Ann’s previous post, Ft. Wayne update: Health Dept strapped, but bring on the Burmese, ends with the thought that it is up to each community to decide if they want refugees and can handle them. That is quite right, in principle.
I’d like to add a consideration about tuberculosis. TB is a public health problem, international in scope. Within the U.S. it should be handled at a national level. The CDC (Centers for Disease Control) reports that TB cases in the U.S. have been dropping slightly overall, but is high among immigrants from certain countries. They don’t list Burma in the top five, but these Ft. Wayne refugees are reported to have a 50 percent infection rate.
My concern is that with half of the Burmese carrying latent TB, that’s a lot of people to treat and keep track of. Latent TB must be treated, or 10-15 percent will develop into full-blown, contagious TB. The treatment goes on for a year and medicine must be taken daily. Public health officials have developed ways to make sure patients get their treatments; it’s been a big problem among native-born Americans, since many TB patients are homeless, drug-addicted, or otherwise living disorderly lives that make it unlikely they would take their medicine regularly without supervision.
I haven’t read anything about how amenable the Burmese refugees (and other refugees) are to treatment. However, we know that refugees do not always stay put in the places where they are settled. And when they leave, they do not necessarily tell the health agencies. I would like to know what provisions the local health departments have made to keep track of the latent TB patients and make sure they complete their treatment. If they don’t do this, TB could be spreading to every corner of the U.S. Since it sometimes takes years for the latent form of TB to become active, when it does, we could be seeing a TB time bomb explode in years to come.
So I think the willingness of a community to take in refugees is only one factor. There should be a national policy on how refugees and other immigrants with latent TB are dealt with, and the public should be informed of it.