Richard Skolnik – Author of Global Health 101
Despite substantial progress in reducing the burden of TB disease, TB remains the leading cause of curable communicable diseases in the world. It is estimated that about 8.7 million people fell ill with TB in 2011 and about 1.4 million people died of it that year. Any course on Global Health has to cover TB in a serious way.
Fortunately, there are some wonderful resources for helping us teach about TB. USAID’s Global Health eLearning is a good place to start, with its courses on TB Basics and on Advanced Concepts in TB. The data in the courses is a few years out of date, but it is easy to complement that data, as noted below.
Once your students have mastered the basics of what TB is, how it is transmitted, and who it effects, for example, the best place for pursuing TB further is the Stop TB website. This site has fact sheets about TB, the annual update on the epidemic, such as the 2012 Global TB Control Report, and a variety of other reports on specific TB topics. These include, for example, the Global Action Plan to Stop TB, and special reports, on topics such as TB in women, TB in children, drug-resistant TB and TB drugs. The site also has a database on the burden of TB disease worldwide.
The Stop TB website also contains a host of reports and other materials to assist people in mobilizing communities around the problem of TB and advocating on behalf of TB. Two recent publications of importance about TB advocacy, for example, include a brochure on TB Reach, a program to expand the coverage of TB programs, and another on childhood TB, No More Crying, No More Dying – Towards Zero TB Deaths in Children.
If you wish to pursue TB in greater depth, then you might want to look at the information on TB at the website of the US Centers for Disease Control and Prevention. The British medical journal, The Lancet, also publishes a range of articles and an occasional series on TB, such as they did in 2010 and 2013. The Lancet Infectious Diseases also published a series on drug resistant TB in 2013. Students who are seriously interested in the scientific and technical aspects of TB will want to refer to the website and publications of the International Union Against TB and Lung Disease. They can also take advantage of a new WHO app on drug-resistant TB.
Partners around the world have been cooperating for more than 20 years to help address TB more effectively, and it will be important for students to learn not only about Stop TB, but also about the Global Drug Facility for TB Drugs. It will also be valuable for them to understand the work of the Green Light Committee, aimed at helping countries better plan and implement programs to address drug-resistant TB, including appropriate drug procurement.
There is a TB vaccine, but it is not very effective. Thus, the world is working hard to discover a TB vaccine, which will, hopefully, be safe and effective against all forms of TB. AERAS is a non-profit company, located in the US state of Maryland, which leads that work.
The world ‘celebrates’ World TB day every March 24, on the anniversary of the discovery by Robert Koch in 1882 of the TB microbe. This is an especially good time to teach TB and get access to a wide range of special TB resources.
ACTION is a global health advocacy partnership that plays an important role in mobilizing interest in and action on TB. The ACTION website also contains a wealth of valuable information and tools on TB.
There are, of course, many different ways to ‘teach TB’. One way that I enjoy … and I think the students enjoy it, too, is to role play. We act as if we were in a town in a poor country in sub-Saharan Africa. The country has a high rate of TB, a high rate of HIV, a high rate of TB/HIV co-infection, and a growing TB problem.
We start the ‘epidemic’ with a student that we say has drug-susceptible TB disease. We ask her to breathe on the student next to her. We then ask what are the health outcomes for the student who was exposed to TB disease. From there we talk about latent TB, why it is so important, and the links between TB and HIV. We also talk about the spread of TB from person to person, among both HIV negative and HIV positive people.
We then ‘complicate’ the scenario a bit further as we discover that: one can also get infected with drug-resistant TB, that children can get TB, and that you can get TB in many organs and not just the lungs.
We follow that with a discussion of the approach to diagnosing TB, the challenges of present diagnostic techniques and the possibilities that the new diagnostic techniques will turn out to be cost-efficient. We then turn to discussing treatment options, the importance of directly observed therapy for TB, and what happens when patients don’t adhere to their drug regimens.
Lastly, we talk about the challenges of achieving a world with “Zero TB Deaths,” including the value of better diagnostics, shorter course drug therapy that could work against all forms of TB, and a vaccine that would work against all forms of TB, as well.
As you can probably tell, TB is one of my keenest interests. My paternal grandmother died of TB, I worked extensively on it at the World Bank, and was deeply involved in the establishment of Stop TB. In addition, ACTION was kind enough, with the help of STOP TB and the Eli Lilly and Company, to train me as a “TB Media Champion.” My hope is that even if you are not so experienced in working with TB, the resources noted above and comments about how I teach TB to undergraduates will be helpful to your teaching TB. This is a disease of exceptional importance. We have made some great strides against it, but we still have many more to make and, in addition, must face with urgency the problem of drug-resistant TB.
Rachel Skolnik Light kindly provided comments on the draft of this blog.
Richard Skolnik is a Lecturer at the Yale School of Public Health, where he teaches global health courses at the undergraduate and graduate levels. Richard was previously an Instructor in Global Health at The George Washington University, the Vice President for International Programs at the Population Reference Bureau, and the Executive Director of the Harvard School of Public Health PEPFAR program. Richard worked at the World Bank from 1976 to 2001, last serving as the Director for Health and Education for South Asia. Richard is the author of Global Health 101, a comprehensive, introductory text on global health.