While Flint, Michigan battles a water crisis in the north, a different predominantly black town in the south is facing its own devastating public health epidemic, one that seems to come straight out of the Dark Ages: tuberculosis.
The rural, impoverished town of Marion, Alabama, has been hit with a TB outbreak that’s even worse than the disease rates in some developing countries. Marion has reported 253 cases per 100,000 people — which is 100 times greater than the state’s overall TB rate. So far, 20 people, almost all black, have been diagnosed since January 2014, and three have died.
Unlike similar international cases, Marion’s spread of the disease has little to do with inability to access the vaccine that protects against tuberculosis. Instead, the community’s long history of distrust in the medical industry — coupled with the fear of small-town ostracization — has left residents reluctant to share their personal information with a doctor or visit a clinic for a quick TB screening.
With 33 percent of the town’s residents living below the poverty line, the state has decided to financially incentivize these screenings to help draw in wary patients. The Alabama Department of Health is paying residents up to $160 to get screened and treated for TB.
As an increasing number of antibiotic-resistant TB strains pop up across the globe, public health experts are growing concerned about their ability to combat the outbreak in Marion.
“It doesn’t sound like people have been panicked enough,” Richard E. Chaisson, the director of the Johns Hopkins University Center for Tuberculosis Research, told the New York Times. “There’s a target group here, but they’re trying to avoid mentioning who they are.””
In October, the World Health Organization announced TB had become the top infectious disease killer on the plane, surpassing HIV/AIDS. In 2014, 1.5 million people in the world died of TB, and nearly 500,000 of these cases are estimated to be antibiotic-resistant. New technology has helped researchers develop new ways to attack drug-resistant strains, but drug companies have yet to integrate the findings. And if antibiotic-resistant strains of TB continue to grow, 75 million additional people could die from TB over the next 35 years. Dr. Tom Frieden, the director of the U.S. Centers for Disease Control and Prevention (CDC), has called TB a top security threat.
“Drug-resistant tuberculosis knows no borders,” he said in a Huffington Post interview. “We risk turning the clock back on antibiotics and making it very difficult for us to stop tuberculosis from spreading around the world and in this country if we don’t improve our control efforts.”
But to improve these efforts in Marion, health care workers may have to finally address the region’s medically murky past. Marion’s neighbor to the east, Tuskegee, was home to one of the most notorious medical experiments by the government on black men in the 1930s. Under the guise of offering free health care, federal public heath researchers studied the natural progression of untreated syphilis in 600 black sharecroppers. None of the men were ever informed of their disease, or given penicillin to cure it. However, they were given free burial insurance.
The community’s deep-seated fear of medical professionals has trickled down to the present black population — and locals say the state and federal government has done little to repair the understandably fraught relationship.
“There is a mistrust of government medicine because of Tuskegee,” Dr. R. Allen Perkins, former president of the Alabama Rural Health Association, told the New York Times. “It dates back to that. We haven’t dealt with the damage of Tuskegee in this state at any meaningful level.”
This damage extends past state lines. The Tuskegee study joins other past federally-funded clinical trials that take advantage of black patients in cementing a national apprehension of the medical industry by black communities. Multiple studies have found trust to be the biggest factor keeping black patients from participating in clinical trials, which, in turn, leaves a huge gap in the research of diseases and health issues among black populations.
“So long as the legacy of Tuskegee persists, African-Americans will be left out of important findings about the latest treatments for diseases, especially those that take a greater toll on African Americans and consequently may not have ready or equal access to the latest medicines,” said Neil Powe, a senior researcher on a Johns Hopkins study on this divide.
This kind of repair could take decades. Meanwhile, Alabama state health officials have begun to seen the disease spread from Marion to other nearby communities.
“[In Alabama], there’s not a culture of care-seeking behavior unless you’re really sick,” said Perkins. “There’s not support for local medical care, so when something like this happens, you have a health delivery system that’s unprepared.”