It's rare for New York to be held up as a model, but the city is a world leader in combating the spread of tuberculosis, according to the World Health Organization.
Praising city health workers, the United Nations agency last month urged other places to adopt New York's strategy for fighting the TB epidemic, which the agency said is growing worldwide at the rate of one new case every second.
The centerpiece of that strategy is to "go wherever the patients are," said Dozen Guishard, regional manager for the city health department's TB outreach program. "Our workers are the soldiers."
Though the war against TB is far from over, and the situation in the South Bronx remains critical, the number of new cases in the borough, after rising precipitously throughout the 1980s, is starting to decline. The decrease has been attributed by health-care experts to the borough's 40 outreach workers in the city's directly observed therapy, or DOT, program.
Every day, these DOT sleuths track down TB patients -- at home, at work or even on park benches -- to make sure they take their daily fistful of antibiotics.
Without supervision, patients often stop taking their drugs as soon as TB symptoms disappear, Guishard said, which can be as soon as a few weeks after starting treatment. The disease can be cured with a concentrated drug regimen lasting six months to a year, but patients who skip doses can suffer relapses and develop drug-resistant TB, which can be passed on to others.
"Finding them, and keeping them in service is the goal," Guishard said. "It's a tall order, but we're trying to keep track of all of them."
It sounds basic, but it seems to be working. The number of new TB cases in the borough fell 16 percent in 1993, to 588 from 706 in 1992. Cases were down citywide by 15 percent, compared with a nationwide drop of 5 percent.
Some South Bronx neighborhoods reported even sharper declines in 1993 than the borough as a whole. In Mott Haven, new cases fell 34 percent, and in Tremont cases were down 23 percent. At the same time, the number of new cases in Morrisania rose 8 percent. Despite the general progress, case rates in these neighborhoods remain well above the city average, which itself is over four times the national case rate.
Thomas Frieden, director of the city's TB Control Bureau, gave three reasons for the higher rates: Increased immigration from Latin America, where many are infected; homelessness and poverty re-creating for man the 19th-century living conditions in which TB thrived; and the increasing number of people with AIDS, who are more susceptible to TB, because their weakened immune systems cannot fight off TB-causing bacteria.
Borough-specific figures for 1994, which will be available in May, are expected to confirm the effectiveness of the DOT program. According to Frieden, the number of new TB cases citywide declined 7.4 percent in 1994, to 2,995.