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For most TB infections, treatment works. It cures the disease. But for patients who don't have a private physician or easy access to health care, medical treatment has to come from the public health system. It's called Directly Observed Therapy, or DOT. And today, it's used for more than half of all TB patients in the U.S.
NPR's Patty Neighmond has that story.
PATTY NEIGHMOND: Directly Observed Therapy means exactly what it says.
Dr. JONATHAN FIELDING (Director of Public Health, Los Angeles County): It's where you give somebody medicine and you watch them take it.
NEIGHMOND: Dr. Jonathan Fielding directs public health for Los Angeles County. He says DOT is the only way to make sure people take their medicine until they're cured.
Dr. FIELDING: The therapy is generally at least six months. And people say, oh, I'm feeling better although I really need to take it.
NEIGHMOND: Not taking all the medication for six to nine months call out new, more potent bacteria to flourish. But as Fielding says, it's hard for patients to stick to the regimen especially when the only ill effects they feel are side effects from the treatment itself. Joint pain, blurry vision, abdominal pain, night sweats and fever. Over the past 12 years, Directly Observed Therapy has become routine for most patients who are treated in the public health system.
One model of that therapy is Boston, where Katherine Schmidt works as a public health nurse.
Ms. KATHERINE SCHMIDT (Public Health Nurse, Boston): You can't walk into somebody's house and not have it be holistic, or not look at all the components that they're having to deal with.
NEIGHMOND: So Schmidt does a lot more than handout medicine.
Ms. SCHMIDT: Well, at first, you go to the house and you see if it smells like something's been cooking here. You look at the pots in the stove, where they in the same place they were in before. Is the same trash in the trashcan?
NEIGHMOND: And if she doesn't see food, Schmidt offers patients and their families grocery store coupons. Sometimes, people are embarrassed and don't use them. Sometimes they use the coupons to barter for rent.
Ms. SCHMIDT: So the next time then, you think, we're going to go to the grocery store and we're going to buy some chicken and we're going to buy some beef, and we're going to bring to the house. And then, it'll get cooked because this person often knows how to cook. And they're very appreciative of us bringing the food and this would last, and it lasts, lasts longer than probably any family could make it last.
NEIGHMOND: And when patients are worried about how apartment managers or other residents might react to their illness, Schmidt finds herself going not to their homes but to some unexpected places.
Ms. SCHMIDT: Street corners, Dunkin' Donuts. Some place where there aren't going to be other people looking, nobody else that they're going to know. So we have to be very discrete.
NEIGHMOND: Discreet while carrying a cup of water for the patient to swallow their pills. Always the goal, says Schmidt, ensure the patient finishes their treatment and so no longer poses a threat to others. Schmidt also contacts the patient's friends, relatives, housemates and coworkers who might be at risk. They are then screened for TB.
Dr. Edward Nardell researches and teaches public health at Harvard University.
Dr. EDWARD NARDELL (Public Health, Harvard University): In general, we've done an excellent job of controlling tuberculosis.
NEIGHMOND: A most recent TB outbreak was in New York City in the late 1980s. At its peak, there were nearly 4,000 people with active TB. DOT therapy, in many ways, resulted from measures New York City had to take in order to stop the spread of the disease. In the city and in the prisons, public health officials fought the outbreak on a limited budget for years. Then, the public realized that things were out of control. Dr. Nardell.
Dr. NARDELL: In New York City, what resulted in a huge outpouring of funding to correct that problem was when health care workers began to die of MDRTB, and a prison guard. When that happened, unions got involved and they couldn't give enough money out and they couldn't spend it fast enough at that point. And $1 billion dollars went into that resurgence of TB in New York City and it turned it around very effectively.
NEIGHMOND: Currently in the U.S., there are more than 14,000 active cases of TB. The number of cases has decreased every year since 1992.
Patty Neighmond, NPR News.
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