TB Notes Newsletter

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No. 2, 2009

TB EDUCATION AND TRAINING NETWORK

TB ETN Member Highlight

Phil Griffin is the TB Controller for the Kansas Department of Health and Environment. He received his Associate of Business Administration degree from Middle Georgia College, his Bachelor of Business Administration degree from Wichita State University, and his Certificate of Public Management from University of Kansas.

Phil’s job responsibilities include providing overall TB program management; conducting TB surveillance for the state; serving as TB Education and Training focal point (developing annual training plans, evaluating education, conducting educational needs assessments, conducting trainings, coordinating training with outside presenters, and planning and implementing annual World TB Day activities); writing and reporting on the CDC TB Cooperative Agreement; managing contact investigation reporting; providing direct assistance with surge capacity needs; and developing budgets.

Phil was introduced to TB ETN at his job orientation and through notices from CDC. He joined TB ETN to become part of an important network of educators who share ideas, learn from the experience of others, and contribute to the growing process of TB education. In the next couple of years, Phil would like to see TB ETN continue its growth in the quality and value of the annual TB ETN conference, with an emphasis on training and use of the new tools being developed and delivered to the field. “This will require increased collaboration with the evaluation, genotype, and laboratory functions of programs,” Phil stated.

Most recently, Phil has been the leader for two upcoming seminars on general TB treatment and program management as part of World TB Day events. He developed a cohort review training course that was presented with an outside expert, followed by a statewide roll-out of cohort review in April 2009. He hosted a regional training for program managers in collaboration with the Heartland National Tuberculosis Center, one of the four TB Regional Training and Medical Consultation Centers (RTMCCs) funded by CDC. He is also working on the development of a mini-fellowship for program managers. Phil is also the primary author of the contact investigation course used regionwide by the Heartland National Tuberculosis Center.

In addition to Phil’s regular job responsibilities, he is the president of the National TB Controllers Association. He also serves on the planning committee for the National TB Conference, the Advisory Board for the Heartland National Tuberculosis Center, the advisory committee for the new TBESC proposal, and the steering committee for the TB evaluation group. He also serves as a liaison member to the Advisory Council for the Elimination of TB.

In his leisure time, Phil loves to cook and finds cooking to be a major stress reliever. He has a collection of approximately 600 cookbooks, but he rarely uses a real recipe. He reads cookbooks to get an idea and then creates his own unique recipe. “I am also a dog lover; and I also enjoy spending time in the summer with friends around my pool. My volunteer work generally revolves around church activities and AIDS support work,” Phil explained.
If you’d like to join Phil as a TB ETN member and take advantage of all TB ETN has to offer, please send an e-mail requesting a registration form to tbetn@cdc.gov . 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, if you would like additional information about the TB Education and Training Network, go to www.cdc.gov/tb/TBETN.htm

—Reported by Regina Bess
Div of TB Elimination

International Council of Nurses and Eli Lilly and Co.
Multidrug-Resistant TB Project

In 2003, the International Council of Nurses (ICN), a federation of national nursing associations representing nurses in 133 countries, begin a partnership with the pharmaceutical company Eli Lilly to strengthen the capacity of nurses working in countries with a high burden of TB and MDR TB. 

The main activities of the project consist of seminars that equip future nurse trainers with information on the clinical aspects of TB control, case management, best practices for patient care, and the principles of adult learning.  The curriculum and materials were developed by ICN with input from experts from CDC, Partners in Health (PIH), the World Health Organization (WHO), and other organizations. The materials are accredited for nursing continuing education credits and, as of this writing, have been translated into Portuguese and Russian.  Each nurse receives copies of all the materials in hard copy and on CD-ROM. 

So far, more than 500 nurses in 10 countries (South Africa, Russia, Philippines, Malawi, Swaziland, Lesotho, Zambia, Kenya, Uganda, and Mozambique) have graduated from the ICN program and been trained to train other nurses in the prevention, control and treatment of TB and MDR TB.  Each graduate of the program commits to training a minimum of 10 nurses and 10 allied health personnel in their home country. The national nurses’ association from each of these countries is committed to engaging other partner organizations to support and monitor this training. To date, over 4500 nurses and allied health workers have benefited from the program. 

In addition to the training, the project aims to recognize best practice; since 2007, the ICN-Lilly partnership has presented an annual award to one nurse in each country included in the program for nursing excellence in TB/MDR TB.  The award consists of a specially designed medal and an educational grant, so the nurse can continue professional development in TB. 

Included in the course training materials associated are the ICN’s TB Guidelines, which attempt to improve upon the inconsistent TB-related information that many nurses receive during their initial training. The second edition versions of these guidelines were published in 2008 and are available from the ICN’s web-based “Global TB/MDR TB Resource Centre.” This resource center was established in March 2005 and makes information about TB and MDR TB available to nurses worldwide.  It contains copies of and links to the latest resource material on TB and drug-resistant TB and is continuously updated. 

For more information on the project, please take a look at the ICN’s “Global TB/MDR TB Resource Centre” at http://www.icn.ch/tb/index.html .

—Submitted by Carolyn Bargman, RN
  TB Education and Training Network, and
Gini Williams, ICN Project Director

Cultural Competency Workgroup Update

In October 2008, the Cultural Competency Workgroup had its first cultural competency–related article review. Each month since then, the workgroup has reviewed a research article on cultural competency, followed by a conference call discussion about the article. In addition, the group has reviewed and discussed one or more cultural competency resources. Below are summaries from October, November, and December. 

Cultural Competency Research
Following is a summary of the article, “Tuberculosis from Mycobacterium bovis in binational communities, United States.” Authors: TC Rodwell, M Moore, KS Moser, SK Brodine, and SA Strathdee. Emerging Infectious Diseases 2008 June.

In San Diego County, California, between 1994 and 2005, M. bovis was identified in 6% of adults with culture-positive TB and 45% of patients under 15 years of age with culture-positive TB. This form of TB is mostly transmitted through consumption of unpasteurized milk and cheese products, not person to person. These products are generally brought from Mexico for personal use, but illegal sales of these products do occur. Because M. bovis is almost universally resistant to pyrazinamide (PZA), treatment time increases to 9 months. Clinicians need to have a heightened suspicion of M. bovis for individuals considered to be at high risk, i.e., those living in communities with close ties to Mexico (e.g., San Diego) and who consume unpasteurized dairy products. In addition, clinicians may want to consider empiric extended TB treatment for at-risk children without culture-positive disease. The mortality rate for M. bovis is almost two times higher than for M. tuberculosis; HIV further increases the risk of mortality to four and a half times that of M. tuberculosis.     

The following is a summary of the article, “Syndemics and public health: reconceptualizing disease in a bio-social context.” Authors: M Singer and S Clair. Medical Anthropology Quarterly 2003;17 (4): 423-441.

The term syndemics refers to two or more epidemics interacting synergistically and contributing to excess burden of disease in a population. It also refers to social conditions (e.g., lower income, homelessness, political violence), in addition to physical disease. Certainly, the concept has implications for TB because of the co-morbidities that often occur with TB, such as diabetes, HIV, and malnutrition. In addition, social conditions such as homelessness, alcoholism, and incarceration are often strongly associated with TB. The article also pointed out that stigma and discrimination contribute to disease. Following the review, discussion took place on how the concept of syndemics can be incorporated into TB control. For example, we can use the concept to address social conditions, refer patients to social workers and social services, and advocate for efforts that emphasize the necessity of social services to improve health outcomes.

The following is a summary of, “Displacement and disease: the Shan exodus and infectious disease implications for Thailand.” Author: Voravit Suwanvanichkij. Conflict and Health 2008, 2:4.

The Shan are an ethnic minority from Burma whose members have been forced to flee to Thailand because of abuses by the Burmese government. These abuses include torture, rape, extrajudicial executions, and Shan homelands being overtaken by Burmese soldiers. In addition, the Burmese government’s mismanagement of the economy has forced many into severe poverty. In Thailand, the Shan are denied refugee status and labeled “economic migrants”; thus, many are forced to work in exploitative conditions, such as prostitution. The Shan lack access to basic health care services, and there are very little data available on the health of this ethnic group. The limited data on the Shan indicate that they have a disproportionately high burden of TB, HIV, and lymphatic filariasis, among other infectious diseases. The failure to address the root causes of the Shan’s migration from Burma, and the barriers to health care access by undocumented migrants (Shan and others), are undermining progress that the Thai public health system has made in controlling infectious diseases.

Cultural Competency Resources

1. Forging Partnerships to Eliminate TB: A Guide and Toolkit, CDC, 2007. This document contains specific recommendations for cultural competence. At the end of the book there is a toolkit containing checklists for linguistic competency, an organizational cultural competency assessment, and a sample letter for community leaders.


2. Summary of State Law Requirements Addressing Language Needs in Health Care (http://www.healthlaw.org/library/item.174993 ). This resource provides a summary of laws for each state regarding what health providers are required to provide for people with limited English proficiency. This is an important resource, because many providers do not know what they are legally obligated to offer their clients, and conversely, what the limited English–proficient patient is entitled to receive from the health care provider.


3. Center for Applied Linguistics.  www.cal.org . This site includes general information on refugees from Iraq, including the cultural orientation that’s provided to them before placement in the United States. It also includes language phrasebooks and cultural orientation information (www.cal.org/co ). Not all of the information is health related, but many cultures are represented.


4. United Spinal Association: Disability Etiquette: Tips on Interacting with People with Disabilities (www.unitedspinal.org/pdf/DisabilityEtiquette.pdf ). This document provides tips for interacting with individuals with various disabilities (e.g., blind, deaf, short stature, cerebral palsy, hidden disabilities). The booklet is easy to read and has cartoon scenarios throughout.

—Submitted by Rachel Purcell, M.P.H.
Florida Department of Health

TBETN’s Ask the Experts

This feature is brought to you by the TB ETN Membership Development Workgroup.

Question:
The thought of having to give a presentation or facilitate an education session makes my heart skip a beat! I don’t know if it’s because I’m excited about the opportunity, or dreading it. Do you have suggestions for how to make it less daunting?

Answer:
No matter which explanation rings true for you, here are a few tips to help make your next presentation a success.

Tips for Effective Presentations

• Know your subject. If you know what you are talking about, you will feel more confident, and if you feel more confident, your presentation will be better.  It’s as simple as that. Research your topic to ensure you have accurate, up-to-date information.


• Know your audience.  The more you know about your audience and what they hope to learn, the better position you will be in to target the session to their needs. Use language and terminology that your audience can relate to and understand.


• Give the kind of presentation you like to attend. We’ve all sat through bad ones, but hopefully a few good ones, too. Think about what made the good ones good and the better ones better. Incorporate these strategies into your presentation.


• Less is more.  Most presenters try to pack too much information into their sessions, exceeding the time available and the audience’s ability to absorb it all. Focus on practical, easy-to-remember information in an amount that can easily be absorbed in one sitting, typically not more than three key points.


• Be prepared. Practice may not make your session perfect, but it will build your confidence. Run through your presentation from start to finish several times before the big day. Test all audiovisual materials and equipment, and have everything ready before the audience arrives. Try to anticipate tough questions and have your answers ready.


• Always have a Plan B. Expect the unexpected. If you are relying on computers, the Internet, or projectors to give your presentation, have handouts or slides ready as a back-up.  Bring two copies of any electronic files you’ll need (preferably in different formats). Have screen-captures of key websites ready in case your Internet connection goes down or is painfully slow.


• Make sure the audience can hear and see you, and that you can hear and see them. There are few things more frustrating than not being able to hear or see what is being presented. Stand. Use a microphone if you have a soft voice. Use fonts and graphics that are large and clear enough to be seen.  Arrange the room so that everyone can see your face, and avoid the temptation to turn your back on the audience and read from your slides.  Make eye contact frequently; audience members are less likely to talk amongst themselves, check e-mail, or fall asleep when the speaker is looking directly at them! Observe your audience for body language and other clues to how they are doing. Yawning, stretching, and fidgeting may suggest it is time to take a short break.


• Tell a story. Whenever possible, personalize the information you are giving by putting it into a real-world context, preferably one that involves you. Your audience will relate to this much better than to cold, dry facts.


• No matter what happens, keep breathing.  Fear of public speaking is a major cause of anxiety for most people - including even the most experienced speakers!  Slow down and keep breathing; it helps. Wear comfortable clothing that makes you feel good. Move around to release tension. Believe in yourself. The audience is there because they think you have something valuable to say. You do not have to be perfect to succeed.


• Deliver what you promise. Choose the title of your session wisely. People will come with expectations based on how the session is advertised and will leave frustrated and disappointed if you do not meet their expectations.


• Respect your audiences’ expertise and experience. You have as much to learn from them as they do from you. Talk to them, invite questions, ask them questions … engage them to participate.


• Do not take yourself or the topic too seriously. You do not have to be funny to be an effective or engaging speaker, but it helps. Use humor appropriately and judiciously. Smile.


• Remain in control. Keep difficult participants in line. Don’t become flustered. Be respectful, but firm. If there is controversy, try to find common ground. If there are concerns or questions that cannot be resolved during the session, put them on a “parking lot list” to revisit later in the session, or follow up with the individual afterward.


• Questions? Tell the audience at the start of the session whether you will take questions as you go along, or at the end. If there are many questions, assign numbers and answer each question in turn. Repeat the question for everyone to hear before you begin to answer it. Direct your answers to the whole audience, not just the person who asked the question. Answer the question, succinctly and clearly! Provide concrete, real-world examples if you can. If you do not know the answer, say so. Ask if someone in the audience knows the answer. If not, say that you will find out the answer for them.
• Finish on time and on a good note. Always be aware of the clock. Ask someone to help you stay on time. If time is running out, don’t just speed up your presentation! If you are not going to be able to cover all of the material, ask the participants how they would like to use the remaining time. Recap the key points of the presentation in a summary, and remember to thank the audience for their attendance and contributions to the session.


• Learn from every session you facilitate. Ask for feedback from the participants, intermittently and at the end of the session. Be specific. Ask yourself what worked well and what did not. Do not get defensive; listen, learn, and move on.

Effective presentations not only inform; they engage, explain, and inspire. By taking the time to learn and practice your presentation skills, you can create and facilitate sessions that others will line up to attend. 

Watch for an article in the next TB Notes issue that will offer strategies for developing and presenting with PowerPoint!

Do you have a question about TB education, training, and communication issues? In each edition of TB Notes, a TB education and training expert will answer questions about these issues and topics submitted by TB Notes readers. Just submit your question to tbetn@cdc.gov. Please keep your questions as brief as possible. Please note, we reserve the right to edit questions.