European Stars and Stripes (Newspaper) - November 30, 1993, Darmstadt, Hesse                                By David Foster the associated press. The patient a 68-Yearoid vietnamese. Refugee could t speak English. Dorothy Byas could t speak vietnamese. So they traded nods and smiles As Byas handed the Man six pills and watched him struggle to Swallow them one by one. Quot i can communicate with anybody Quot Byas said later outside the Man s apartment. Quot As Long As i show them warmth and that i m there to help them they feel it so far i Haven t met anybody i can t relate  that s Noe mall feat Given her Job on the multicultural front line of the War against tuberculosis a contagious disease making a deadly comeback in the United states. Byas is a tuberculosis outreach nurse in new York and her patients reflect the changing face of an old disease. During a recent Day s work All but one of her 14 patients were immigrants a four from Vietnam three from Cambodia and one each from Tibet Laos the Philippines Mexico Ethiopia and Somalia. 1 ten years ago to was considered a Scourge of the past vanquished in America by Modem antibiotics. But now after decades of decline it is on the Rise due in part to the growing number of immigrants Yho carry the disease from countries where it still is common. Health officials consider it a serious threat a chronic bacterial infection that usually strikes the lungs and spreads through coughing and sneezing tuberculosis was the nation s no. 1 killer in the ,1800s. Worldwide it still r kills More people than any other infectious agent. Last year in the United states 26,673 cases of Active to were reported a 20 percent increase since 1984, according to the Federal centers for disease control and prevention. Twenty seven percent of those 1992 cases were among foreign born patients the cd says and states with Large immigrant populations report even higher percentages. In Washington 46 percent of All the state s to cases last year occurred among immigrants in California 61 percent and in Hawaii 83 percent immigrants Are not the Only cause of to s resurgence. The cramped quarters arid unsanitary conditions of poverty play a role and the disease also has become a leading opportunistic infection striking aids patients. In some areas particularly new York and other Eastern cities the main worry now is the spread of new Multi drug resistant strains of to that develop when patients Stop taking Medicine before it completely kills the infection. But immigrants present a special Challenge As health officials struggle with language and cultural barriers to find Active to cases and cure them before they spread to the general population. In California where undocumented aliens from Mexico have contributed to a statewide 54 percent Rise in tuberculosis since 1985, the state runs an offic Euf Border health and conducts to screenings in migrant labor Camps. In Hawaii officials inspect Chest a rays of every Legal immigrant Quot because we re an Island even one Case can be catastrophic Quot said or. Azucena Ignacio head of Hawaii s to control program. In Washington state an experimental project targets Young hispanic men in jail screening them for to and then following up with preventive care once they re on the streets of Seattle. Health officials tap the Best of modern medical wizardry. In California s Orange county Dan fingerprinting recently helped Trace a to outbreak among foreign born High school a guard enters an isolation room in a Hospital at riders Island n.y., where to patients Are treated. Not students Back to a single student. But More often the Battle hinges on old fashioned methods such As Community outreach education and screening of High risk populations. A Staple of elimination efforts is directly observed treatment. Knocking out a to infection requires that a patient take potent antibiotics for at least six months. But symptoms a which May include fever Chest pain and coughing up blood a diminish after a few weeks and Many patients Don t bother to finish their treatment that s where outreach workers like Byas come in personally delivering packets of pills arid making sure they Are swallowed. When she started in 1984, most of her patients Ware skid Row drunks wheezing old men who washed Down their pills with swigs of fortified wine. The foreign born  now Predom state present different challenges. By the time Byas deals with them an interpreter has explained what is going on but difficulties remain. Some immigrants especially asians and africans Are leery of die pills Byas offers. ,. Quot people will Tell us our Medicine is Nasty that it s going to kill them Quot she said. Quot some of them will wait until i leave and spit their pills right out so i stay a while and. . Them to make sure they  without such Diligence the War against to May never be won. Wind can disperse and sunlight can sterilize the airborne bacteria in about an hour. Dark moist poorly ventilated conditions Hie Barracks Sty la shelters for the homeless can preserve them for hours or even months. Anatomy of a disease a primer on tuberculosis transmission tuberculosis travels from person to person in tiny airborne droplets exp Ilad when someone with Active tuberculosis coughs exhales or sneezes. Who is susceptible usually Only 10 percent of the people who become infected by tuberculosis will get sick. If a person has a healthy immune system it will kill off the germs. But  on factors like Lig strength of the go amp it amp Eria and a person s health  can gain a some cases Al Derla will simply. Elf infant in the body Iggy we a shout producing symptoms but Able to a reactivate months or. Years later. Who is contagious7 persons with Active tuberculosis. Those at High risk a people with h.i.v., the virus that causes aids a drug abusers and alcoholics a the homeless a people living and working in close Contact to infected people a immigrants from countries where to is common  aft although mainly a a a Seabee of the lunge to can spread through the bloodstream and Lymphatic system to the brain Bones eyes and skin. Source. Symms th0 Fei Cost Hon Cix a via Jim him Tyx City of atm Oheath am can a tuesday november 30 1993 the stabs and 5tripi5 19