GUEST VIEW

By Dave Orvis

Edmonds City Council

TB a prime target of vigilant health district

The latest tuberculosis case in Alderwood reminds us why we need the Snohomish Health District.  The health district is charged with controlling infectious diseases like TB, and they work hard to do so.

I had an opportunity recently to take a tour of the Snohomish Health District’s tuberculosis control program.  Tuberculosis is very treatable and curable, but also very serious, so the SHD has a dedicated staff devoted to dealing with this one disease.

 The health district takes a proactive approach to the treatment of tuberculosis, because tuberculosis is an infectious disease that can be spread through the air (although it requires some time for the exposure to take place).

 For active cases of TB, the health district will help the individual achieve isolation from others while contagious.  The SHD will provide rental assistance and even shop for food for patients.

In the case of a homeless victim, they will provide housing and food, so the patient remains away from others.

The Snohomish Health District will also treat family members together, so that they can support each other through treatment.  The SHD has special treatment rooms with negative air flow so TB patients can safely see medical staff without exposing others to the disease.

Folks with active tuberculosis are not given a bottle of pills.  They need to follow a prescribed regimen of medication and stick to it, which prevents those nasty drug-resistant strains of TB from occurring.

Active tuberculosis patients undergo Directly Observed Therapy (DOT), which requires someone from the health district to observe patients taking their medication.  Typically, a patient will get a visit from an outreach worker each day, with the medication needed.

Some patients pick up their pills at one of two centers in Snohomish County, and those who need to work (and demonstrate good compliance with their regimen) take their pills with the aid of videophone.

However, monitoring medication and isolation are just part of the duties of the tuberculosis team.  They also work hard to track down anyone who has had significant contact with a person with the active disease.

This isn’t new for them.  Tracking is something they know how to do.  They find those at risk and administer the appropriate skin tests to determine if they have been infected.

A positive skin test means a person has been infected but does not mean he or she has the active form of the disease.  Only one in ten people with a positive skin test will develop active TB, but the team will offer preventative therapy to all who are infected.

Sometimes folks with this latent TB only need to take medication twice a week, which again is monitored closely by outreach workers.  Those with inactive TB, who undergo preventative treatment, are at substantially lower risk of getting the active form of the disease, which helps prevent a further spread of TB.

Needless to say, the tuberculosis control staff at the SHD works hard, but I want to conclude with the most impressive part of my tour with staff.

Sometimes we think of health districts as being enforcers, making sure folks with contagious TB stay isolated and take all of their pills.  However Konstantin, the outreach worker I was touring with, preferred to think of himself as a caregiver.

He doesn’t just dispense pills but also looks for side effects of the medication.  Sometimes TB victims will literally take a handful of pills (it makes me nauseous just looking at them all).  If a patient develops side effects, Konstantin will communicate these effects to the case manager and physician, and quickly get prescribed medications back to the patient to ease the side effects.

 In short, the Snohomish Health District sees its duty to enforce as an opportunity to care.  They want to cure TB patients just as much they want to protect the rest of us from TB.

If I were to ever get this disease, I would want to be here in Snohomish County.  However, since I live in Snohomish County, I probably won’t ever have to worry about it.

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(Councilman Orvis was assisted in assembling this report by county health official Gary Galbanum and by Donna Allis, the head of the tuberculosis control program.)