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Tuberculosis Education within the Burmese Refugee Community in Wyandotte County, Kansas

by H. Marlene Johnson

Funding source:

Funding was provided to the Unified Government Public Health Department from the Kansas Department of Health and Environment to address the tuberculosis incidence through additional testing and education in the Burmese community in Kansas City, Kansas.

Background:

Rates of tuberculosis in the United States are often disproportionately high among minority and refugee populations. For example, in 2007, the TB rate among foreign-born persons in the United States was 9.7 times that of U.S.-born persons (CDC, 2008). In early 2018, an active case of tuberculosis was diagnosed among the Burmese Zotung Chin Christian Church in Kansas City, Kansas. Language and cultural barriers influence the lives of the Zotung Chin in many ways and often inhibit knowledge and understanding of several health conditions, including tuberculosis.

Purpose:

To collect information from the affected community to create a successful TB educational campaign and to successfully implement the campaign among the Zotung Chin and other Burmese residents living in Kansas City, Kansas.

Methods:

The health department worked with the pastor of the Zotung Chin church to improve upon an already existing relationship with this community and to set up focus groups with church members. Focus groups were conducted to obtain a better understanding of community members’ knowledge of TB symptoms and treatment and to inform the creation of educational materials aimed at reducing the burden of disease in this community.

The results of the focus groups were used to inform the creation of a TB educational campaign that was implemented in the Zotung Chin Church and wider Burmese Community.

Results:

Results from the focus groups showed that many of the participants did not know the symptoms of tuberculosis, wanted to know “how scary” the disease was, and how they could mitigate transmission without hindering their culture. The educational campaign included a presentation at the church; individual brochures to be handed out at the church with information on symptoms, transmission and treatments; free TB blood testing vouchers; and multiple Burmese tuberculosis posters to be hung in the church. The results of the pre- and post-survey will be included once the program analysis has been completed.

Discussion:

The presentation occurred at the church in December 2018 (and more presentations were asked to be completed in the beginning of 2019). About 10 members of the congregation stayed to listen to the December presentation and an interpreter was there to answer any questions following the conclusion of the video.

Conclusion:

It is important to tailor education and community health efforts to those most affected. By utilizing the results of the focus groups, we could develop a more effective and inclusive educational program for this population. The relationships built between the health department and the church were indispensable in contributing to the primary and secondary forms of tuberculosis intervention, however, there were still barriers to be addressed that could have resulted in more attendees for the presentation to reach a wider audience.

Reflection:

As a result of this experience, I realized that there is a larger non-English speaking, underserved population in Wyandotte County than I could have imagined. If miscommunication and cultural competence go unnoticed by public health professionals, then this population will continue to suffer poor health outcomes due to lack of education and knowledge. My study interests as a Master of Public Health student include diverse populations, cultural competence, public health policy, public health data, and sexual health. Because of this, I designed my capstone around addressing possible disparities in the non-English speaking population of Wyandotte County by analyzing the data from the Unified Government’s Sexually Transmitted Infections Clinic. At the end of the analysis, the Public Health Department can use this data to make decisions in possibly reallocating funds to the translation of education materials, culturally competent targeted education campaigns, hiring of bilingual personnel, and/or community engagement with non-English speakers.

1. Centers for Disease Control and Prevention. Trends in tuberculosis. Morbid Mortal Wkly Rep 2008;57(11):281-285.

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