In Alabama Town Of 3,600, 20 Active Tuberculosis Cases, Three Deaths So Far - NYT [View all]

[hatrack]

EDIT

Marion is in the throes of a tuberculosis outbreak so severe that it has posted an incidence rate about 100 times greater than the state’s and worse than in many developing countries. Residents, local officials and medical experts said the struggle against the outbreak could be traced to generations of limited health care access, endemic poverty and mistrust — problems that are common across the rural South.

“There’s not a culture of care-seeking behavior unless you’re really sick,” said Dr. R. Allen Perkins, a former president of the Alabama Rural Health Association. “There’s not support for local medical care, so when something like this happens, you have a health delivery system that’s unprepared.”

Ed. - emphasis added

In Marion, a city of fewer than 3,600 people, the toll of the slow-growing bacteria, commonly referred to as TB, has been staggering. Since January 2014, active tuberculosis has been diagnosed in 20 people, nearly all of them black; three have died. (Six people who live in other cities in Alabama have also received diagnoses of active tuberculosis and have been linked to the outbreak here.) More than two dozen others have been infected but have not shown symptoms and can be easily treated. State officials expect that figure will increase as hundreds, and possibly thousands, more people are tested.

The authorities said the outbreak had spread so widely and lasted so long because patients had been reluctant to disclose their contacts to public health officials. Some of that is linked to suspicions that the health officials will report illegal activity to law enforcement, but it is also connected to worries of being ostracized, or at least stigmatized, in a community as small as this one.

EDIT

http://www.nytimes.com/2016/01/18/us/in-rural-alabama-a-longtime-mistrust-of-medicine-fuels-a-tuberculosis-outbreak.html