TB Monitor International-Web site offers a global view
TB Monitor International-Web site offers a global view
TB Net has resources, too
Think of it as TB's talk radio — only without the strident tone and with a distinctly international flavor. Whether you're looking for a spirited debate on the merits of World Health Organization policy, advice on how to set up a laboratory in a developing country, or information on BCG, TB Net is the undisputed place to go.
"The exciting thing is bringing people together who otherwise never would have had the chance to tie into an information or resource network," says Ian Smith, MD, the longtime South Asia regional adviser for the World Health Organization and the creator of TB Net. "Basically there are so many people just working away on their own," he adds. "One thing we try to do at TB Net is to allow that knowledge and experience to be shared more widely."
The e-mail subscription list is probably the most high-profile of TB Net's various missions. With 674 subscribers, the e-mail list represents about 80 countries around the world, Smith estimates. There's never been a charge to join the list.
One of the hottest topics these days has to do with the merits of Directly Observed Therapy, Short-Course (DOTS). On a typical day, a correspondent in South Africa or Pakistan may provide details about exactly what he or she dislikes about DOTS; the next day, another correspondent — often an American — can be counted upon to jump into the fray with a spirited defense.
Subscribers also have written in on topics including how best to collect sputum specimens from TB-infected elephants, what sort of materials work well as floors in TB wards, how to dispose of contaminated sputum cups, and what to make of an abscess at the site of an old BCG vaccination.
Value-added talk
With Smith acting as moderator, practically every request for advice or information (except for correspondence clearly aimed at peddling a product) gets aired, and practically everyone seems to leave with something of value.
In addition to the e-mail list and as another function of TB Net, Smith has been staging annual conferences in Katmandu since 1997. Those who can't make the trip to Nepal can follow the proceedings on the Web page and benefit from attending a virtual conference.
In addition, Smith makes sure TB Net takes all possible advantage of the Internet to disseminate policy and guidelines. "The great thing about the Internet is that you can get a lot of information out very cheaply," he says. For example, last summer he and his colleagues prepared a booklet titled "Ten Steps to DOTS," promoted on the TB net Web site, the booklet went out to 100 people who'd requested it in more than 40 countries — at essentially no cost.
TB Net developed out of a conference Smith helped host in 1994. That gathering was aimed simply at establishing guidelines for organizations in the region that were the beneficiaries of a charitable agency based in the United Kingdom. The response to the conference was so enthusiastic that Smith decided to hold a second conference, which he opened to any TB-related organization in the world.
The response to the second conference was even keener: "We had 120 people from 15 countries," he says. "Everyone said they felt the need to have a more ongoing network." The result was the birth of TB Net.
So far, the service has shared cramped quarters with Smith's WHO offices and those of the Nepalese national TB control program. A single paid employee maintains the Web site. (Because the name "TB Net" already was taken by the Taiwan Bicycle Company, the Web page address retains its name from the days it served solely as a host site for a regional conference: www. south-asia.com/ngo-tb.) As the e-mail moderator, Smith donates his time and spends about an hour a day reading and editing messages.
A much-needed forum
The Katmandu Internet service provider also has chipped in services free of charge, although that's finally about to change, Smith has been told. Still, expenses should be nominal, and because he's determined to keep providing the Internet service for free, he is looking for a donor to pick up the monthly charges.
Although Smith founded TB Net with an eye to providing useful information to people in developing countries, the e-mail subscription list is still somewhat top-heavy with people from developed countries; for example, South Africa boasts the most subscribers of all African nations, and there are many correspondents from Australia and the United States.
"That's got a lot to do with the way the Internet has evolved," he concedes. And because e-mail conversation is carried out in English, language acts as a second limiting factor. Recently, however, new subscribers have joined who represent a variety of African and Asian countries.
Debate is key
Though he says he doesn't view his role as that of a censor, Smith says he tries to limit e-mail conversation that seeks clinical advice about a particular patient.
Along with serving as a conduit for information, he relishes being the chair of ongoing debates. "I think it's only through debate, through sharing experiences and knowledge, that people can make more effective decisions," he says.
Not only when it comes to DOTS, but with other elements of TB policy, debate has been a crucial part of setting policy in public health all along, he adds. "It's an important way to help people feel an ownership of strategy. It's better to have debate in the open, rather than people chattering away their opposition but never getting the chance to air it."
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