123435 - 2 Pages within 24 Hrs

ltdprinwival

MPH510_Case_Study_21.pdf

Home >Nursing homework help >123435 - 2 Pages within 24 Hrs

C A S E S T U D Y # 2 ADDRESSING THE

TUBERCULOSIS CRISIS ABSTRACT

In 2003, the incidence of TB fell to an all-time low in the city of Poohville. Despite this decline, racial and ethnic

disparities continue to persist, particularly among African Americans. A plethora of factors have precipitated this

disparity in TB infections in the African-American community, including socioeconomic, cultural, and biomedical

factors.

To address the TB problem in African-American communities in Poohville, the Department of Public Health

established a task force in partnership with the Tigger Society, a community based organization in the Tigger

neighborhood, which was particularly hard hit by TB. The task force was charged with developing a TB

prevention program. The partnership drew on the Department of Health’s expertise in treating TB and using

assurance methods, with the Tigger Society’s strengths of cultural competency and community relationships.

INTRODUCTION

Poohville

Poohville, one of the epicenters of the Midwest, is an extremely segregated city with a history of community

activism.

The Tigger Society

In face of the alarming physical, social and economic decay of their community, the residents of the Tigger

neighborhood began to organize for change. In 2000, a group of religious and block club leaders brought

together a coalition of over 100 neighborhood associations, religious institutions and civic organizations to fight

against the forces of disintegration. Contrary to what many believed, Tigger had a number of organizational

resources. As one of the group's leaders, Reverend Christopher Robin points out, "The idea that black

communities were disorganized was really a fallacy. They were not disorganized; they were unorganized."

The Tigger Society mobilized Tigger’s residents to pressure merchants, landlords, city bureaucrats and others

who were responsible for the neighborhood's blighted conditions to respond to their demands for change. These

small victories were important because they proved that low-income people could gain power through collective

action.

The Poohville Department of Public Health

In 2002, the Poohville Department of Public Health (PDPH), under a grant from the Centers for Disease Control

and Prevention (CDC), began to review its data on tuberculosis (TB) in the city. While TB rates in general were

going down, the emergence of new drug resistant strains made TB a continuing concern. The PDPH produced a

report on the incidence rates of TB in various populations in Poohville, which clearly showed a major disparity

between African Americans and other populations.

The Poohville Prevention and Early Treatment of TB Project

The Poohville Times covered the release of the report, and presented the high level of racial disparities in TB,

including the particularly high prevalence of TB in the Tigger neighborhood and two neighboring communities.

The reporter covering the story interviewed Reverend Robin, who expressed outrage that the PDPH wasn’t

addressing the disparities. “Why are we spreading resources across the entire city, when the highest risks and

most significant impact are clearly in the Tigger community?” asked Reverend Robin.

The Mayor of Poohville, who was extremely sensitive to bad publicity, called the Director of the PDPH, Dr. Alice

Kanga, and asked the same question. Dr. Kanga directed her staff to meet with the Tigger Society and develop

interventions to address the problem.

Case Body

Recognizing the importance of community involvement and understanding the cultural and community factors

involved in successful disease prevention and reduction efforts, Dr. Kanga asked the Tigger Society to organize a

community meeting. The purpose of the meeting was to review the findings of the report and begin to discuss

how to address the racial disparities in TB rates. In addition to Reverend Robin and other staff from the Tigger

Society, a number of other community representatives attended the meeting. The attendees included Pastor John

Eeyore, a Tigger Society Board member, and several congregants of the Tigger First AME Church, and Jack

Rabbit, the director of the local community health clinic. Marcy Piglet from the Poohville Defender (a paper

historically dedicated to covering issues in Poohville’s African-American community) covered the meeting for her

paper.

Dr. Kanga presented the following data from the report:

In 2003, the incidence of TB fell to an all-time low in the city of Poohville (Figure 1). The Board of Health reported

a total of 339 cases (11 per 100,000 populations) of active tuberculosis, representing an 11.3% decrease in the

number of TB cases and an 11.4% decline in the overall TB case rate from 2002.

Despite this decline in the incidence of TB in the city of Poohville, racial and ethnic disparities continue to persist.

From 1993 through 2003, non-Hispanic whites experienced the greatest decline (80%) in TB cases followed by

63% for African Americans, and 39% for Hispanics (Figure 2). However, in 2003, the highest proportion of

Poohville TB cases continued to be in the African American racial group, accounting for 53% of the total cases; a

case rate of 17.2 per 100,000. This is more than six times the rate for non-Hispanic whites (2.5 per 100,000) and

double the rate for Hispanics (9.4 per 100,000).

After presenting the data, Dr. Kanga asked the group how the PDPH ought to proceed. After vigorous discussion,

the group consensus was to appoint a task force to investigate the underlying reasons for the disparities in the

community, and develop a prevention and TB reduction plan. Dr. Kanga assured the group that the PDPH would

move forward with the idea. Two months elapsed, and Marcy Piglet called Reverend Robin and Dr. Kanga to learn

what had transpired, and the progress of Task Force. Unfortunately, the task force had not been appointed yet.

Ms Piglet published an article that summarized the TB data from the report and described the PDPH inaction.

After reading the article, Reverend Robin scheduled a meeting with Dr. Kanga on behalf of the Tigger Society.

Reverend Robin wanted to identify potential Task Force participants and move the project forward. In response,

Dr. Kanga made the policy decision to shift TB prevention funds to the Tigger neighborhood in order to focus the

intervention efforts of the department on the area of greatest need.

Additional members of the Task Force were recruited from varied segments of the resident population of the

Tigger neighborhood and the two adjacent communities. Dr. Kanga set a priority for a “cultural” majority on the

Task Force. She achieved that when the majority of the Task Force members were African American. Although

there was a strong interest in having the usual community representatives on the Task Force, the Task Force

leadership recognized that health and social service professionals from the Tigger neighborhood would have

more time to devote to the project. Their agency management encouraged them to participate. Also, as a result

of the strong faith community participation in the Tigger Society, many church volunteers also were recruited.

The Reverend Dr. Robin chaired the first meeting of the Task Force. The group discussed how to obtain

information about the underlying issues and how to implement any intervention. The result was that the group

decided and recommended that information should come from field staff and the community at large. The group

decided that holding focus groups was the best way of gathering assessment data from the three target

neighborhoods/communities.

To gather information from staff, focus groups were held with Public Health Nurses and Communicable Disease

Investigators. The staff focus groups felt that a lack of information regarding TB was an important factor. They

expressed a need for more prevention messages and general information letting the public know that TB is still

with us and that it is not eradicated. Some staff felt that African Americans didn’t go to the doctor or seek

professional health care until they were too sick to care for themselves, leading to delayed diagnosis and

subsequent extended exposure of family and friends to the infectious disease. Some staff members also felt that

patients tended to stop complying with their treatment regimen when they began to feel better, thus giving rise

to multi-drug resistance TB. Many respondents felt that there was a great disparity in the way doctors treated

African American patients as opposed to white patients. Talking down to patients and treating them as less than

a person served to make African American clients reluctant to participate or cooperate with the health care

system. The professionals also expressed concern about the stigma associated with TB.

The community focus groups involved a wide variety of participants, ranging in age from 18 to 86 years; 40%

were male and 60% were female. Both individuals with and without health insurance were included. All

participants were African American. Using a 17-question open-ended semi-structured interview format, the focus

group leaders were able to elicit qualitative information concerning the communities’ health care decision

making. Based on these responses, the focus group determined that African Americans delayed seeking health

care for historical, traditional, and contemporary reasons, which further exacerbates the TB problem. Historically,

African Americans were perceived to be guinea pigs for physician experimentation. Traditionally, African

Americans used home remedies to treat disease conditions rather than using more expensive drugs with more

side effects. Finally, discussions revealed a number of contemporary horror stories concerning physician

insensitivity to African Americans in Poohville.

The Task Force convened to review the results of the focus groups. Acknowledging the fact that the underlying

factors resulting in higher TB rates among African Americans than Whites had a historical origin, the Task Force

determined that a shortterm program would not address the problem. Thus, the challenge was to develop

interventions with measurable processes that were sustainable and that would result in the desired outcomes of

reduced TB incidence rates and early treatment for TB in the African-American communities. Consequently,

using the information garnered from the focus groups, the Task Force created a three-pronged intervention of

community awareness, system change, and patient education. The Task Force developed this type of intervention

because it would make a difference and made sense to the community. From the assessment data, the Task

Force concluded that the best organization to implement the interventions was the Tigger Society because of its

history of commitment to the community. Citing the newspaper articles published in the Tigger Defender and

several delays by PDPH in funding, the Task Force passed a resolution requesting that the PDPH appoint the

Tigger Society as the lead agency to implement the interventions. Several members of the Task Force met with

their local alderman to ask for his assistance in pressuring the PDPH to comply with this resolution. The PDPH

noted its strengths in implementing assurance programs, compared to the Tigger Society’s strengths in

community access, trust, and community knowledge. Thus, PDPH took the lead to address the system

intervention and awarded the Tigger Society a contract to produce the patient education and community

awareness campaign. PDPH assured the quality of the program through its monitoring of the Tigger Society’s

progress and continued participation in the Task Force.

References 1. Chicago Department of Public Health, Tuberculosis Control Program, April 2005. 2003 Annual Tuberculosis Morbidity

Report. Chicago, Illinois.

2. Chicago Department of Public Health, Tuberculosis Control Program. Intensification of TB Prevention, Control, and

Elimination Activities in African-American Communities, Southside Project. Chicago, Illinois.

3. Kouzes, James , Pozner, and Barry. The Leadership Challenge, third edition. San Francisco, CA: Jossey-Bass, 2002.

4. Himmelman, A. Collaboration For A Change. rev. Jan 2002. p3

5. website: http://www.picced.org/cdc-two.php

ABSTRACT