Mormon missionaries educated on TB threat

Church policy on testing is strengthened

Since its founding in 1830, the Church of Jesus Christ of Latter-day Saints, whose followers are commonly known as Mormons, has placed its young missionaries in every corner of the globe. With TB rates high in many of the countries where those missionaries serve, Utah TB controllers have been asking the church to work harder at making its young people aware of the risks.

"There is the potential for a problem," says Teresa Garrett, RN, MSN, head of Utah’s TB control program in Salt Lake City and director of the state’s refugee health program. "Anytime you go to a country where TB is [an] epidemic for an extended period of time, you need to get tested for TB upon your return." For the last year, state TB controllers have been working with the church to provide education and help develop policies, Garrett says. "We believe the church has a responsibility to provide that education [to missionaries], and, to their credit, the church agrees."

Reports of illness not unusual

The LDS church, as the entity is known in Utah, has a longstanding TB policy that encourages returning missionaries to be tested for TB. The problem is that until recently, enforcement has been minimal. "In the last year, church leaders have begun to talk more about the policy and to work harder at enforcing it," Garrett adds.

Mostly because infection isn’t a reportable condition in the state, TB controllers don’t know how many returning missionaries are infected with TB or how many go for the skin test upon returning home, she notes.

Clifton Harris, MD, chairman of the Medical Services Commission of the missionary department of the church, says the data aren’t tracked by the church, but he guesses the rate of conversion among returning missionaries is 1% to 2%. Whatever the rate, reports of sickness among returning missionaries don’t seem to be especially unusual.

Rebecca Reese, RN, a nurse consultant to the state TB program and a member of LDS, says when her son returned from a two-year stint in the Dominican Republic, he had dengue fever "and several other things." Fortunately, TB or TB infection weren’t among them. "He looked terrible when we first saw him," she remembers. "They pick up all sorts of things."

Many go to Latin America or Asia

At present, about 60,000 Mormons are engaged in mission work, says Harris. About two-thirds of them serve outside the United States, he adds. Top destinations include Latin America, Asia, and Africa, Harris says. Russia, the Pacific Islands, Taiwan, and Hong Kong run close behind.

Even when the missionaries serve stateside, church members say, they frequently land in postings where TB rates are high. For example, a family Reese knows sent its son to live with a community of Hmong refugees in Chicago.

In host countries, missionaries divide their time between Bible study and proselytizing. They also devote a day a week to community service projects, like digging latrines or working in day care centers. Harris says he’s not sure how many young men and women do mission work. Church members say the percentage is high, with men much more likely to serve than women. According to church tradition, young men who feel they’ve been called to do mission service can begin at age 19; women must wait until they’re 21. Men serve for two years; women for a year and a half.

Utah TB controllers emphasize they aren’t singling out Mormons for special attention or criticism. "We’re reaching out to all international travelers, from Presbyterians who do missionary work for their church to people who go to Africa to work in a medical clinic to volunteers who go work with Habitat for Humanity," says Garrett.

Even so, some church members are uncomfortable with the topic. Harris suggests that foreign-born residents of the United States, not mission- aries, pose the real danger. "We’ve got a lot of foreigners coming in, and they’re inundating us with TB," he says. "We’ve got Russians, Filipinos, Laotians, and Vietnamese, not to mention all the Mexicans who swim the river. And they’re all bringing resistant organisms with them."

The state has started looking at members of the church because in other respects, Utah’s TB rates are extremely low, says Garrett.

"We had only 40 cases last year, and our incidence rate was 1.9," she says. "We’re closing in on elimination. That’s why it’s time to turn our attention to this."