Fighting TB, One Pill at a Time

Her house calls are a form of "directly observed therapy" -- a technique that health officials say is the best way to make sure patients stick to their medications, which most must take for about nine months. The state subsidizes treatment, which can run into the thousands of dollars, on a sliding scale.

Janoscrat said she knew little about TB growing up, other than that her uncle had it. She and other relatives figured he got it because he slept on a blanket on the floor, or perhaps because he showered at night.

Now that she knows better, Janoscrat tries to dispel such myths with her patients while she escorts them through what can be a long, trying recovery. Infectious patients must be isolated for about two weeks, which can cause work problems. Janoscrat has advised the Peruvian woman in Ashburn, who is infectious, to avoid holding her children.

Those things can feel like punishment, Janoscrat said. "People say, 'But I have been a good person. Nobody in my family has TB.' "

As she makes her rounds in her gray minivan, returning day after day, Janoscrat also becomes a friend. On a recent morning, Janoscrat stopped by to see a Somali refugee who lives with her eight children in a Sterling apartment. Inside a dark living room furnished with an ornate red and gold sofa, Janoscrat watched as the woman took her four pills.

"School -- you going to school today?" Janoscrat asked the woman, who wore a vibrantly colored gown.

"Yeah," the woman said, nodding.

On most days, Janoscrat stays to help the woman with her English homework, armed with a Somali-English dictionary she bought for the woman and her own Spanish-English dictionary. She sometimes arranges rides for other patients.

With those kinds of interactions, Janoscrat said she forms bonds and that the patients feel comfortable enough to tell her if they are experiencing side effects from the medications or are having other problems.

"You get their trust, then you're good," Janoscrat said. "Then they can take their medicine."

Earlier in the morning, Janoscrat sat at a kitchen table in a Leesburg townhouse. A Turkish woman cringed as she washed down six pills with water and Diet Coke and spoke of the anguish TB has caused her.

Before they diagnosed TB, doctors performed a biopsy, thinking the woman might have lung cancer. The sickness forced her to cancel a trip to visit family in Turkey, and she said she has been too ashamed to tell anyone, other than her husband and a few family members, that she has TB. Thankfully, she said, she will probably be finished with her treatment in July.

"It's too hard to take medicines. . . . I'm the bad client for her," the woman said, referring to Janoscrat.

"I wasn't going to say anything," Janoscrat joked.

But there has been a benefit to having TB, she said.

"We like each other," she said, pointing to Janoscrat. "See? I got one more friend. Only good thing."