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  1. #1
    Senior Member Brian503a's Avatar
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    Medic goes one on one in city's battle against TB

    http://www.sfgate.com/cgi-bin/article.c ... JFCSB1.DTL

    Medic goes one on one in city's battle against TB
    S.F. tuberculosis rate dips but still is 3 times U.S. average

    - Vanessa Hua, Chronicle Staff Writer
    Friday, June 16, 2006



    A medic who served in Afghanistan, Virgilio Comia is at war again, this time fighting tuberculosis in San Francisco, which has the highest TB rate of any city in the United States.

    Comia calls on his patients four times a week. He drives to Chinatown, the Sunset, the Tenderloin and the Mission District and watches each one swallow a handful of antibiotics. He asks if they are itchy, achy, nauseated or suffering other side effects. He brings along applesauce for those who have trouble swallowing and calls the TB clinic at San Francisco General Hospital for those who have questions. And he does it for six months or longer, whatever it takes to kill off the bacilli that cause the disease.

    "At first they're hesitant, resistant, looking you up and down, trying to feel out whether you're here to take care of me or just to give me pills," said Comia, 45, who is compact and agile like a soccer player. "I'm here for you. Whatever you need, let me know."

    San Francisco saw 132 cases of active tuberculosis last year, the lowest incidence ever recorded in the city but three times the national average. San Francisco's rate is high in part because of its large immigrant population, an estimated 39 percent of city residents.

    Tuberculosis cases have fallen steadily in the United States, from 84,304 in 1953 to 14,093 last year. But the disease has been on the rise worldwide since the 1980s -- particularly in southern Africa and Southeast Asia -- and more than 2 million people die of it annually.

    One-third of the world's population carries TB, and if they immigrate they bring it with them.

    Foreign-born people account for three-quarters of San Francisco TB cases, and half of those are among people from China, according to the city's Department of Public Health. Other Bay Area counties have a similar pattern. Nationwide, foreign-born people make up 11 percent of the population and 60 percent of TB cases.

    For public health workers, treatment of infectious diseases is a balancing act. They must reach out to the communities affected without singling them out for stigma.

    "San Francisco is an international city that we take pride in," said Dr. Masae Kawamura, director of the TB Control Section of San Francisco's Department of Public Health. "And with it, we inherit the global diseases of the world."

    After outbreaks, Irish immigrants once were associated with cholera, Italians with polio, Chinese with bubonic plague and Jews with tuberculosis.

    "This is an old story about American history -- concern about public health and the diseases that immigrants might bring," said Alan Kraut, a history professor at American University in Washington, D.C. "There's nothing particular about being Italian that makes you vulnerable to polio. But if you're poor and living in difficult circumstances, you might be more vulnerable to infection."

    The type of work many immigrants perform and a lack of access to health services make many of them vulnerable to infectious disease, said Xochitl Castañeda, director of the California-Mexico Health Initiative at UC Berkeley.

    "They don't have enough money to pay for the problem, and what you see is not very happy," said Castañeda, adding that the majority of Mexican immigrants are healthier when they first arrive than they are a decade after settling here.

    And when people with active TB aren't treated, they can infect others.

    An illegal immigrant from Latin America who had lived at an unlicensed home-child-care center in San Francisco's Mission District off and on since 2002 spurred a tuberculosis outbreak there in 2004, infecting nine children and two adults. He had sporadically dosed himself with pills from his homeland. When he eventually sought medical treatment here, the Department of Public Health checked whether anyone in his circles of friends, family and other contacts was infected.

    Agencies around the country began doing "direct observation therapy" like Comia's house calls in the early 1980s for the most contagious, frail and infirm patients, who account for 50 to 65 percent of TB cases in San Francisco.

    On a recent weekday, Comia visited a cluttered house in the Mission, sparsely furnished public housing in the Tenderloin and dark, tiny apartments in Chinatown.

    "I never knew there were such rundown places. Places with only a community shower, with only a community kitchen," said Comia, who immigrated from the Philippines as a teenager and was an active-duty military police officer in the Air Force during the Gulf War before he became a medic in the Air Force reserve. "You can't be picky or annoyed by the environment. You see a lot of nasty or gross things, but you get used to that."

    Comia speaks Tagalog with his Filipino patients, and staff at the San Francisco General Hospital clinic are available to translate by phone into Mandarin Chinese, Spanish, Bengali, Korean, Russian, Thai, Laotian, Vietnamese, Cambodian and other languages.

    At his apartment in the Tenderloin, Chen Fu, 74, coughed as he gulped down his pills, so Comia rubbed his back. Chen closed his eyes and looked away as Comia drew his blood. With only informal sign language in common, the two men exchanged thumbs-up after each step in the visit.

    "Good, good, very good. Thank you," said Comia, watchful for weight loss, muddy eyes and other changes.

    He tries to accommodate those who fear being stigmatized.

    One man preferred to get in Comia's parked car, for example, to take his pills and get his blood drawn rather than be treated in his apartment building.

    Calling on Sun Yu-gu, Comia slipped off his hiking boots before entering the small, immaculate house decorated with an ancestral altar and a fish tank.

    Sun, 25, who immigrated three years ago from China and had a baby last year, discovered she had TB when she saw a doctor last month because of a persistent cough and weight loss.

    "Hen hau," she said of the house calls. Very good.

    "Hen guanxin." Very thoughtful.

    "It's basic, what I do," Comia said while driving an elderly couple to the clinic. "At the same time, I want to make sure they are OK. I take pride. All I can do is give them some comfort."



    --------------------------------------------------------------------------------
    Tuberculosis basics
    People with active TB spread the disease into the air by coughing, sneezing, speaking and singing.

    The likelihood of transmission is based upon how long someone is exposed, how strong the carrier’s infection is and how well air circulates in the area.

    TB can almost always be cured with medicine.

    Nine of 10 people infected with TB do not develop symptoms.

    Of the 10 percent who develop symptoms, half do so in one to two years.

    Source: San Francisco Department of Public Health



    --------------------------------------------------------------------------------
    Tuberculosis and poverty
    -- The national tuberculosis rates of Latinos, African Americans and Asian Americans in 2005 were 7.3, 8.3 and 19.6 times higher than the rate among whites, according to the federal Centers for Disease Control and Prevention.

    -- Researchers have found much of the increased tuberculosis rate among racial minorities correlates to socioeconomic factors such as crowding and poverty rather than intrinsic differences. (Note: poverty accounts for much, but not all, of the increased rate.)

    -- The poverty rate among black and Hispanic people in 2004 was nearly three times the rate among whites -- 24.7 percent of African Americans and 21.9 percent of Hispanics compared to 8.6 percent of non-Hispanic whites. Asian Americans' poverty rate was 9.8 percent overall, though the group includes some of the nation's poorest residents.


    Source: San Francisco Department of Public Health

    E-mail Vanessa Hua at vahua@sfchronicle.com.
    Support our FIGHT AGAINST illegal immigration & Amnesty by joining our E-mail Alerts at http://eepurl.com/cktGTn

  2. #2
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    Am I supposed to feel sorry for these diseased people?

    They are bringing these disease into our country to infect us and our children while making us pay for their treatment and I am supposed to feel sorry for them?

  3. #3
    Senior Member gofer's Avatar
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    Nationwide, foreign-born people make up 11 percent of the population and 60 percent of TB cases.
    And we WANT this?? I am sure that most of these people are illegal. This alone is enough reason to want to stop this madness!!

    "They don't have enough money to pay for the problem, and what you see is not very happy," said Castañeda, adding that the majority of Mexican immigrants are healthier when they first arrive than they are a decade after settling here.
    SO much for coming for a better life! I guess making 10 times the money has no effect on them?! Over a third of those from the last amnesty are still living in poverty and of course on welfare.

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