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No. 3, 2009


TB ETN Ninth Annual Conference and TB PEN First Annual Conference

Conference Highlights

The TB Education and Training Network (TB ETN) held its ninth annual conference July 28–30, 2009, in Atlanta, Georgia, in conjunction with the first annual TB Program Evaluation Network (TB PEN) Conference. Participants numbered 175 and represented state and local TB programs, non-profit organizations, and academia, from across the United States, as well as from Canada, Haiti, Nigeria, Egypt, China, and the Philippines.

TB Education and Training Network (TB ETN) held its ninth annual conference July 28–30, 2009, in Atlanta, GeorgiaThis year’s theme, TB Education and Training: Recipes for Success!, inspired exciting presentations and activities throughout the two-and-a-half day meeting. Plenary topics included understanding generational differences and the implications for educators; program evaluation and the implications for training and education; and health literacy. Presenters from TB program areas spoke on a variety of topics, including the implementation of a TB education program for adolescents, using the educational process to improve LTBI treatment in a crack cocaine community, and challenges and opportunities of TB program evaluation in Arkansas.

In addition to the plenary sessions, there were a variety of engaging and useful breakout sessions held throughout the conference. Session topics included strategies for evaluating TB education and training, developing logic models, using the systematic health education process to develop materials, and designing effective PowerPoint presentations.

For the first time, a special lunch-time roundtable session was held for TB ETN members who were interested in research design, course development, materials development, and cultural competency. The roundtable sessions provided an opportunity for participants to network, discuss topic challenges, and share common experiences.

Learning and networking continued outside of formal plenary and breakout sessions. Participants viewed posters submitted by their colleagues and visited exhibits featuring TB education and training resources from DTBE, the Regional Training and Medical Consultation Centers, and state and local TB programs, among others. Tuesday evening’s social event gave attendees a chance to catch up with old friends and to make new ones.

Although evaluations will not be available for several weeks, many attendees indicated that they enjoyed the conference and they learned a lot. Having the conference with TB PEN this year provided new learning opportunities, as well as a chance to meet some new folks.

—Reported by Peri Hopkins, MPH
Div of TB Elimination

Rachel Purcell on sabbatical from the public health position described here, and is currently in India.TB ETN Member Highlight

Editor’s note: Rachel is on sabbatical from the public health position described here, and is currently in India.

Rachel Purcell, MPH, served as the Director of Education and Training at the Bureau of TB and Refugee Health, Florida Department of Health. She received a B.S. degree in Psychology at Illinois State University and an MPH with a concentration in health education at the University of South Florida.

Rachel’s main responsibilities were to plan and conduct education and training activities for the state of Florida, specifically for professionals who work in TB. As chair of the Statewide Meeting Planning Committee, Rachel coordinated the planning of their yearly meeting for TB professionals throughout the state. The Statewide Meeting includes expert speakers and cutting-edge content. “But this meeting is definitely a team effort,” Rachel noted. In addition, she developed a 1-hour presentation on cultural competency as part of their TB Contact Investigation Course. “Here at the Bureau, we typically work as committees to get input from multiple disciplines,” she reported. 

Rachel also worked on compiling a packet for primary care physicians and private providers.  These packets will include quick-reference material for use by clinicians who rarely work with TB when confronted with a TB patient. The material included will come from a variety of sources, including CDC, the Regional Training and Medical Consultation Centers (RTMCCs), and the Florida Bureau of TB and Refugee Health. “Although I was trained as a Health Educator in public health, my prior interest was in drug abuse prevention, violence prevention, and other social aspects of public health.  I had never thought about TB.  I have learned so much in the last one and a half years, and it has opened my mind tremendously.  The interconnectedness between the medical and social aspects of TB truly fascinates and inspires me,” Rachel stated.

Rachel learned about TB ETN when she began working for the Bureau of TB and Refugee Health. She was told about TB ETN by co-workers who recommended that she join. She joined TB ETN to network with other TB health educators and professionals, learn from others, and apply new skills in her everyday work. She was also a member of the cultural competency subcommittee. She joined this subcommittee because of her interest in cultural diversity and competency. “I believe this is an area that needs attention in TB care and treatment,” Rachel explained. In the next couple of years, Rachel would like to see TB ETN expand its membership by marketing to TB professionals who conduct training, but don’t consider themselves “educators.”

In Rachel’s spare time, she enjoys cooking creative vegetarian food, walking, practicing yoga, and studying philosophy.

If you’d like to join TB ETN and take advantage of all the network has to offer, please send an e-mail requesting a registration form to You can also send a request by fax to 404-639-8960 or by mail to TB ETN, CEBSB, Division of Tuberculosis Elimination, CDC, 1600 Clifton Rd., N.E., MS E10, Atlanta, Georgia 30333. Or, visit the TB Education and Training Network website for additional information.

—Reported by Regina Bess
Div of TB Elimination

TB ETN’s Ask the Experts

This feature is brought to you by the TB ETN Membership Development Workgroup.

I am not very skilled with the computer and until recently have been using photographic slides and overheads when giving presentations.  I would like to use PowerPoint but don’t know where to start.  Can you help? 

Fortunately, PowerPoint is easy to use, which is why it is used so often.  But, it is also easy to overdo things when you are tempted by all the fancy options the software developers added to the program. These 10 tips will help you develop a professional-looking presentation that will keep your audience engaged.

Designing Good PowerPoint Slides

  1. Choose an appropriate color scheme. For presentations in a well-lit room, choose a light background and dark text.  If you are presenting in a darkened room, then a dark background with light text works better.  If in doubt, bright yellow text on a blue background is always a good option.  
  1. Pick a font size and style and then stick to it. Use the same font size and style throughout your slides.  It is distracting if the appearance of the slides keeps changing. For presentations, font styles that are “sans serif” such as Arial or Tahoma are easier to read than “serif” styles such as Times New Roman. In general, aim to use 40-48 size font for titles and 28-32 size font for slide text.
  1. Maps and Signs Keep the Audience from Getting Lost. Objectives act as a road map, telling your audience where you are going, and titles act as signposts.  They also help you organize your material.  The presentation title should be able to tell the story in the same way that a newspaper headline tells the story of the article below.  Headlines should be short and “punchy.”  Put headlines in a larger font than the rest of the slide. 
  1. A picture is worth 1000 words.  Use quality graphics and clipart images that are relevant to your topic.  Pictures should add to what you are saying; don’t use them as “filler,” because the audience may become distracted by them and not listen to what you are saying.  Ask yourself:  Without reading the text, does the visual tell me what the text says?  Is the visual “attached” to the correct text?  Does the tone of the graphic match the tone of the text?  Equally useful are stories and case examples that act as verbal pictures. 
  1. Use simple graphs and charts to illustrate statistics and trends.  Scanning or cutting and pasting tables from journals will give you very small text, and these graphics are often much too complex to see and understand from the back of a large room.  If you aren’t sure how, ask a co-worker to help you make your own simple graphs and charts to add to a slide. It’s easy once you get the hang of it.
  1. Just because you can, doesn’t mean you should.  Animations can take a lot of time to set up and rarely enhance a presentation. It may be distracting to have text moving on and off the screen or lines of text being slowly revealed.  The audience may find themselves thinking about what is coming next rather than what you are saying. 
  1. The audience is there to hear you. Keep each slide to one core idea, with no more than five points to a slide.  If you have a great deal of text on a slide, it becomes very difficult to fit without reducing the font size. Also, the audience will be tempted to read and not listen, and they can do that more easily in their own offices!
  1. Don’t start a sentence with: “This is a really busy slide…”  If it’s busy for you, then it’s certainly busy for the audience, so don’t use it! Nor should you say, “You really don’t need to know this, but….”  If we don’t need to know it, then why include it?
  1. Run Spell Check. Then have a co-worker (or several) review spelling and grammar.  Spelling, typing and gramer errors make it luk lik u diidn’t take time to prepare and u quikly loose credibility.
  1. Count your slides and time your talk. Nothing is worse than going to an event that runs over into your lunch hour, or the babysitter’s time limit.  Think about how long it will take you to get through each slide -- a title slide only takes a couple of seconds, but a graph or picture may take a couple of minutes to explain.

Done properly, PowerPoint presentations can be an extremely effective way to share your message with an audience. Designing a PowerPoint presentation can be a fun and creative activity once you’ve learned some basic skills. For more information about using PowerPoint, visit

Do you have a question about TB education, training, or communication issues? In each issue of TB Notes, a TB education and training expert will answer questions about these issues and topics submitted by TB Notes readers. Just submit your question to Please keep your questions as brief as possible. Please note, we reserve the right to edit questions.

A Physician’s Perspective: TB in Pakistan

Dr. Bashir is a special projects epidemiologist in Arizona and serves as Deputy TB Control Officer for the state. She attended medical school in Pakistan from 1983 to 1989.

Tuberculosis in Pakistan is commonly known by its English names, tuberculosis or TB. It carries a huge stigma; a person who has TB is ashamed to tell others, and that person is shunned by society. People are scared to talk to or be near someone who has TB. People in Pakistan know TB is a serious disease and that other people can get it. In urban areas, depending on a community’s education and exposure to media (e.g., TV), they may or may not understand how TB is spread. Many correctly think TB is spread through respiratory secretions, while in the rural/village areas they know it can be spread to others, but they usually do not know how it is spread.  People in Pakistan think TB runs in families and is due to some weakness in the person. Generally, people know the symptoms of TB such as coughing a lot, coughing up blood, and losing weight. People associate this disease with the poor, street dwellers, bad health, and those living in overcrowded conditions.

There are still TB sanatoriums in Pakistan. People know that is where you can get treated for TB. These places will house a person with TB at no charge and treat the disease. The treatment one receives for TB depends sometimes on one’s location. In urban areas, a person will tend to go to the physician and hospital first, while in rural areas or villages they may first go to the Hakim (local medicine man who is not a physician) or to a homeopathic medicine man (also a nonphysician). In these situations, the treatment basically consists of herbs and prayers. For most Pakistanis, the trend is to go first to the physician, then to the Hakim.

TB treatment in the community can be a challenge depending on the affordability and availability of the medications, as well as on the impact of stigma. In my own experience as a medical student and from talking with other Pakistani physicians, the TB sanatoriums were the best thing available. Some medical schools in Pakistan offered a clinical rotation in a TB sanatorium, including the one I attended. It provided great hands-on experience. The TB sanatorium where I worked was an open ward, with multiple beds and patients and a lot of windows that were open during the day, allowing for a lot of exchange of the inside with the outside air. There were no negative-pressure rooms; however, the health care workers and medical students wore surgical masks. Most of the medical students had never heard about directly observed therapy (DOT) when treating TB patients. When I think about it, you could say the TB sanatorium was a form of DOT.

Education on TB in the medical schools was good—detailed and thorough. They put a lot of emphasis on learning about prevalent diseases like tuberculosis. We were taught by lectures, tutorials, and tests (both written and orals) and through the clinical rotations in clinics and the hospital setting, including the TB sanatorium. We had more than an ample supply of TB cases.

The public health programmatic involvement in TB was something most of us did not know anything about. In medical school, the only public health exposure was our community medicine rotation, which included going to the water development plant and learning how pasteurization is done, but there was nothing in the area of public health interventions for TB. We were never taught about the public health aspects of TB or what is done at the government level or the local level. In my own and other colleagues’ perspective, public health has a long way to go in Pakistan.

—Submitted by Ayesha Bashir MD, MPH
Arizona Department of Health Services

I would like to thank the Pakistani physicians in Arizona who helped me with this.

Cultural Competency Update

TB Screening Program in Minnesota

On February 5, 2009, the TB Education and Training Network (TB ETN) Cultural Competency Workgroup held a special topic discussion call on tuberculosis (TB) in refugees. Marge Higgins, Immigrant and Refugee Coordinator, Minnesota Department of Health (MDH) TB Prevention and Control Program, joined the call. She gave a detailed overview of refugees’ overseas and domestic screening, as well as Minnesota-specific information.

Minnesota has a vibrant, growing refugee population that has brought several rich cultures to the state. Over recent years, Minnesota has received refugees from Somalia and Burma, as well as the Hmong from Laos and Thailand. Minnesota is the third highest recipient of refugees in the U.S., behind only California and Texas. Refugees in Minnesota generally settle in the Minneapolis/St. Paul metropolitan area and in areas where there are jobs not requiring proficiency in English such as meat-packing plants.

The goal of domestic refugee health screening in Minnesota is to control communicable disease among newly arrived refugees through health assessment, treatment, and referral. When screening and treating a new refugee, health care workers strive to prevent the spread of infectious disease while also keeping in mind the cultural stigma that TB may present to the refugee within their community. The process must be navigated by a dedicated and invested group of health care workers.

The MDH refugee screening program assists newly arrived refugees with health examinations and referrals within 90 days of arrival. These examinations include health history, physical assessment, immunization update, and TB screening, including tuberculin skin test (TST) and a chest x-ray.  Although the refugees are screened before they leave their home country, they are screened again when they arrive in their new community. This domestic screening process allows Minnesota to follow up with refugees who may have had an incomplete or inadequate health screening prior to U.S. arrival. The Minnesota program maintains a database of all screening information for tracking and surveillance.

Recent data show that 75% of TB cases in Minnesota are among refugee populations. In 2007, the rate of latent TB infection (LTBI) among 2,643 primary refugees in Minnesota was 45%. The rate of LTBI varied among populations, from 29% of refugees from Europe to 50% of refugees from Sub-Saharan Africa.

In identifying the unique needs of these communities and addressing issues that are important to public health, the Minnesota team has used culturally sensitive and ethnically inviting education tools that have improved the accessibility and quality of health care.

MDH’s TB web site is

—Reported by LCDR Darla McCloskey, RN, BSN
Health Systems Specialist
Winnebago Hospital, Winnebago, NE


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