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TB Notes 4, 2007
Director's Letter
Highlights from State and Local Programs
  Delaware’s Lang TB Clinic Team Selected as Finalist for 2006 Team Excellence Award
New Tools Available to Help With Program Evaluation
TB Education and Training Network Updates
  Member Highlight
  Seventh Annual Conference Highlights
  TB ETN Cultural Competency Workgroup Update
  Second Annual Focal Points Meeting
Data Management and Statistics Branch Update
  Public Health Information Network (PHIN) Conference Held in August 2007
Surveillance, Epidemiology, and Outbreak Investigations Branch Updates
  11th Semiannual Meeting of the TB Epidemiologic Studies Consortium
  CDC Team Teaches TB/HIV Operational Research Course in Kiev, Ukraine
  2006 Annual Surveillance Report
New CDC Publications
Personnel Notes
Calendar of Events
Return to Table of Contents

TB Notes Newsletter

No. 4, 2007


Member Highlight

Martha Alexander, MHS, is the Director of Education and Training for the Bureau of Tuberculosis Control, New York City Department of Health & Mental Hygiene. She received her Masters of Heath Sciences degree in International Health from Johns Hopkins University, Bloomberg School of Public Health, and her BA in Sociology/ Anthropology and Spanish from West Virginia University.

Martha leads the Education and Training Unit and other Bureau staff in conducting and coordinating trainings for 350 staff members. She is also responsible for developing, implementing, administering, and evaluating the unit’s training plans and protocols. Also, as the Bureau’s Training Focal Point, she serves as the liaison to the TB ETN and the Northeastern Center of Excellence in New Jersey. Along with the Outreach Coordinator, she directs the planning of events for the delivery of education to providers and the general public. She also assists in the planning and implementation of local World TB Day activities.

Martha first learned of TB ETN through a written overview of the network in the job description when she applied for her first position with the Bureau of TB Control. As the designated Training Focal Point, she wanted to be in touch with other TB educators and have access to TB resources. She is now the co-chair of the Cultural Competency Workgroup. “I’ve always been interested in other cultures, and living in New York City, I see how important it is to be mindful of cultural differences. Health care providers need to be aware that every health interaction involves cross-cultural communication and power differentials,” Martha explained.

In the next couple of years, Martha would like for every TB ETN member to have a basic knowledge of how to train others in cultural competency. Also, she would like for every member to know where to find TB resources and information.

Most recently, Martha has been conducting cultural competency training for staff, and trained a group of triage staff. “I love the cultural competency training because it almost teaches itself: everyone has a story about an interaction that was difficult for them. Everyone can learn more about working in a cross-cultural environment,” Martha said.  In addition to the cultural competency training, Martha has been updating and adapting their TB 101 lecture based on her experience in presenting it to different groups.

In Martha’s leisure time, she loves to cook all kinds of food. She also enjoys exploring New York City's restaurants, museums, parks, and beaches with her partner who is also named Martha. Prior to joining the Bureau of Tuberculosis Control staff, Martha lived in Mymensingh, Bangladesh, for 2 years and taught English to nongovernmental organization (NGO) workers as a Peace Corps Volunteer. In college, she studied abroad in Buenos Aires, Argentina. She speaks Spanish and a little Bengali.

If you’d like to join Martha as a TB ETN member and take advantage of all TB ETN has to offer, please send an e-mail requesting a TB ETN registration form to You can also send a request by fax to (404) 639-8960 or by mail to TB ETN, CEBSB, Division of Tuberculosis Elimination, CDC, 1600 Clifton Rd., N.E., MS E10, Atlanta, Georgia, 30333.

Or, visit the website if you would like additional information about the TB Education and Training Network.

—Reported by Regina Bess
Div of TB Elimination

Second Annual Focal Point Meeting

On August 6, 2007, over 30 educators who serve as their TB program's Focal Point for TB Education and Training met for a 1-day meeting in Atlanta, Georgia.  Each TB Cooperative Agreement recipient is required to designate a focal point in their program to serve as primary contact for DTBE and the Center of Excellence (COE) for training and education activities, needs assessment, capacity building, and resource development/sharing; ensure implementation of the annual human resource development (HRD) plan; and coordinate development and implementation of subsequent annual HRD plans. 

This was the second annual meeting of the focal points, held in conjunction with the TB ETN conference. The purpose of the focal points' meeting is to emphasize the vital role they play in TB education and training, provide them with a forum for networking with each other, and enable them to meet with their respective COE. The meeting included two presentations from the field:  Martha Alexander, New York City focal point, and Melinda Diaz, Ohio focal point. They discussed their current TB education and training needs, goals and objectives, and accomplishments. Additionally, an interactive presentation on training basics was given to enhance participants’ knowledge of some best practices for training.

—Reported by Cheryl Tryon
Div of TB Elimination

TB ETN Seventh Annual Conference Highlights

TBETN 7th Annual Conference logo: The Amazing Race to Eliminate TBAugust 7–9, 2007, marked the seventh annual TB Education and Training Network (TB ETN) conference. In addition to the record temperatures being set in Atlanta, this year’s conference set the record for the highest number of registrants at 197. Of those who registered, 143 were able to participate. Attendees represented nearly all 50 states, several U.S. territories, Canada, and South America.

This year’s theme, “The Amazing Race to Eliminate TB: Education and Training Skills to Succeed,” was loosely based on the reality television show, “The Amazing Race.” The conference focused on the show’s concepts of world travel and racing and added the element of cultural competency. In light of recent events, these characteristics easily translated from TV land to the world of TB education and training.

The theme inspired presentations and activities throughout the two-and-a-half day meeting. Plenary topics included cultural competency, meeting the education and training needs of refugee populations, and building partnerships to help you cross the finish line. Other plenary sessions featured local programs sharing their TB education and training experiences in the United States and abroad. Local presenters spoke on a variety of topics from working with hard-to-reach populations, to enlisting peer educators, to training volunteers and nurses.

Conference ParticipantsMore Conference ParticipantsIn addition to the plenary sessions, participants had many interesting breakout sessions to attend. Examples of the topics covered included the systematic health education process, education and training during outbreaks, working with corrections facilities, evaluating education and training programs, and designing effective PowerPoint presentations.

New to this year’s conference was a special pre-conference session for TB ETN members who joined within the past year and first-time attendees. David Oeser and Ann Poole, the 2007 membership development workgroup co-chairs (pictured here), facilitated the session. Participants learned about TB ETN and some of the education and training resources available to them, such as the TB Education and Training Website and the regional training and medical consultation centers.

Other Conference ParticipantsLearning and networking continued outside of formal presentations. Participants were given opportunities to view posters submitted by their colleagues and to visit exhibits featuring TB education and training resources from DTBE and state TB programs, among others. Tuesday evening’s social event, sponsored by VersaPharm Inc., gave attendees a chance to show off their international attire, catch up with old friends, and meet new contacts.

A preliminary look at the conference evaluations shows that 97% of the participants strongly agreed or agreed that the overall objectives were relevant to the goals of the conference. Many attendees indicated that they enjoyed the conference and that they learned a lot. Thanks and congratulations go to the conference planning workgroup for their hard work in organizing and implementing another successful meeting!

If you were not able to join us at this year’s conference, we hope to see you in 2008. Stay tuned for information as we begin to plan the eighth annual TB ETN conference.

—Reported by Holly Wilson, MHSE, CHES
Div of TB Elimination

TB ETN Cultural Competency Workgroup Update

In May 2007, the focus of the TB ETN Cultural Competency Workgroup monthly conference call was on TB and homelessness. It was the third in a series of discussions intended to introduce Workgroup members to various aspects of cultural competency, and to highlight groups that may not be included in traditional definitions of “culture.” The presentation and discussion was led by Marcia Stone, Public Health Nurse in the Health Care for the Homeless Network of Seattle and King County, Washington; Nancy Mills, Public Health Nurse in Seattle and King County, Washington; and Genevieve Greeley, Health Program Specialist with the Utah Department of Health.

The speakers defined homelessness, discussed common contributing factors and associated problems, and explained ways that providers and programs can work to better treat TB in homeless clients. Homelessness is considered to be on the rise in the United States; in 2005 it affected between 2.3 and 3.5 million people per year, or 842,000 per night. Veterans and racial, ethnic, and sexual minorities are overly represented (a sexual minority is a group whose sexual identity, orientation, or practices differ from the majority of the surrounding society). People who are homeless often live with limited health insurance, domestic violence, substance abuse, mental illness, poverty, or a combination of these factors. They experience high rates of diabetes, cardiovascular disease, and asthma. In their day-to-day lives, they may struggle to find safe shelter, freedom from violence, and a secure space to store their belongings. All of these constraints serve to place health care — which can also be time-consuming and difficult to access — low on their list of priorities. The physical and mental stress in their lives can also place them at greater risk for TB.

Programs can improve their services for TB patients experiencing homelessness by using an interdisciplinary, patient-centered approach that builds relationships based on trust and that is sensitive to the cultural context and norms. Offering convenient services onsite can accommodate the competing day-to-day priorities of the homeless. Building relationships with community partners such as jails, clinics, shelters, food banks, drop-in centers, and supportive housing agencies can improve services for clients; some organizations may be good sources of funding for incentives and enablers. In contact investigations involving homeless populations, programs should consider the social networks both inside and outside of shelters, and keep in mind that newly housed people usually continue to socialize with their homeless friends. Programs should also be aware that working with homeless clients’ complex situations can be challenging and even overwhelming for staff members.

Staff can show sensitivity to homeless issues by treating patients with dignity and respect. Staff should be self-aware of their own tendency to possibly judge or label clients. They should work to offset the ways in which homelessness and its associated causes can take away people’s power and contribute to their feelings of marginalization. Communicating regularly with the agencies, service sites, and circumstances that are a part of homeless patients’ lives can help build trust. Working with the homeless can require creative problem solving, as one presenter explained: She worked with a noncompliant homeless patient who seemed hardened to the system and unwilling to cooperate. When she asked what would help him complete treatment, the patient replied that he would like to have a toaster. Once he received the toaster, he complied with treatment.

The following websites were recommended for more resources on working with the homeless: 

—Submitted by Martha Alexander, MHS
Director, Education & Training
Bureau of Tuberculosis Control
New York City Department of Health and Mental Hygiene

Cultural Competency Tip:

Prevention programs are most successful when they build on relationships of trust with community leaders and institutions, and when they emphasize connections between the individual, family, and community. 

From: A Primer for Cultural Proficiency: Towards Quality Health Services for Hispanics

By the National Alliance for Hispanic Health, page 34.


Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination -

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