A Tale of Treatment: Tuberculosis Control in a Low Income Neighborhood in the United States

Abstract

This article chronicles the process by which a homeless tuberculosis patient is located, interviewed and placed on a course of directly observed therapy (DOT). This approach, based on an illness narrative model, emphasizes the intersubjective nature of both illness and treatment and the powerful impact of an impoverished social environment. Based on the extensive field notes of a public health worker in the city of Chicago, the article demonstrates how the social process of `building rapport' enables completion of a complex treatment regimen amid adverse circumstances. Nevertheless, the article concludes that the administration of individualized therapies, even when couched in culturally sensitive methods that respect social difference, cannot overcome the deleterious health effects of structural poverty and inequality.