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TB Notes 3, 2008
Director's Letter
Highlights from State and Local Programs
  Florida TB and Corrections Team Wins 2008 Prudential-Davis Productivity Award!
  Program Collaboration and Integration Activities in Connecticut
  Los Angeles County TB Control Program Collaborates with Community Groups to Organize and Present a Successful World TB Day Symposium
  Arizona TB Nurse Case Management Course
NTCA Workshop Poster Contest
2008 EIS Conference a Success for DTBE
Release of New Civil Surgeon TB Technical Instructions
Nurses’ State and National Partnership Celebration
Partners Recognized for NTIP Development
Updates from the TB Education and Training Network
  Member Highlight
  Ask the Experts
  TB ETN Cultural Competency Workgroup Update
Clinical and Health Systems Research Branch Updates
  A Ferguson Fellow’s Experience
Surveillance, Epidemiology, and Outbreak Investigations Branch Updates
  TBESC Task Order 12 Update
  13th Semi-annual Meeting of the TBESC
New CDC Publications
Personnel Notes
Calendar of Events
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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 Ethnic 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.

  1. A rolling stone gathers no moss. Preoccupation with mobility.
  2. The early bird gets the worm. Getting ahead, achievement, having an advantage.
  3. 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 below.

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 Materials

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 Materials

“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, 2008:

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


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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