TB Challenge: Partnering to Eliminate TB
in African Americans
An Eyewitness Account: TB Past and Present
Chris W. Caudill, Senior Public Health Advisor, Chicago Department
of Public Health
Ms. Gennell Wilson is a Communicable Disease Investigator (CDI)
for the Chicago TB Program and proud of it! Born and raised in Chicago,
she has spent the last 20 years protecting the health of the city
Chris Caudill: How did you become interested in public health work?
Gennell Wilson: I studied liberal arts in school and had numerous
jobs that taught me what I did not want to do. When I eventually
took a job with the city as a health education aide, I liked the
field work and working with people.
CC: What brought you to the TB program?
GW: After I was laid off as a health education aide, a friend told
me about an opening in TB. I think I got the job because, being
from Cabrini-Green, I did not fear the projects or other “difficult”
areas where patients may live.
CC: Tell me about the early days working with TB.
GW: “A happy worker is a productive worker” is not just a cliché.
Upon hiring me as a CDI in 1983, then Program Director John Kuharik
assured me that my paycheck would not be compensation for my labor,
but the satisfaction in helping to save lives and reduce the spread
of TB would be my reward. What an understatement! Twenty years later
I am still here and I love my job. John was right. After one of
my quarantined patients needlessly died of TB, I made a personal
commitment to the patients and my job.
CC: What interests you most about your job?
GW: I consider myself the patient's advocate. Communication is
the quintessential element of my work. I speak up and out against
compliance barriers. I think one of the greatest barriers is the
health care worker's attitude. I often tease new Investigators by
telling them to keep a roll of toilet paper around because in this
job we kiss a lot of butts. I love the challenge of persuasion.
At the start of the conversation, they (patients) tell you they
don't want the meds, but at the end they are taking them and asking
when you are coming back.
CC: How has Chicago changed over the years?
GW: Chicago has changed and forced TB to change as well. The old
“skid row” once littered with my drunken clients, either in their
chickenwire-cage rooms or lying in their urine on the street, is
now the “West Loop Area.” What was once a soup kitchen is now a
Starbucks. Many of the CHA [Chicago Housing Authority] high-rises
where we walked up and down six or eight flights are now townhouses,
lofts, and condominiums.
CC: TB rates in Chicago are over four times higher for African-Americans
than whites. How can this disparity be reduced?
GW: I don't think we can treat TB in anyone without treating the
patient as a whole. We must address their needs. If not, TB remains
secondary to their concerns. Recently, I had a 15-year-old client
who had not been to school in over 2 years because she had no clothes.
I took it personally. I took her to the store and we shopped. She
had a new attitude and her very large family, who had been hostile,
became receptive. We must act as a resource for referrals to agencies
that can help with housing, health, and economic problems. We need
to understand all the needs of the patient.
CC: What can an individual field worker do?
GW: Field workers need to remove attitudinal barriers like prejudice,
ignorance, fear, insensitivity, bigotry, stereotyping, and intolerance.
I think all health care workers should show respect, understanding,
trust, a genuine concern, objectivity, sensitivity, and patience
with the patients. For me, those are the secret ingredients to compliance.
Also, cultural sensitivity training needs to be more than just a
class. You need to become involved in activities in different communities
to get help in understanding community perspectives.