Tuberculosis in the Wild West

You probably don’t think about Tuberculosis all that often. You probably don’t think about San Juan County all that often either.  Out of site is out of mind, so they say.  

I never thought much about San Juan County until I brought my family here a few years ago.  Even for a guy who  grew up in Fairview, moving here was eye-opening.

 The sheer size and diversity of the area is stunning. The county is the largest in the state and dwarfs Rhode Island, Delaware, and Connecticut.  

San Juan County really isn’t comparable to any of those states, though.  Most of those areas are flat, and you can get around easily.   Due to the deep and spectacular canyons which crisscross this landscape, roadways are often indirect and travel times are significant.

In order to reach our central WIC clinic in Blanding, families must travel up to 60 miles from the north and east (Spanish Valley, La Sal) or up to 180 miles (3.5 hours) for residents of  Navajo Mountain.

Driving from Monticello to Navajo Mountain by vehicle requires traveling over 200 miles and is roughly the same distance as driving from Salt Lake City to Elko, NV or Idaho Falls, ID! 

The vivid desert we live in is vast… from Dead Horse Point to Hovenweep to Lake Powell and Monument Valley. 

Perhaps you’re most aware of Bears Ears National Monument and our Native American history and cultural resources. Roughly half of the population here is Native American today, and the local heritage and culture is wonderful.  

We are very far removed from the hectic traffic of the Wasatch Front. 

Sometimes, when you’re out here, you can imagine yourself as part of the local history of cowboys, miners, rustlers, and outlaws.  Perhaps for many that is the reason they’ve ended up here, in what remains of the Wild West.

We may be far removed from our state’s capitol by distance and culture, but when it comes to threats on our health, we face many of the same issues, just on a larger geographic scale.  I want to share with you a recent scare we faced with a terrifying infectious disease: Tuberculosis.

I’m assuming you’ve never been infected with tuberculosis.  Most likely you’ve never known anybody that’s contracted it, let alone died from it.  But Tuberculosis is an ancient disease that infects the lungs and is a leading cause of death in many parts of the world to this day. 

If you get infected with tuberculosis, you might not have any symptoms for months or years, but eventually you’ll likely begin to cough up blood and mucus, lose weight, and suffer fever, fatigue, and night sweats. 

If you catch this disease (through no fault of your own, most people catch it simply from spending time with someone who has an infectious cough), the tuberculosis bacteria will spread within your lungs and form nodules that break down your tissues, creating holes in your lungs. 

If you’re particularly unlucky, the bacteria might move from you lungs into your kidneys, spine, or brain.

Public health is all about prevention.  So when it comes to Tuberculosis, our goal is to nip it in the bud and make sure nobody gets infected to begin with. And if they do get infected, we like to treat them before they even get sick.

How can you treat someone before they get sick, you ask?  Well, we have a system in place which relies on labs, hospitals, and doctors to alert us whenever a new Tuberculosis infection is identified.  

When we learn of a new infection, we “swoop in” and make sure that if there’s a risk, the infected person’s family, friends, coworkers, and contacts are all tested or treated.  

In some cases, we might pre-treat them (called prophylaxis), just in case they have some Tuberculosis bacteria in their lungs already.  Prophylaxis is a way to kill off any germs in their lungs without waiting around to see if they get sick.

These Public Health efforts are incredibly important, not just because it prevents the person from getting sick, but also because it prevents that person from getting more people sick while they’re walking around feeling okay!  

We prevent the “snowball” effect of the spread of infectious diseases.

With all that background in mind, I wanted to tell a quick story. (We’ll keep it a little vague to protect the anonymity of those involved.).

Last winter, our alert system notified us of a person who had been diagnosed with tuberculosis in a way that suggested he was probably very, very contagious. 

We leapt into action, learning where they lived, worked, and recreated. To our surprise, we initially had upwards of 1,000 potentially exposed people!  

After coordinating with various agencies and several days of interviewing people, we narrowed our focus to about 105 people who needed to either be monitored or treated.  About half of them were very young children.  

Dealing with very young kids complicates things for a couple of reasons.  Young children are at a higher risk of getting sick from Tuberculosis. They’re less able to communicate, and it’s much more difficult to get them to actually swallow medications!

Our amazing nurses spent MONTHS following up with every single person we identified.  We ended up giving prophylaxis to two dozen infants and toddlers (which is no small feat!) and testing and monitoring another 80 adults and children.  

When all was said and done, we found and treated one infected person. In addition, we provided prophylaxis to about 30 people (most of them young children), to ensure they never become sick and never spread the disease to anyone else.  

We spent over 1,000 man-hours and roughly $30,000 to stop this disease dead in its tracks, and it took a lot of travel in this beautiful desert to get it done. 

Now let me ask you a question. How valuable were our efforts?  Maybe it seems like it wouldn’t be such a big deal to do nothing, and let a few of those kids get sick. 

Until you realize that one of those sick kids without symptoms might move next door and attend the same school as your kids.

I often worry that the better job we do at preventing disease, the less people are aware of what’s at stake, or what it takes to maintain the better world we’re living in.  

Fewer people see the devastating effects of Tuberculosis, they see fewer infected people, and they feel less threatened. 

Do you think our efforts are worth it?