When good manners give better TB control
When good manners give better TB control
Ten Against TB’ head walks tightrope
What may come as a surprise to many Americans is that when the subject is multi-drug resistant tuberculosis, negative emotions run just as deep on the Mexican side of the border as in the United States.
As part of the effort to overcome the suspicion, distrust, and resentment many Mexican public-health officials bear toward their American counterparts, Annette Riggio was hired as director and coordinator of Ten Against TB, a new organization that is among numerous binational efforts to tackle drug-resistant tuberculosis along the southern U.S. border.
Ten Against TB partners include health officers from the four U.S. states that share a border with Mexico, along with the six bordering Mexican states. With five years’ experience in marketing, Riggio says her greatest accomplishment so far has been winning the trust and friendship of public health officials in Mexico.
When Riggio calls, Mexican officials answer; at binational conferences, she is the recipient of hugs and kisses.
Though such accomplishments may appear slight, they are hardly so in the formal Latin culture, where deal-making must be preceded by formalized rituals intended to establish trust, Riggio contends. "Mexico is terribly sensitive about admitting they have a problem [with resistant TB]," she says. "It’s a real tightrope we have to walk, balancing trying not to blame anyone against the sheer weight of data."
Mexico’s traditional approach to TB control doesn’t include routine testing for resistance, and when resistance emerges, the country does not have the financial resources to deal with it. When efforts to change the situation are perceived as patronizing or bullying, they’re doomed to fail, Riggio says.
Take the case of a second-hand centrifuge New Mexico had donated to Mexico for use in a laboratory.
"Of course, the centrifuge was worth its weight in gold," Riggio says, since even state labs in Mexico are typically so strapped for money that standard equipment includes antiquated devices such as Bunsen burners. Yet for a year, the centrifuge sat languishing in a warehouse in El Paso. Finally, the warehouse owner vowed to set it on the curb if the recipient didn’t show up to claim it.
Riggio made impassioned telephone calls and finally persuaded an official in Mexico to come get the gift. The machine made it safely past international customs, but 60 kilometers into the interior, trouble arose at a checkpoint manned by officials who wanted nothing to do with the suspicious-looking object.
Riggio became frantic. A month’s worth of calls and letters later, the centrifuge was finally approved for passage but in pieces, which were later reassembled at its destination.
More centrifuges and more DOT
Despite the stress of the episode, upgrading Mexican lab facilities with donated American equipment is still one of three major goals Riggio has set herself all targeted at decreasing drug resistance, a problem she declines even to name on record, for fear of giving offense.
When Mexico decided to begin implementing its own interpretation of directly observed therapy (DOT), one of the provisions of the plan was that at first, new programs would be started only in selected pilot sites in each Mexican state. Perhaps significantly, not a single site chosen lay anywhere near the U.S. border, Riggio says.
That explains why developing border pilot projects to instill DOT has become Riggio’s first goal for Ten Against TB.
Meanwhile, she is still arm-twisting lab directors in the United States., trying to get them to donate used equipment (plus help transport the equipment to the border). Her ultimate goal is to get 100 local labs in Mexico along the border capable of performing basic smears and to equip six state labs in Mexico with the means to perform culture and sensitivity testing. (So far, she’s netted only a dozen or so promises of equipment, since most states say red tape prevents them from making donations.)
Finally, Riggio is looking for someone to write translator software that she hopes can link the software packages used by the United States and Mexico so that two nations’ databases can be shared. That way, she says, binational patients could continue their treatment uninterrupted when they relocate or migrate to seasonal jobs.
Although plaudits and commendations for the work of Ten Against TB have poured in, Riggio is still awaiting the money she hopes will eventually follow. Some experts say it will take someone like Riggio who speaks the language and knows the turf to get border projects moving, and keep them alive.
"The sociology is such that [such work] has to be done by people who understand that part of Texas," says Jeff Starke, MD, associate professor of clinical pediatrics at Baylor University in Houston.
In any event, the time is ripe for binational collaboration, Riggio believes. "The relationship between Ten Against TB and Mexico is better than cordial; it’s actually friendly," she says. "Whatever health problems the two countries share in common, now is the time to address them."
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