TB Notes Newsletter
No. 3, 2008
TB ETN Cultural Competency Workgroup Updates
Cultural Self-Awareness Discussion
On May 1, 2008, the Cultural Competency Workgroup held their
fifth special topic discussion call. The topic chosen for this call
was “Cultural Self-Awareness.” The presentation and discussion was
led by Julie McCallum, Regional TB Nurse with the American Lung
Association of Michigan; Rachel Purcell, Health Educator Consultant
with the Florida Department of Health; and Allison Maiuri, then a
Fellow with the Association of Schools of Public Health.
The speakers outlined cultural self-awareness and why it is
important in developing cultural competency. The objectives for the
session were to identify two cultural values through self assessment
and to describe how cultural assumptions affect professional
judgments. Prior to the call, organizers e-mailed to the workgroup
members a short
Identity Measure and asked them to complete it. The purpose of
the assessment was to get each group member thinking about their own
cultural identity and the value that they place on it.
A brief presentation was given to the group on cultural
self-awareness. According to the research and as stated in the
presentation, the first step in developing cultural competence is
“cultural self-awareness,” which is knowing and understanding one’s
own culture. Because America is a melting pot of diverse cultures
from across the country and around the world, it may be difficult to
tease out core cultural precepts, making it challenging for
Americans to have a clear understanding of their own culture. Mark
Twain once said, “The only distinguishing characteristic of American
character that I’ve been able to discover is a fondness for ice
water.” Although humorous, this statement is not necessarily true.
Culture influences everything we do and because it is a part of us,
we may not see it. One article used an example of fish in a
fishbowl. The fish are surrounded by water and glass, but are
unaware that these elements exist and that they distort their view
of the outside world.
Following the brief presentation, the group engaged in
discussion. To stimulate discussion, the following American idioms
were presented and the values they represented were discussed.
- A rolling stone gathers no moss. Preoccupation with
- The early bird gets the worm. Getting ahead, achievement, having
- There’s no fool like an old fool. Value placed on youth.
There was a great deal of discussion regarding these proverbs,
and many on the call had differing interpretations of these idioms.
The conversation was stimulating and provided much food for thought.
TB affects people from all around the world. Understanding one’s
own culture and becoming more culturally competent helps TB health
professionals work capably and respectfully with people from diverse
racial and ethnic backgrounds.
—Submitted by Allison Maiuri, MPH, Julie
McCallum, RN, MPH, and Rachel Purcell, MPH
TB ETN Cultural Competency Workgroup
Ramadan and TB Medications
Ramadan is the month of fasting in the Islamic
calendar. The Islamic calendar follows the lunar cycle, thus dates
of the month will vary year to year when using a Gregorian calendar
(or solar calendar) as is done in the United States. This year
Ramadan started on September 1, 2008.
For 30 days, Muslims who follow the tradition will
abstain from ingesting any food or drink from sunrise to sunset each
day. This can pose a TB treatment challenge to health care providers
who have U.S-born or foreign-born Muslim TB patients, since this
also includes abstaining from taking oral medications. In efforts to
help health care providers work with their Muslim TB patients who
would like to observe Ramadan, some basic information is offered
A practicing Muslim is not obligated to fast if a
medical condition renders the person too ill to fast or requires
oral treatment. In essence, if the illness is life-threatening, the
patient can choose not to fast during Ramadan and thus be compliant
with taking their TB medications.
A Muslim TB patient concerned about not being able to fast due to TB
treatment generally has two options to “make up” the missed days of
fasting. One option is to postpone fasting to later dates when the
treatment is completed and the patient no longer ill. The other
option is for the patient to provide a meal to another person who is
less fortunate (charity). There is no set fee or amount of food that
a Muslim is obligated to pay/donate if choosing the second option.
The act of donation can be as simple as donating canned food to a
shelter or buying a homeless person a food item that is affordable
to the client.
If practical and medically appropriate as determined
by the client’s health care provider, TB program staff can work with
their Muslim patients who would still like to fast by offering them
directly observed therapy (DOT) before sunrise or after sunset.
Likewise, latent TB Infection (LTBI) patients who are fasting can be
advised to take their medications before sunrise or after sunset. If
additional support or information is needed when working with Muslim
clients during Ramadan, TB programs should elicit the help of local
Islamic community organizations.
—Reported by Amera Khan, MPH
Div of TB Elimination
Burmese Refugees: Resources and Educational
Background on refugees from Myanmar:
Refugees from Myanmar (formerly Burma) began U.S. resettlement in
2006. Over the next 10 years, 140,000 refugees currently in Thai
camps will resettle in the U.S., Canada, Australia, and Scandinavia.
Most of these refugees, however, are not ethnic Burmans (the
majority ruling people of Myanmar), do not speak or read Burmese,
have little formal education, and are primarily from rural
communities. They predominantly consist of other ethnic groups (and
speak other languages) including the Karen, Chin, Mon, Shan, and
Kachin, and they practice several religions. These refugees will
settle all over the United States. The resources below provide
historical and cultural background and include patient education
materials in Karen and Burmese.
1. Background on Burmese Refugees
TB & Cultural Competency Notes from the Field:
Reaching Out to Burmese Refugees. 8 pages, Newsletter Issue #7,
spring 2008. (PDF)
Karen Refugees from Burma: A Backgrounder, Church
World Service, 2 pages, June 2006.
Karen Refugees from Burma in Tham Hin Camp: A
Profile, Church World Service, 2 pages, 2006.
Burmese Resettlement from Tham Hin Camp in Thailand,
UNHCR Quick Fact Sheet, 4 pages, Feb. 2007. (PDF)
Burmese Refugee Camps in Thailand’s Tak Province—Mae
La, Umpiem, Nupo. International Organization for Migration–Cultural
Orientation Resource Center, 1 page, 2007.
Burmese Muslims, International Organization for
Migration/Bangkok–Cultural Orientation Southeast Asia Program, 2
pages, Nov. 2007.
Who are the Muslim Karen? Karen Konnection, 1 page,
Jan. 2008. (PDF)
Refugees from Burma: Their Backgrounds and Refugee
Experiences, Cultural Orientation Resource (COR) Center, Center for
Applied Linguistics, Culture Profile No. 21, 88 pages, June 2007. (PDF)
People from Burma Living in Chapel Hill and
Carrboro, Department of Health Behavior & Health Education, School
of Public Health, University of North Carolina at Chapel Hill, May
25, 2007. (PDF)
Burmese Community Profile, Commonwealth of
Australia, 28 pages, Aug. 2006. (PDF)
Welcome to the United States, A Guidebook for
Refugees (English). (PDF) Cultural Orientation Resource Center,
Center for Applied Linguistics, 2004. ENGLISH.
Note: KAREN VERSION of this guidebook is available for purchase on
the CAL website for $10.00, and video versions in Karen and English
on DVD are available for $15.00.
2. TB-Related Resources / Patient Education
“How to Break the Chain of Transmission:
Tuberculosis,” (PDF) Communicable Disease Control, Health Messenger, Issue
33, Sept. 2006. Aide Medicale Internationale, Mae Sot, Thailand, pp.
58–69. ENGLISH, BURMESE.
What is TB?
USCRI (US Committee for Refugees & Immigrants), 2 pages, 2007.
Minnesota Department of Public Health, 2 pages,
Georgia Division of Public Health, 2008:
Patients Rights and Responsibilities. USCRI (US
Committee for Refugees & Immigrants), 2 pages, 2007.
What is HIV? USCRI (US Committee for Refugees &
Immigrants), 2 pages, 2007.
Basic Facts about HIV / AIDS. Immigration and
Refugee Services of America, distributed by USCRI, 2 pages, 2002.
What is Diabetes? and Brochures on other
comorbidities. Immigration and Refugee Services of America,
distributed by USCRI, 2 pages, 2007.
—Reported by Stephanie S. Spencer, MA
Program Liaison, TB Control Branch
Division of Communicable Disease Control
Center for Infectious Diseases
California Department of Public Health