tuberculosis Center (CITC)
CITC creates, enhances, and disseminates resources and models of excellence, and performs research to control and eliminate TB in the United States and internationally.
CITC is designated by the Centers for Disease Control and Prevention (CDC) as the Regional Training and Medical Consultation Center (RTMCC) for the Western Region, serving Alaska, California (including Los Angeles, San Diego, and San Francisco), Colorado, Hawaii, Idaho, Nevada, Oregon, Utah, Washington, and the U.S. Affiliated Pacific Islands.
Committed to the belief that everyone deserves the highest quality of care in a manner consistent with his or her culture, values and language, CITC develops and delivers highly versatile, culturally appropriate trainings, educational products, medical consultation, and technical assistance.
NTCA Milestone: 20 Years of Advocacy and Action
Next year, the National TB Controllers Association (NTCA) will celebrate 20 years in existence (1995-2015). This upcoming anniversary is an opportunity to reflect on past achievements and future priorities, as NTCA pursues its vision of “A World Free of Tuberculosis.”
Based in Smyrna, GA (northwest of the Atlanta metro area), NTCA provides a collective voice for TB Controllers in state, local, and territorial programs to advance and to advocate for TB control and elimination activities in the U.S. NTCA serves the TB community by hosting an annual national conference, promoting trainings sponsored by other agencies, and developing a library of resources, tools, and reference materials. NTCA staff and board members are actively engaged with other TB organizations at the federal and state levels to raise awareness about the disease and emphasize the importance of adequately funded TB public health programs.
NTCA also supports three membership sections within its organization: the National TB Nurse Coalition (NTNC), the National Society of TB Clinicians (NSTC) and the recently established Society for Epidemiology in TB Control (SETC). Recently adopted bylaws provide expanded opportunities for the organization’s membership and governance structures, focusing on greater inclusiveness and recognizing the multi-disciplinary focus required for TB control efforts.
In June 2014, NTCA installed John Bernardo, MD, as NTCA president for 2014-2015 at its annual meeting in Atlanta. Dr. Bernardo comments on his priorities as president during his tenure: “We desperately need to maintain infrastructure to assure that the Essential Components of TB Control, set forth by ACET in 1995, are maintained at state and local levels as Federal and jurisdictional funding for categorical TB prevention and control activities is reduced. This will involve collaborating with Federal partners and other organizations as necessary to develop strategies that will accommodate changing epidemiology of the disease and maintain expertise and clinical resources at the local level, where so much of our work is done. We also need to use the power of our organization to develop a research agenda that will answer programmatically-relevant questions that relate to the diagnosis, prevention, and management of tuberculosis. If we fail in these areas, we could face a resurgence of tuberculosis in our country that will be more difficult and more costly to manage than the resurgence of the 1980’s.”
Donna Wegener, MA, has served as NTCA Executive Director since 2013, and she notes the organization’s major accomplishments during its first 20 years: “NTCA has established itself as a member organization committed to representing those public health professionals who protect the public from tuberculosis. Over time, the National TB Conference has evolved into the annual meeting focused on tuberculosis and brings together clinicians, programmatic personnel, frontline staff, researchers, laboratorians and the CDC's Division of TB Elimination staff to learn, network and renew their commitment to TB elimination. Secondly, by building on its 20-year foundation, NTCA has increased its advocacy efforts, and is recognized as the one voice representing TB public health programs.”
Considering the decade ahead, Ms. Wegener adds: “Now is a critical time for NTCA to position itself as a vibrant, effective and active organization. As we focus our energies on eliminating, not just controlling, TB in the United States, NTCA will join other TB organizations to advocate for adequate funding to implement and achieve the TB elimination plan outlined years ago by the Institute of Medicine.“
Membership in the NTCA is not restricted to TB controllers; the organization is open to any professional interested in TB and public health. Learn more on the NTCA website, or by calling 1-877-503-0806.
Coming Soon: Homelessness and TB Toolkit
CITC will soon release Homelessness and TB Toolkit, an online toolkit and resource guide to assist both public health programs and homeless service agencies in the important work of TB control among homeless patients.
Persons who are experiencing homelessness are at increased risk of TB infection and active disease; they represent a vulnerable sub-population of patients treated by public health providers. Beyond the healthcare system, other agencies that serve homeless clients, such as shelters and community service organizations, play an important role in the prevention and control of TB. Specialized tools can help agencies to meet these challenging needs. Homelessness and TB Toolkit contains forms, signs, educational materials, and other resources collected from many sources in the United States and Canada. The forms are presented as templates that can be modified or edited for a given site’s needs.
The toolkit is a work-in-progress, and CITC invites the TB and social service communities to submit additional resources for possible inclusion.
Watch for Homelessness and TB Toolkit on the CITC website by the end of 2014.
UCSF Magazine Highlights History of TB in San Francisco
As the University of California, San Francisco (UCSF) marks its 150th anniversary, the Fall 2014 issue of UCSF Magazine presents "Scourge of the City," an article highlighting the history of tuberculosis in San Francisco.
Starting with the rise of TB in San Francisco during the Gold Rush of the 1800s, the fascinating article traces the University's early public health partnership with San Francisco General Hospital, leading up to the current research and training programs that combat TB in the global arena.
Firland Northwest Tuberculosis Center Marks One-Year Anniversary
In September 2013, a new resource was established for TB researchers, educators and service providers in the northwest region of the United States: the Firland Northwest Tuberculosis Center (FNWTBC), based at the University of Washington / Harborview Medical Center in Seattle, Washington.
FNWTBC is a partnership between the University of Washington and Public Health – Seattle and King County. Its mission is to promote regional TB services through the support of TB-related education, clinical activities and research. The Center is funded by the Firland Foundation, the modern-day philanthropic legacy of the Firland TB Sanitarium (1911-1973) in Shoreline, WA. Masa Narita, MD, and David Park, MD, are FNWTBC co-founders; David Horne, MD, MPH, serves as the FNWTBC Medical Director, and Jessica Matthews, MPH, is the Center Coordinator.
Among its first-year activities, FNWTBC created a website and held stakeholder meetings to assess the needs of providers and researchers in the region. FNWTBC also collaborated with the Curry Center to develop two online radiology products: Tuberculosis Radiology Practice Cases and Tuberculosis Radiology Image Library.
Dr. Horne shares his vision for the Center during these formative years of its development: “We are thrilled to grow the FNWTBC and work on enhancing TB services within Seattle and regionally. In particular, we are excited to partner with our stakeholders and develop new regional relationships. We are grateful to have the mentorship and support of the Curry Center and hope we can complement their activities.”
Future plans for the Center include a needs assessment of regional Native American tribes, organizing a clinically-oriented TB interest group, and exploring teleconferencing opportunities to support and educate regional providers.
The TB community bids farewell to two long-time colleagues who are retiring at year’s end: Houmpheng Banouvong, with the San Francisco TB Control Program, and Eileen Napolitano, with the Global TB Institute in New Jersey.
After 35 years of service with the San Francisco TB Control Program, Houmpheng Banouvong, Chief of TB Surveillance and Health Program Coordinator, is retiring in December, leaving an indelible legacy of dedication and excellent work. As much as his San Francisco TB colleagues will miss him, Mr. Banouvang's three grandchildren will eagerly command more of his time and attention.
Eileen Napolitano, Deputy Director at the New Jersey Medical School Global Tuberculosis Institute (GTBI) at Rutgers, will also retire at year’s end, concluding several decades of work in the TB world. The CITC team has enjoyed working with Ms. Napolitano since the Center’s inception in 1994, when the Curry Center and GTBI were two of three national “TB Model Centers.” In retirement, she looks forward to time with her two young grandchildren, and she will continue her work on the StopTBUSA board.
Fellowship Trainings Offered to TB Care Providers
CITC offers mini-fellowship trainings to TB care providers – physicians, nurses and programmatic staff – from the western region of the United States. These one- to five-day fellowships provide hands-on experience with TB control activities and opportunities, enabling participants to deepen their understanding and widen their experience with tuberculosis care.
Fellowships can be based at a variety of locations, some outside of California. The location is determined based on the specific needs of the applicant. One area of focus is “leadership development” for new TB Controllers, Health Officers, Program Managers, Nursing Supervisors, and Outbreak Investigators. The individual needs of applicants are addressed by assessing areas of practice and communities served, and matching the applicant’s objectives with appropriate activities.
CITC’s schedule of upcoming trainings (through August 2015) offers a variety of courses for clinicians and public health providers.
January 21, 2015
Molecular Diagnostics for Tuberculosis: What are NAATs and How Do You Use Them?
75-minute presentation followed by a 15-minute Q and A session for health care professionals who diagnose and treat tuberculosis. The webinar will describe what NAATs can and cannot tell you and how to best use these tests for AFB smear positive and smear negative clinical specimens. The webinar will also discuss the interpretation of specific mutations and drug resistance.
Spring 2015 (date TBD)
Mycobacterium Bovis: Epidemiology, Diagnosis, and Treatment
75-minute presentation followed by a 15-minute Q and A session for physicians, other licensed medical professionals, and public health professionals involved in M. bovis community prevention strategies and M. bovis case contact investigations.
April 21, 2015
California Tuberculosis Controllers Association (CTCA) Educational Conference
April 22, 2015
CITC Training (topic TBD) in conjunction with CTCA Educational Conference
May 26-28, 2015
Los Angeles, CA
Tuberculosis Case Management and Contact Investigation Intensive
Three-day training for physicians, nurses, and other licensed medical care providers who manage patients with tuberculosis or who are at risk for TB.
Summer 2015 (date TBD)
Tuberculosis Nursing Workshop
One-day workshop for nurses, communicable disease investigators, and other licensed medical care providers who work with tuberculosis patients.
Summer 2015 (date TBD)
Tuberculosis Clinical Intensive + Focus on LTBI Pilot
Three-day intensive for physicians and other licensed medical professionals who manage patients with or at risk for tuberculosis.
August 11-14, 2015
Tuberculosis Contact Investigation Interviewing Intensive
Four-day training for health professionals responsible for conducting TB contact investigation interviews. Consists of didactic lectures and small group activities focused on skill building for improved tuberculosis interviewing skills.
For periodic updates on additional trainings, complete course descriptions, and application forms, view our training section.
To better acquaint our readers with the corps of TB experts that comprise our training and medical consultation faculty, each issue of CITC Newsletter presents a profile of a CITC faculty member. In this issue we feature Stephanie Spencer, MA.
The diagnosis and treatment of tuberculosis are based on practices firmly rooted in medical science – lab tests, clinical examinations, radiology. Effective TB care and control also require expertise deep within the social sciences. The communication, trust, and rapport established between patients and providers during the patient interview, the contact investigation, and visits for directly observed therapy all play a critical role in successful outcomes. These human interactions are often complicated by cultural identity and language differences. It is in this realm that cultural anthropologists like Stephanie Spencer, MA, Program Liaison with the California Department of Public Health (CDPH) – TB Control Branch, make a very special – and crucially important – contribution.
Born in Charleston, South Carolina, Ms. Spencer was introduced to the challenges of cultural adaptation early in life. Her father worked for the U.S. State Department, and by age 12, Ms. Spencer had lived with her family in three states and five countries, including Peru, Lebanon, Egypt, and Tunisia. “During my childhood I was exposed to so many cultures, I couldn’t have avoided an interest in culture and languages,” she notes. For her high school years, the family settled in Arlington, Virginia. Already proficient in Spanish from her time in Peru, Ms. Spencer studied Anthropology and French at Beloit College in Wisconsin, where she spent six months as an exchange student at a French university. After college, she worked for an international development consulting firm in Washington, D.C., supporting projects in diarrheal disease control. There she noticed a tendency within some public health circles to view culture as a “barrier,” rather than a dimension that offers insights into “the social and cognitive factors” that motivate people to make decisions related to health. A few years later she entered the Masters/Doctoral program in Cultural Anthropology at Boston University, with the goal to explore the social and cultural factors that shape people’s identities. This interest was informed by her life experience, too. “Not until graduate school with other students who had an anthropological perspective on the world did I feel ‘at home’,” she reflects. “I have also always felt comfortable with immigrant communities because I know what it feels like to adapt.”
While working on her dissertation research, Ms. Spencer lived in a village in Eastern Java, Indonesia, for two years, studying how the national Indonesian educational curriculum was implemented in local settings. There she became fluent in her third foreign language, Bahasa Indonesia. She spent the next several years at work on a PhD dissertation, an effort that seemed increasingly futile as the job market for anthropologists in academia dwindled. Shifting from academic to applied anthropology, her employment experiences were rich and varied: jobs in philanthropy, public health, and faith-based international development, where she made site visits to social service and community development projects in Indonesia, Thailand, Nepal, Pakistan and Afghanistan; teaching college anthropology and sociology courses; and community organizing for immigrant integration, civil rights, and multicultural education. Ms. Spencer identifies a common thread among these diverse jobs: “I was always a liaison, an intermediary, at the local, national, or international level. To this day, my interest is: How can I best make connections among people?”
In 2004, Ms. Spencer moved with her partner to California, and began her current association with the CDPH TB Control Branch. “This was a fortuitous time to land at the Branch,” she recalls. “It was the beginning of the last wave of Hmong resettlement in the Central Valley, and I provided cultural background information to assist Branch staff.” Promoted to Program Liaison in 2006, Ms. Spencer serves local health department staff in a region of eleven California counties that stretches from the Bay Area to the Nevada border. She considers herself an “information broker,” assisting the Outbreak Team in tracking newly-arriving refugee populations, designing and delivering cultural competency training curricula, and collecting TB materials in the many languages needed to serve foreign-born patients.
A member of the Curry Center training faculty since 2007, Ms. Spencer developed Effective Strategies for Working with Interpreters, a module she regularly presents as part of the Center’s TB Case Management and Contact Investigation Intensive courses. “I’m a teacher at heart, and I love doing the trainings,’ she admits. Her knowledge and enthusiasm are evident in the rave reviews she consistently receives from course participants. She also developed and presented the cultural competence module for the CDC STD Program Managers Course.
When asked about her future career plans, Ms. Spencer emphasizes the “sense of mission” she shares with the people who work in tuberculosis. In her eyes, the long-term focus of TB elimination in the U.S. will center on growing numbers of foreign-born residents who are not seen within the official healthcare system: “Meeting their special needs will require direct engagement with immigrant communities, collaboration with community-based organizations, and ethnically-based groups.”
CITC Associate Medical Director Ann Raftery, RN, PHN, MS, applauds Ms. Spencer’s special skills and knowledge: “Stephanie is my go-to person for hard-to-find cultural resources. She is always willing to help and goes above and beyond my expectations when providing assistance and input on tough culture-related challenges. She has both breadth and depth as a cross-cultural expert for TB programs.”
Curry International Tuberculosis Center
University of California, San Francisco
300 Frank Ogawa Plaza, Suite 520
Oakland, CA 94612-2037
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Principal Investigator/ Medical Director: Lisa Chen, MD
Associate Medical Director: Ann Raftery, RN, PHN, MS
Deputy Director: James Sederberg
Director of Education: Kelly Musoke, MPH
Program Manager: Jeannie Fong
Epidemiologist: Baby Djojonegoro, MS, MPH
Newsletter Editor: Kay Wallis, MPH
Web Developer: Mari Griffin, MS
Program Assistant: Dominique Reminick, MA