A generations-old wariness of the medical profession might be contributing to a spike in tuberculosis cases in the rural Alabama town of Marion, according to a report published Jan. 17 in the New York Times.
“There’s not a culture of care-seeking behavior unless you’re really sick,” R. Allen Perkins, MD, a former president of the Alabama Rural Health Association, said in the article written by Alan Blinder. “There’s not support for local medical care, so when something like this happens, you have a health delivery system that’s unprepared.”
Marion, with a predominantly African-American population, has had 20 cases of active tuberculosis since January 2014. The case rate of 253 per 100,000 population is 100 times the rate of 2.5 cases per 100,000 in Alabama as a whole, according to a news release from the Alabama Department of Public Health. The department held a town hall meeting in Marion on Jan. 14 to inform residents about its effort to halt the outbreak.
In the Times report, Blinder spoke with Patricia Church, a 41-year-old warehouse worker who did not have tuberculosis, but was frightened enough of the possibility that she went to a doctor to check her cold symptoms. “I feel like I had been around someone that had it, and I might die from it if I don’t find out whether I got it or not and get it treated,” Church said in the article. “I was nervous. I was real nervous.”
Healthcare officials worry that it takes that kind of nervousness to prompt people to see a physician. They also worry that the outbreak has spread so widely because patients are reluctant to disclose their contacts to public health officials, whether from worry the officials will report illegal activity to law enforcement agencies or fear of being stigmatized in the small community, the Times reported.
“For most of us, it’s not too hard to come up with the main people that you hang around,” Pam Barrett, director of the division of TB control for the Alabama Department of Public Health, told the Times. “But if you’re doing maybe some things that you don’t want other people to know about, or doing some things you’re ashamed of, you don’t want people in your business, and you’re not going to tell me.”
Beyond that, a history of distrust of the medical profession in Alabama dates back to the 1932-1972 Tuskegee experiments on African-Americans suffering from syphilis. “There is a mistrust of government medicine, in the African-American community especially, because of Tuskegee,” Perkins said. “It dates back to that. We haven’t dealt with the damage of Tuskegee in this state at any meaningful level.”
According to the Times report, even people who knew little about Tuskegee said a wariness of the medical profession had been passed on for generations. Others said authorities had not been aggressive enough to contain the TB outbreak.
Many people in Marion, where about 63% of the residents are African-American, had decided to consult medical professionals only because of the seriousness of the warnings about TB. “It’s a good thing that they are here to try to help us, so this thing won’t kill us all,” Lula Clemons, told the Times. “But I felt like when the first case of TB came along, they should have quarantined that person.”
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