TB Notes Newsletter
No. 4, 2007
TB EDUCATION AND TRAINING NETWORK UPDATES
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
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 firstname.lastname@example.org.
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
by Cheryl Tryon
Div of TB Elimination
TB ETN Seventh Annual Conference Highlights
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.
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
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.
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.
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
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:
by Martha Alexander, MHS
Director, Education & Training
Bureau of Tuberculosis Control
New York City Department of Health and Mental Hygiene
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.