Partnerships lead to success in Seattle

A few years ago, Seattle’s King County TB control program found itself confronting the same situation that faces cities like Boston today: When it came to providing services to the city’s foreign-born communities, the work that TB controllers were doing was good but they simply weren’t doing enough.

"We could feel good about the 1,000 patients we could reach," says Charles Nolan, MD, King County chief of TB Control. "But the numbers were so big that we could ratchet up our program as hard as we could and still barely make a dent in the need."

Seattle’s approach to that challenge has been to form partnerships with community-based organizations that serve the foreign-born, providing backup and support to those agencies while letting them do much of the actual work.

"Our approach has mainly been to increase the interest level on the part of community health centers and clinics," he says. "Typically, we provide the medications, the protocols for the correct use of isoniazid, X-ray services if needed, provider education, patient educational materials, and convenient consultations."

It’s a big job for a community clinic to take on, Nolan adds, and over the years has proven to work better in some situations than others.

One success story involves the International District Community Health Center, which provides health care mainly to Asians and Pacific Islanders. With encouragement from Nolan’s division and a small grant supplied by a West Coast-based advocacy organization, the health care center began to devote some staff time to tracking patients — making sure that those who came in for skin testing returned to have their tests read or contacting patients who failed to come in for their isoniazid refills and encouraging them to come back.

Nolan credits the project’s success mainly to the sense of dedication and the strong commitment to serve the rest of the community that he sees among staff members at the health center. "There’s really a remarkable quality of leadership there," he says.

"They truly believe that whether you’re immunizing a child or picking up a latent TB infection, you’re doing a service not just to the person sitting in front of you, but to the whole community," Nolan explains.

Things don’t always go that smoothly, he adds. "We’ve had other [partners] we’ve worked with who’ve finally said to us, Look, this is your job, not ours. You’re the people who do TB.’"

Even so, TB control departments all need to be doing more of this kind of partnering, Nolan says. "I read on a conference poster recently that over the last seven years, Los Angeles has partnered with six or eight organizations and started 40,000 people on preventive therapy," he says.

"They can bury the rest of us with their numbers, but we all need the support of our neighbors. The more help we can get from the community, the better off we are," Nolan adds.