For the past several months, the District of Columbia's only tuberculosis clinic has been forced to borrow staff and supplies from other health programs, preventing the clinic from treating its patients adequately at a time when the city's TB rate is nearly three times the national average.
Dr. Hazel Swann, director of the District's TB control program, says that for the last three months her clinic has been out of the primary medication used for tuberculosis patients, forcing the staff to send patients elsewhere for supplies.
Moreover, last week she ran out of X-ray film and the preventive medication used for treating people who have been exposed to TB patients, while the contract for cleaning the X-ray machine expired.
In addition, Swann says the clinic needs a second X-ray technician, as well as more investigators and public health nurses. She said that last month when the only X-ray technician became ill, no patients could receive X-rays month when the only X-ray technician became ill, no patients could receive X-rays until the Department of Human Services temporarily assigned another technician to the clinic. Then, two weeks ago, Swann had no film to do annual chest X-rays for National Zoo employes who were exposed to TB a few years ago. The zoo donated 60 pieces of film to the clinic for the checkups.
Swann's clinic, called the Chest Clinic, is located on the grounds of D.C. General Hospital and has had about 800 patients each month instead of the usual 300 since the TB testing facility at the Upshur Street Clinic in Northwest Washington was closed last year. The increased volume of activity has forced Swann's staff to stop conducting free X-ray screening for people requesting the service when they need it for job applications, or from serving patients with other routine chest ailments.
Swann says she's has "raised hell and used profanity" to get action within the Department of Human Services [DHS], the Chest Clinic's parent agency. When television station WJLA reported on the shortage of supplies earlier this week, Swann says, "People started running in bringing us stuff. Media intervention is highly effective in Washington."
Still, the clinic only has a two-week supply of necessary medication, she said. Virgil McDonald, DHS' chief administrator, says an emergency order of $17,000 worth of X-ray film has been placed.
Swann says she often has had to borrow medical supplies "wherever our friends are." Supplies have been donated or sold to the city's TB program by the Veterans Administration Hospital, George Washington University, D.C. General Hospital, the Prince George's County health department, Baltimore, D.C. Village and the city Department of Corrections.
"It's enough for me to be chief cook and bottle washer for the Chest Clinic," the exasperated Swann says. "I can't be procurement officer."
The District continues to rank second only to San Francisco in the number of TB cases reported each year. A total of 53 people per 100,000 develop the disease each year in the District, compared to the national average of 19 per 100,000.
In 1979, there were 323 new cases of TB reported to the TB Registry, part of Swann's program. The reports came from hospitals, other health clinics and private doctors. Last year, 341 new cases were reported.
Swann says the lack of public health nurses and investigators is largely responsible for the District's failure to bring TB under control. The Chest Clinic currently has three investigators and must share DHS public health nurses with other city health programs. Investigators locate people who come in contact with patients with active cases of TB, while public health nurses administer skin tests to those people, follow up on the results and track down active patients who fail to adhere to their treatment schedules.
Swann says she probably could operate the program on her current annual budget of $563,000, but is hampered by the city's cash flow problems plus the unusually long delays in replacing necessary employes and in getting supply requisitions processed by the District's balky computerized Financial Management System [FMS].
McDonald agrees that cash shortages and FMS are responsible for the supply problems. He said that a freeze on hiring and purchasing was lifted at the beginning of the year. But by that time, he says, DHS' warehouse at Taylor Street NE was in trouble.
He says many of the department's 3,000 regularly stocked items, especially drugs, were completely depleted."As rapidly as we purchase it, there are users to request it," he said.
Dr. Martin E. Levy, the city's acting public health commissioner, said he is aware of the problem. He authorized special orders for medical supplies, but says it will take about 90 days for their delivery. Until then, he says the city's health programs must borrow supplies from other places.
Tuberculosis is caused by a bacteria that is inhaled and spread by breathing, coughing and sneezing. The infection settles in the lungs or other organs where it may lie dormant for years. Positive skin tests indicate that a person has been exposed to tuberculosis though the person may not be sick, according to Sarah M. Farley, the TB clinic's nursing coordinator.
Pneumonia, flu or other illnesses may trigger the TB bacteria to multiply and cause cavities in the lungs that eventually bleed. Patients with active cases of the disease typically develop a nagging cough, are sluggish and have a fever.
Once isolation and bed rest was the prescribed treatment for TB, an antiquated disease like polio. But the sanatoriums that treated patients are gone now. Therapy consists of a regimen of drugs that must be taken for none months to a year.
Swann said the greatest problem with treatment is that patients resist or forget to take their medications regularly. Clinic investigators often drive to the homes of such patients and bring them to the clinic for their medication.
In Washington, TB is primarily a disease of indigent black men between the ages of 25 and 44. "It's a disease you generally see in debilitated people," Swann said. It goes hand in hand with other problems such as poverty and poor housing. Ward 1 has had the highest number of TB cases.
Nurse Farley reports that the 1300 block of Kenyon Street NW, near Columbia Road NW, has the greatest number of active TB patients. The unsanitary conditions in the area are a perfect breeding ground for the disease. There are four active-case patients in one building alone, Farley says. Most are older alcoholics.
"People roam in and out of the buildings, drinking, coughing and sleeping together," she said.