Vivir a Todo Pulmón Educational Tools to Address Tuberculosis in Spanish-speaking, Foreign-born Communities

Live Life to its Fullest

Your Guide to Using the Vivir Materials

Vivir a Todo Pulmón Vivir a Todo Pulmón was created through a collaboration between the Southeastern National Tuberculosis Center (SNTC) and the Rural Women’s Health Project (RWHP). The SNTC is one of four Regional Training and Medical Consultation Centers (RTMCCs) funded by the Centers for Disease Control and Prevention. The SNTC supports the education and training missions of TB programs throughout the Southeastern United States, Puerto Rico and the Virgin Islands. The RWHP is a non-profit organization that supports the health education needs of those serving rural communities nationally and internationally. RWHP is known for their expertise in conducting community needs assessments, developing community-based education materials and facilitating health campaigns in underserved communities, with a focus on rural women and Spanish-speaking immigrants in the United States. The development of this Toolkit was funded through CDC Cooperative Agreement U52/CCU/40051 between the CDC and the State of Florida Department of Health’s Bureau of Tuberculosis and Refugee Health. All materials in this document are in the public domain. The use, printing and distribution of these materials is strongly encouraged and may be done without permission. Citation of the source is requested. Suggested citation: Southeastern National Tuberculosis Center, 2007; Vivir a Todo Pulmón: Educational Tools to Address Tuberculosis in Spanish-speaking, Foreign-born Communities. The materials included within this publication are available on the Southeastern National Tuberculosis Center website: http://sntc.medicine.ufl.edu/Foreign.aspx#toolkit. Users may download each file and the accompanying instruction sheet which highlights essential information related to the Toolkit and its use in the Spanish-speaking, Foreign-born community. Acknowledgements All Vivir a Todo Pulmón materials were developed by the Rural Women’s Health Project under contract with the SNTC. Authors: Fran Ricardo and Robin Lewy, RWHP (www.rwhp.org) Editors: Michael Lauzardo, MD, Principal Investigator, SNTC Donna Hope Wegener, MA, Director, SNTC Karen Simpson, MSHSE, Director of Education and Training, SNTC Kristina Ottenwess, MPH, Training Specialist, SNTC Paula Hamsho-Diaz, MD, Graduate Research Assistant, SNTC Special thanks to: Denise Dodge, RN and Ellen Murray, RN, Nurse Consultants at the SNTC who reviewed the clinical content of the material for accuracy and provided insights into some of the complex challenges faced by individuals with TB. North Central Kentucky AHEC Promotor program, Coordinator, Rosa Martin; the promotores of the Alianza de Mujeres Activas (AMA) , Coordinator Ana Bolaños and Healthy Start of Manatee County’s Promotor program, Coordinator Luz Corcuera for assisting in the collection of community surveys and the sponsoring of the Comunity Education Sessions which allowed for community input. For more information about this and other educational materials related to tuberculosis, contact the i SNTC staff at 888-265-7682, or by email, [email protected].

Vivir a Todo Pulmón Table of Contents

Introduction

iii

About this Toolkit

iv

Poster

¡Entérate! La Tuberculosis es una Realidad (Get Informed! Tuberculosis is a Reality)

1

Calendar

Vivir a Todo Pulmón (Live Life to it's Fullest)

3

Audio files

En Nuestra Comunidad (In Our Community) 30-second PSA

5

La Preocupación de Teresa (Teresa’s Worry) 60-second PSA

7

Novela strip

La Preocupación de Teresa (Teresa’s Worry)

9

Fotonovela

Vivir a Todo Pulmón (Live Life to its Fullest)

11

Fotonovela

La Tuberculosis: Como lograr tu tratamiento con éxito 12 Consejos de pacientes con tuberculosis

19

(Tuberculosis: How to Successfully Complete Your Treatment - 12 Tips from Tuberculosis Patients)

ii

Vivir a Todo Pulmón ¡Vivir a Todo Pulmón! (Live Life to its Fullest!) Educational Tools to Address Tuberculosis in Spanish-speaking, Foreign-born Communities About this Toolkit TB program staff requested training tools Early Southeastern National Tuberculosis Center (SNTC) educational needs assessment efforts identified an absence of TB informational materials in Spanish and educational tools to better reach the at-risk community of Spanish-speaking, foreign-born individuals. The target audience was identified as the Spanish-speaking, foreign-born community and included farm workers, day laborers and service workers in both rural and urban areas. Discovering the best methods and tools to reach the target population SNTC’s partner, the Rural Women’s Health Project (RWHP), explored the specific needs, barriers to services and best practices for provision of educational materials within this Spanish-speaking, foreign-born population. The findings of their multi-faceted needs assessment approach were used to develop educational tools to increase awareness of TB and to reduce TB transmission and non-compliance within this target group. The result of these efforts is the toolkit, !Vivir a Todo Pulmón! Translated into English, ¡Vivir a Todo Pulmón! means “Live Life to its Fullest.” Materials designed for use in a hard-to-reach, at-risk community The SNTC is pleased to offer these training tools and educational materials for providing essential TB content to this often at-risk and hard-to-reach community. Program staff, including TB experts from the southeastern US region, informed the content and community forums conducted in several SE states provided essential information for tailoring the educational messages for this community. The community provided guidance on all aspects of the material preparation including content presentation, format, material color use, font size, and visual presentation. Attention to these details have generated materials that will be well-accepted by the target audience within your community. Multi-media approach A variety of educational pieces are provided in various formats to best suit the individual needs of your community. Wherever possible, accommodations have been made to allow you to personalize the materials with your clinic's contact information. The various media formats chosen (poster, calendar, fotonovelas, novela strips, and audio public service announcements) have been proven to be effective techniques to reach this target community. These tools were designed for use by TB program staff and others to support their work with the Spanish-speaking, foreign-born communities.

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Vivir a Todo Pulmón Format of this Toolkit The Toolkit contains three components to aid in your education efforts: AWARENESS SECTION These materials support the clinician’s need to create an awareness of TB within the target community. Raising awareness is a necessary and useful step according to community-based research which concluded that many individuals in this community had limited knowledge of tuberculosis. • Poster • Calendar GENERAL COMMUNITY EDUCATION These essential materials address concerns of TB prevention and disease transmission. These tools speak directly to the target community in a familiar language and with images to increase perception of self-risk recognition. A variety of formats of media are included. • Vivir a Todo Pulmón, fotonovela • Audio public service announcements (PSA’s) • Novela strip PATIENT EDUCATION These materials support and reinforce the face-to-face education provided by TB staff and clinicians. This set of materials is a supportive resource for patient education, complimenting clinical directives. These tools are designed to increase patient understanding, communication and adherence, using the Spanish language combined with visual messaging. • La Tuberculosis: Como lograr tu tratamiento con éxito - 12 Consejos de pacientes con tuberculosis, fotonovela • Vivir a Todo Pulmón, fotonovela Additional materials are under development and will be available on the SNTC website upon completion. The Spanish-language material is provided here for use within this community. The English translation and a user’s instruction sheet is provided for each material to facilitate your use of these Toolkit materials. The actual materials are exclusively in Spanish. For additional information and suggestions for using these materials contact the SNTC: 888-265-7682, or by email, [email protected].

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Vivir a Todo Pulmón ¡Entérate! La Tuberculosis es una Realidad (Get Informed! Tuberculosis is a Reality) Topic: Target Audience: Tool/Format:

General TB Awareness Spanish-speaking, foreign-born community Poster, print resource

Objective: Using a quilt of images to increase self-identification, this poster will raise awareness of the existence of tuberculosis within the target community. Key messages include: • TB is a reality in our community • Get informed! • One needs to be informed to “live life to its fullest”

La tuberculosis es una realidad en nuestra comunidad. ¡Entérate! Aprender sobre la tuberculosis es

¡Vivir a todo pulmón!

© 2007. Producido por el Rural Women’s Health Project (El Proyecto de Salud en pro de la Mujer Rural) contratado por el Southeastern National Tuberculosis Center (Centro Nacional de Tuberculosis del Sureste). CDC No. U52/CCU/40051.

Usage suggestions: • Widely distribute these posters as part of a community awareness campaign to inform the community of the existence of tuberculosis. • Provide this resource to medical centers, clinics, social service offices and communitybased agencies which serve the Hispanic community, in addition to utilizing this poster in your health department. • Distribute this poster at locations where the community gathers and interacts, such as Hispanic businesses (stores and restaurants), laundromats, daycare facilities, schools, churches and local organizations. • Consider utilizing additional community staff outside of the TB program to deliver the educational messages. Outreach workers, lay-health workers (promotores) and community health educators who already have developed the respect and trust of this community may be exceptional resources to distribute TB educational materials. These individuals may be receptive to distributing the poster and other educational materials in their gatekeeper role within the community. Printing information: This poster can be printed in color on 12" x 18” gloss cover paper at your local print shop. To print it out on your personal printer, it can be printed on legal paper, set at 70%. Download information: To download an electronic version of this poster visit this website: http://sntc.medicine.ufl.edu/Files/Resources/EnteratePoster.pdf Material Personalization: This poster may be personalized with your clinic’s contact information and location. Consider placing a pre-printed label at the suggested location (noted by a black star) on the sample poster on the next page.

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Vivir a Todo Pulmón Poster with English translation

Tuberculosis is a reality in our community.

Live Life to its Fullest Get informed!

La tuberculosis es una realidad en nuestra comunidad. ¡Entérate! Aprender sobre la tuberculosis es

¡Vivir a todo pulmón!

© 2007. Producido por el Rural Women’s Health Project (El Proyecto de Salud en pro de la Mujer Rural) contratado por el Southeastern National Tuberculosis Center (Centro Nacional de Tuberculosis del Sureste). CDC No. U52/CCU/40051.

Learning about tuberculosis is to Live Life to its Fullest! Place your personalization information here.

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Vivir a Todo Pulmón Vivir a Todo Pulmón ¡Entérate! (Live Life to its Fullest. Get Informed!) Topic: Target Audience: Tool/format:

Tuberculosis Awareness Spanish-speaking, foreign-born community 2008 Calendar print resource

Objective: Similar to the poster, the varying age groups depicted on this calendar increase self-identification and raise awareness of the existence of tuberculosis, highlighting that age is not a factor in TB infection risk. The calendar format is a welcomed gift and acknowledges the tradition celebrated by the target community. Key messages include: • TB is a reality in our community • Get informed! • Learning about TB is “to live life to its fullest” • TB symptoms are difficult to distinguish from symptoms of other illnesses • TB symptoms list • If you are in doubt, contact your healthcare provider

Enero

Julio

2008 La tuberculosis es una realidad en nuestra comunidad.

Febrero

Marzo

¡Entérate!

Agosto

Septiembre

Abril

Octubre

Mayo

Noviembre

Junio

Diciembre

Los síntomas de la tuberculosis se parecen a los de otras enfermedades. 

Pérdida de peso Tos persistente Debilidad y agotamiento Fiebre Sudoración nocturna

Si tienes alguna duda, consulta a un médico.

Usage suggestions: The giving of a calendar to celebrate the New Year is a tradition followed by many retailers in Mexico and other Hispanic communities. • Consider distributing calendars as a gift to the targeted community. • Provide this resource to medical centers, clinics, social service offices and community-based agencies who serve the Hispanic community in addition to posting this calendar within the health department. • Consider utilizing additional community staff outside of the TB program to reach this community. Outreach workers, lay-health workers (promotores) and community health educators who already have developed the respect and trust of this community may be exceptional resources to distribute TB educational materials.    

© 2007. Producido por el Rural Women’s Health Project (El Proyecto de Salud en pro de la Mujer Rural) contratado por el Southeastern National Tuberculosis Center (Centro Nacional de Tuberculosis del Sureste). CDC No. U52/CCU/40051.

Printing information: This calendar can be printed in color on 12" x 18” gloss cover paper at your local print shop. To print it out on your personal printer, it can be printed on legal paper, set at 70%. Download information: To download an electronic version of this calendar visit this website: http://sntc.medicine.ufl.edu/Files/Resources/VivirATodoPulmon2008Calendar.pdf Material Personalization: This calendar may be personalized with your contact information and location, if you desire. Consider placing a pre-printed label at the suggested location (noted by a black star) on the sample calendar poster. An Avery™ label #5162 for laser printers and #8161 for ink jet printers, will fit within the space identified for personalization.

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Vivir a Todo Pulmón Calendar with English translation Learning about tuberculosis is to Live Life to its Fullest!

Tuberculosis is a reality in our community.

Enero

Julio

2008 La tuberculosis es una realidad en nuestra comunidad.

Febrero

Marzo

Tuberculosis symptoms are difficult to distinguish from other illnesses.

¡Entérate!

Agosto

Septiembre

Abril

Octubre

Mayo

Noviembre

Junio

Diciembre

Los síntomas de la tuberculosis se parecen a los de otras enfermedades. Pérdida de peso Tos persistente Debilidad y agotamiento  Fiebre  Sudoración nocturna   

Si tienes alguna duda, consulta a un médico.

© 2007. Producido por el Rural Women’s Health Project (El Proyecto de Salud en pro de la Mujer Rural) contratado por el Southeastern National Tuberculosis Center (Centro Nacional de Tuberculosis del Sureste). CDC No. U52/CCU/40051.

For example:  Weight loss  Persistent cough  Weakness or fatigue  Fever  Night sweats

Get informed!

If you are in doubt, contact your healthcare provider.

Clinic personalization location. 4

Vivir a Todo Pulmón En Nuestra Comunidad (In Our Community)

Topic: Target Audience: Tool/format:

Community Tuberculosis Awareness Spanish-speaking, foreign-born community 30-second audio MP3 file, public service announcement (PSA)

Objective: To raise awareness about tuberculosis in the community, use this MP3 audio file to highlight that TB is curable and that symptoms should be assessed by a health professional. Key messages include: • TB is a contagious disease with symptoms that are similar to other diseases • TB is curable • Get informed! • Learning about TB is “to live life to its fullest” Usage suggestions: Using professional Spanish-speaking announcers’ voices, this 30-second audio file (MP3) is provided to raise awareness of the existence of tuberculosis using a medium that is well received in this community. Ways in which you may use this audio educational piece: • Request local radio stations play this educational piece as part of their required public service. • Play this announcement in clinics, at health fairs or at the beginning of workshops to increase interest in and awareness of TB. Outreach workers, lay-health workers (promotores) and community health educators may identify other potential uses of this education piece. Health Department staff are encouraged to work closely with the community in distributing these materials. Download information: To download an electronic version of this audio file visit this website: http://sntc.medicine.ufl.edu/Files/Resources/EnNuestraComunidad30SecondAudioPSA.mp3 Material Personalization: Radio station staff may personalize the message of this PSA to include clinic name, location, hours of operation and services provided.

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Vivir a Todo Pulmón Radio PSA with English translation

English Radio, 30-second PSA Woman 1

Did you know that tuberculosis is a contagious disease? It is caused by germs that travel through the air when a person with TB coughs, sneezes, talks or laughs.

Man 1

The symptoms of TB seem like those of other diseases, that’s why it is difficult to identify it without an exam.

Woman 2

TB is curable! But you can't get better without completing treatment.

Man 2

Tuberculosis is a reality in our community. Get informed! To learn about TB is to Live Life to its Fullest!

Spanish Radio, 30-second PSA Mujer 1

¿Sabías que la tuberculosis es una enfermedad contagiosa? Es causada por gérmenes que viajan en el aire cuando alguien con tuberculosis tose, estornuda, habla o se ríe.

Varón 1

Los síntomas se parecen a los de otras enfermedades, por eso es difícil reconocerla sin hacerse un examen.

Mujer 2

¡La tuberculosis es curable! Pero ya enfermo, uno no se puede curar sin terminar su tratamiento.

Varón 2

La tuberculosis es una realidad en nuestra comunidad. ¡Entérate! Aprender sobre la tuberculosis es ¡Vivir a todo pulmón!

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Vivir a Todo Pulmón La Preocupación de Teresa (Teresa's Worry) Topic: Target Audience: Tool/format:

Community Tuberculosis Awareness Spanish-speaking, foreign-born community 60-second audio MP3 file public service announcement (PSA)

Objective: To raise awareness about tuberculosis in the community, highlighting that TB is curable and that symptoms should be assessed by a health professional. Key messages include: • TB symptoms discussion • TB exists in our community • TB is curable • If symptomatic, get tested and seek medical treatment Usage suggestions: Using professional Spanish-speaking announcer’s voices, this 60-second audio file (MP3) highlights a conversation of three women discussing one woman’s ill husband who has symptoms of TB. Ways in which you may use this audio educational piece: • Request local radio stations play this educational piece as part of their required public service. • Play this announcement in clinics, at health fairs or at the beginning of workshops to increase interest and awareness of TB. Outreach workers, lay-health workers (promotores) and community health educators may identify other potential uses of this education piece. Health Department staff are encouraged to work closely with the community in distributing these materials. La Preocupación de Teresa is also available as a novela strip for placement in newspapers, bulletins or as a poster. Download information: To download an electronic version of this audio file visit this website: http://sntc.medicine.ufl.edu/Files/Resources/LaPreocupaciondeTeresa60SecondAudioPSA.mp3 Material Personalization: Radio station staff may personalize the message of this PSA to include clinic name, location, hours of operation, services provided or other pertinent information.

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Vivir a Todo Pulmón Radio PSA with English translation English, 60 second Radionovela Women 1 Women 2

(Whispers) Mari? I know it's late, I'm sorry. What's wrong Teresa?

Women 1

My husband is really sick, he has a fever, night sweats and a terrible cough… Lend me some honey for tea…

Women 2 Women 1

Look friend, take the honey, but he needs medical attention, not just tea. Maybe he'll get better?

Announcer The next day. Women 1 Women 2

Mari? Teresa, how is Juan? I brought my friend Veronica. She is a community health worker from the clinic.

Women 3 Women 1

Teresa, Mari told me that your husband has been sick for a while. ---it's true. He has lost weight…it's terrible.

Women 3

Look, I'm not a doctor, but he could have an infection or…even tuberculosis.

Women 1 Women 3

(Surprised) Tuberculosis? That's from our countries… No Teresa, tuberculosis exists here in our community.

Women 3

Look, tuberculosis is curable, but you must get tested to be sure. If you like…I can make you an appointment,

Announcer For more information, contact your local health clinic.

Spanish, 60-second Radionovela Mujer 1 Mujer 2

(Un susurro) Mari, perdóname, sé que es tarde. ¿Qué pasa Teresa?

Mujer 1 Mujer 2 Mujer 1

¡Mi esposo sigue mal! tiene calentura, sudoraciones y una tos terrible. Préstame un poco de miel… A ver amiga- llévale la miel, pero él necesita atención médica, no sólo un té. ¿Quizás se va a mejorar?

Locutor

El día siguiente.

Mujer 1 Mujer 2 Mujer 3 Mujer 1

¿Mari? Teresa, ¿cómo está Juan? Traje a mi amiga Verónica, una promotora de salud de la clínica. Teresa, Mari me contó que tu esposo ha estado enfermo por un buen rato. …es cierto, ¡ha perdido peso…está muy mal!

Mujer 3

Mira, no soy médico, pero él puede tener una infección o…quizá tuberculosis.

Mujer 1 Mujer 3

(Sorprendida) ¿Tuberculosis?, eso es algo de nuestros países. No Teresa, la tuberculosis existe aquí en nuestra comunidad.

Mujer 3

Mira, la tuberculosis es curable, pero es necesario hacerse una prueba para estar segura. Si deseas…Le hago una cita.

Locutor

Para más información, contacte a su clínica pública.

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Vivir a Todo Pulmón La Preocupación de Teresa (Teresa's Worry) Topic: Target Audience: Tool/format:

Tuberculosis Awareness/Importance of Testing Spanish-speaking, foreign-born community Newspaper novela strip print resource This novela strip provides a fictional view of life in the target community using an educational format that is familiar to Hispanic readers. It includes a conversation between two women with a health outreach worker discussing one woman’s ill husband who has symptoms of TB.

Objective: To raise awareness about tuberculosis in the community, highlighting that TB is curable and that symptoms should be assessed by a clinic. Key messages include: • TB symptoms discussion • TB exists in our community • TB is curable • If symptomatic, one needs to get tested and seek medical treatment

La Preocupación de Teresa A media noche... Mari, perdóname, sé que es tarde. ¿Qué pasa Teresa?

¡Mi esposo sigue mal!, tiene calentura, sudoraciones y una tos terrible.

Mira, no soy médico, pero él puede tener una infección o...quizá tuberculosis.

¿Mari?

Teresa ¿Cómo está Juan? Traje a mi amiga Verónica, una promotora de salud de la clínica.

¿Quizás se va a mejorar?

Préstame un poco de miel...

Teresa, Mari me contó que tu esposo ha estado enfermo por un buen rato.

El día siguiente...

A ver amiga, llévale la miel, pero él necesita atención médica, no sólo un té.

¿Tuberculosis? eso es algo de nuestros países.

Mira, la tuberculosis es curable, pero es necesario hacerse una prueba para estar segura.

...es cierto, ¡ha perdido peso, ...está muy mal! No Teresa, la tuberculosis existe aquí en nuestra comunidad... ©2007. Producido por el Rural Women’s Health Project (El Proyecto de Salud en pro de la Mujer Rural) contratado por el Southeastern National Tuberculosis Center (Centro Nacional de Tuberculosis del Sureste). CDC No. U52/CCU/40051.

Si deseas.... le hago una cita... pe nd Es té de se ie nt e de nl ac l e. ..

Usage suggestions: This novela strip is similar to a cartoon strip that depicts a conversation between individuals regarding TB. Ways in which you may use this printed educational piece: • Distribute this novela strip to local newspapers, coupon booklets (ex. the Penny Saver™) and community newsletters which cater to Hispanic clientele. • Encourage Community Health Outreach Workers (Promotores), Outreach Workers and others who work in this community to distribute this one-page fotonovela strip as a small poster or handout to reinforce a TB awareness message. La Preocupación de Teresa is also available as a 60 second audio MP3 file. Printing information: This is designed to be printed in a newspaper. To print it out on your personal printer or at yourlocal print shop, it can be printed on 8.5” x 11” size paper at 92%. Download information: To download an electronic version of this novela strip visit this website: http://sntc.medicine.ufl.edu/Files/Resources/LaPreocupaciondeTeresaNovelaStrip.pdf Material Personalization: This novela strip may be personalized with the clinic’s contact information and location, if you desire. The local print shop can place this additional text for you when you have this inserted in their publication. If you decide to distribute these within your community, consider placing a preprinted label at the suggested location (noted by a black star) on the sample novela strip on the next page. An Avery™ label #4207 will fit within the space identified for clinic personalization. 9

Vivir a Todo Pulmón Novela Strip with English translation

La Preocupación de Teresa A media noche... Mari, perdóname, sé que es tarde. ¿Qué pasa Teresa?

¡Mi esposo sigue mal!, tiene calentura, sudoraciones y una tos terrible.

Mira, no soy médico, pero él puede tener una infección o...quizá tuberculosis.

¿Mari?

Teresa ¿Cómo está Juan? Traje a mi amiga Verónica, una promotora de salud de la clínica.

¿Quizás se va a mejorar?

Préstame un poco de miel...

Teresa, Mari me contó que tu esposo ha estado enfermo por un buen rato.

El día siguiente...

A ver amiga, llévale la miel, pero él necesita atención médica, no sólo un té.

Mira, la tuberculosis es curable, pero es necesario hacerse una prueba para estar segura.

¿Tuberculosis? eso es algo de nuestros países.

...es cierto, ¡ha perdido peso, ...está muy mal! No Teresa, la tuberculosis existe aquí en nuestra comunidad... ©2007. Producido por el Rural Women’s Health Project (El Proyecto de Salud en pro de la Mujer Rural) contratado por el Southeastern National Tuberculosis Center (Centro Nacional de Tuberculosis del Sureste). CDC No. U52/CCU/40051.

English Translation

Si deseas.... le hago una cita... pen Esté d des iente d enla e ce.. l .

Clinic’s contact information

In the middle of the night... Women 1 Women 2

Mari? I know its late, I'm sorry. What's wrong Teresa?

Women 1

My husband is really sick, he has a fever, chills and a terrible cough… Lend me some honey for tea

Women 2 Women 1

Look friend, take the honey, but he needs medical attention, not just tea. Maybe he'll get better?

The next day...

Women 1 Women 2

Mari? Teresa, how is Juan? I brought my friend Veronica. She is a community health worker from the clinic.

Women 3 Women 1

Teresa, Mari told me that your husband has been sick for a while. ---it's true. He has lost weight…it's terrible.

Women 3

Look, I'm not a doctor, but he could have an infection or…even tuberculosis.

Women 1 Women 3

Tuberculosis? That's from our countries… No Teresa, tuberculosis exists here in our community.

Women 3

Look tuberculosis is curable, but you must get tested to be sure. If you like…I can make you an appointment.

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Vivir a Todo Pulmón Vivir a Todo Pulmón (Live Life to its Fullest) Topic: Target Audience: Tool/format:

Basic General Tuberculosis Educational Information Spanish-speaking, foreign-born community Fotonovela print resource, general educational piece This fotonovela provides testimonials from residents of the target community, using an educational format that is familiar to Hispanic readers. It includes pictures and educational content in a conversational format.

Objective: To increase awareness and general knowledge about tuberculosis. Key messages include: • TB is contagious • The way TB is transmitted • The many symptoms of TB • TB is curable • If symptomatic, one needs to get tested and seek medical treatment

Aprender sobre la tuberculosis es

Usage suggestions: This fotonovela will increase community awareness about the disease by conveying general TB information. Ways in which you may use this printed educational piece: • Widely distribute these fotonovelas as part of a community awareness campaign to inform the community of the existence of tuberculosis. • Provide this resource to medical centers, clinics, social service offices and community- based agencies which serve the Hispanic community. • Utilize this fotonovela in waiting rooms at the health department. • Distribute this fotonovela at locations where the community gathers and interacts, such as Hispanic businesses (stores and restaurants), laundromats, daycare facilities, and schools. Hispanic churches and local organizations may also be receptive to this educational piece. • Consider utilizing additional community staff outside of the TB program to reach this community. Outreach workers, lay-health workers (promotores) and community health educators who already have developed the respect and trust of this community may be exceptional resources to distribute TB educational materials. They may be receptive to distribute the poster and other educational materials as they are gatekeepers to this community with a similar goal of providing assistance to this community. Printing information: This booklet is printed double-sided, in color on 8.5" x 14” paper, cut in half and made into a booklet at your local print shop. To print it out on your personal printer, you will need legal paper. If your printer has a duplex setting it should automatically print it double-sided. If you don't have a duplex setting, you will need to print the odd numbered pages first, reverse the order in which they came out of the printer, turn them over, and place them back into the paper tray. Then print all the even numbered pages. You should test this with a two-page document so you know which direction to place the pages back in

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Vivir a Todo Pulmón the paper tray. Once printed, reverse the order of the pages again so the cover page is the first page, cut in half, lengthwise, to create two long printed strips, fold over into booklets and staple along the left edge. Download information: To download an electronic version of this fotonovela visit this website: http://sntc.medicine.ufl.edu/Files/Resources/VivirATodoPulmonFotonovela.pdf Material Personalization: This fotonovela may be personalized with the clinic’s contact information and location, if you desire. Consider placing a pre-printed label at the suggested location (noted by a black star) on the back page. Avery™ label #5180 will fit within the space identified for personalization.

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Learning about Tuberculosis is to Aprender sobre la tuberculosis es

Tuberculosis is an illness that mostly affects the lungs.

Live Life to its Fullest

La tuberculosis es una enfermedad que afecta sobre todo a los pulmones.

También se conoce como TB. 2

It is also known as TB.

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Tuberculosis is a transmittable disease and anyone can become infected. But it is easy to detect and it is curable. La tuberculosis es una enfermedad transmisible y cualquier persona puede ser afectada. Pero es fácil de detectar y es curable.

Sin embargo, si no se atiende a tiempo, puede ser mortal.

3

However, if the illness is not attended to in time, it can be fatal.

La tuberculosis es causada por pequeñísimos gérmenes que están en el aire cuando un enfermo con TB tose, estornuda, habla, canta o se ríe.

4

Tuberculosis is spread by small germs in the air when a person with TB coughs, sneezes, talks, sings or laughs.

14

You are more at risk of becoming infected if you live or work in closed spaces.

Existe más riesgo de infectarse si está viviendo o trabajando en espacios cerrados.

5

It is easy to contract TB if your health is fragile, if you are very stressed or if you have a chronic disease (HIV/AIDS, diabetes, cancer, etc…).

Es más fácil contraerla si uno está delicado de salud, si vivimos con mucho estrés o si tenemos una enfermedad crónica (VIH/SIDA, diabetes, cáncer, etc).

También aumenta el riesgo si toma alcohol o usa drogas. 6

You are also at risk if you drink alcohol or use drugs.

15

The symptoms of tuberculosis are common, and as a result, are difficult to distinguish from those of other illnesses.

Los síntomas de la tuberculosis son comunes, por eso es difícil distinguirlos de los de otras enfermedades.

Por ejemplo:

For example:



Pérdida de peso  Debilidad y agotamiento  Tos persistente  Fiebre  Sudoración por la noche y otros…



Weight loss Weakness or fatigue  Persistent cough  Fever  Night sweats and others... 

7

La única manera de saber si uno tiene tuberculosis es mediante una evaluación y exámenes especiales realizados en una clínica.

8

You can only know if you have tuberculosis after being evaluated and tested by a doctor. This test is done at a clinic.

16

If your test results indicate that you have tuberculosis, you need to begin taking your medicine as soon as possible.

Si los resultados indican que usted tiene tuberculosis, necesitará empezar a tomar medicina lo más pronto posible.

9

If you have had symptoms, the medicine will make you feel better and you won't transmit tuberculosis to others.

Si ha tenido síntomas, con la medicina usted se sentirá mejor y no transmitirá la tuberculosis a otros.

10

17

So that you don’t infect your family and those you live and work with...

Para no infectar a su familia o a los que viven o trabajan cerca de usted... ...siempre debe cubrirse la boca al toser o estornudar.

11

...you should always cover your mouth when you cough or sneeze.

You should know that tuberculosis services are available for everyone. © 2007. Producido por el Rural Women’s Health Project (El Proyecto de Salud en pro de la Mujer Rural) contratado por el Southeastern National Tuberculosis Center (Centro Nacional de Tuberculosis del Sureste). CDC No. U52/CCU/40051.

Debe saber que los servicios para la tuberculosis están disponibles para todos. Para más información:

12

For more information:

18

Vivir a Todo Pulmón La Tuberculosis: Como lograr tu tratamiento con éxito 12 Consejos de pacientes con tuberculosis (Tuberculosis: How to be Successfully Complete Your Treatment 12 Tips from Tuberculosis Patients.) Topic: Target Audience: Tool/format:

Adherence for Patients with Active TB Spanish-speaking, foreign-born community with active TB Disease Fotonovela print resource Using an educational format that is familiar to Hispanic readers, this fotonovela provides testimonials from TB patients from the target community. It includes photos and dialog boxes with educational content in a conversational format.

Objective: To provide information regarding the importance of adherence to TB medications. Key messages include: • TB is contagious • Your medical team will work with you during your treatment • Medication side effects • Call your doctor/clinic if you have problems during treatment • Other considerations while taking TB medications • Take your medications to successfully complete your treatment • Clinic appointment reminder • Clinic contact information

La Tuberculosis:

Cómo lograr tu tratamiento con éxito

12 Consejos de pacientes con tuberculosis

Usage suggestions: This fotonovela will increase awareness of key concepts related to successful treatment for persons with active TB. This novela focuses on issues related to adherence to TB medications. Ways in which you may use this printed educational piece include: • Distribute this fotonovela to patients with active TB disease to inform them about the importance of adherence to your treatment recommendations. • Empower the patient to take an active role in their treatment. Blank ledgers located at the back of this novela may be used by patients to note their medical appointments and clinic contact information. Printing information: This booklet is printed double-sided, in color on 11” x 17” paper, cut in half and made into a booklet at your local print shop. Use the 11” x 17” file for your local print shop. To print it out on your personal printer, you will use the file set up for legal paper. If your printer has a duplex setting it should automatically print it double-sided. If you don't have a duplex setting, you will need to print the odd-numbered pages first, reverse the order in which they came out of the printer, turn them over, and place them back into the paper tray. Then print all the even-numbered pages. You should test this with a two-page document so you know which direction to place the pages back in the paper tray. Once printed, reverse the order of the pages again so the cover page is the first page, cut in half to create two printed strips, fold into booklets and staple along the left side.

19

Vivir a Todo Pulmón Download information: To download an electronic version of this fotonovela visit this website: http://sntc.medicine.ufl.edu/Files/Resources/LaTuberculosisFotonovela.pdf Material Personalization: Encourage patients to record their medical appointments (including the appointment date, hour and location) on page 15 of the fotonovela. The back page was created for clinic personalization, and you may include specific contact information for key TB staff or provide a general clinic contact phone number. The three personalization sections include: 1. “If you feel bad during your treatment, call: _________” 2. “To change your appointment with the doctor, call: _____________” 3. “For more information about TB call: _________________”

20

La Tuberculosis:

Tuberculosis:

Cómo lograr tu tratamiento con éxito

How to Successfully C o m p l e t e Yo u r Tr e a t m e n t

12 Consejos de pacientes con tuberculosis

12 Tips from Tuberculosis Patients

To get healthy faster, follow the tips that in our experience, have been helpful in curing us without any setbacks.

Para que te cures más rápido, sigue los consejos que en nuestras experiencias, han sido efectivos para una cura sin atraso.

2

La tuberculosis es una enfermedad contagiosa, pero es curable. ¡Tu necesitas tratamiento!

Tuberculosis is a contagious disease, but it is curable. Treatment is necessary! 21

You are not alone! A medical team will work with you during your treatment.

¡No estás solo! Tus médicos van a trabajar contigo durante tu tratamiento.

¡Puedes combatir la tuberculosis con paciencia y con el apoyo de tus médicos!

3

You can win the fight against tuberculosis with patience and assistance from your medical team!

Tip #1 ejo Cons #1

Recuerda que tomar otros remedios puede disminuir la efectividad de tu tratamiento.

Remember, taking other medicines can interfere with your treatment’s effectiveness.

Usa solamente los medicamentos que te recete el médico. Informa a tu médico si estás tomando otras medicinas, hierbas o remedios caseros. 4

Use only medicines that are prescribed by your doctor. Tell your doctor if you are taking other medicines, herbs or home remedies. 22

Tip #2 ejo Cons 2 #

Symptoms or physical changes that require you to call your healthcare provider immediately:

Cambios físicos o síntomas que requieren que hables con tu médico inmediatamente:  Náusea y vómito  Cambios en el color de la orina  Comezón  Molestias estomacales  Visión borrosa  Somnolencia  Fatiga  Inflamación en las articulaciones

Me sentía mal. Por eso llamé al médico inmediatamente.

I was feeling really bad, so I called the doctor immediately.

Si durante el tratamiento notas cualquier cambio físico o síntoma, necesitarás hablar con tu médico o enfermera inmediatamente. Puede ser algo grave. 5

Nausea or vomiting  Change in the color of your urine  Itching  Stomach or intestinal problems  Blurred vision  Sleepiness  Fatigue  Swelling in the joints 

If during your treatment you notice any physical changes or symptoms, you need to contact your doctor or nurse immediately! It could be something serious.

Tip #3 ejo Cons #3 El médico me ayudó a aliviar mis malestares. ¡Pregúntale sobre cualquier duda que tengas!

Si tienes un malestar durante tu tratamiento, comunícaselo a tu médico.

Ask your doctor for help! The doctor was able to give me something to relieve some of the symptoms.

6

You should let your doctor know if you feel bad during your treatment.

23

Tip #4 ejo Cons #4

Si por alguna razón, tienes alguna necesidad de cambiar el horario para tomar el medicamento, consulta con tus médicos.

Es importante mantener tus citas para tomar tus medicamentos. Eso asegurará que completes tu tratamiento sin atraso.

If for any reason you need to change the time for taking your medication, talk with your healthcare provider. 7

It is important to keep your appointment to take your medicines. This assures you that you complete your treatment without setbacks.

Tip #5 Tu médico te avisará cuando ya no puedes enfermar a otros.

ejo Cons #5

Your doctor will advise you when you are not contagious.

Para evitar transmitir la tuberculosis a otros: 1. Cubre tu boca cuando tosas. 2. Usa el cubre boca cuando estés cerca de otros. 3. Mantén el área donde vives ventilada.

Toma precauciones para evitar la transmisión de la tuberculosis a tu familia u otros. 8

To avoid transmitting tuberculosis to others: 1. Cover your mouth when you cough. 2. Wear your mask when you’re around others. 3. Keep the area where you live ventilated.

Take precautions so that you don’t transmit tuberculosis to your family or others! 24

Tip #6

ejo Cons 6 #

Tengo diabetes. Pero trabajando con mi doctor, puedo mantener mi azúcar bajo control y seguir con éxito mi tratamiento para la tuberculosis.

I have diabetes. But, by working with my doctor, it’s under control and I am able to successfully continue treating the tuberculosis.

Si tienes una enfermedad crónica (como diabetes, presión alta o cáncer...) no dejes de tomar tu tratamiento.¡Informa a tu médico! 9

If you have a chronic disease (such as diabetes, high blood pressure or cancer) don’t stop taking your treatment for this condition! Talk with your doctor!

Tip #7

ejo Cons #7

Be careful when you are outside! Don’t forget to apply sunscreen! ¡Ten cuidado cuando estés afuera! No te olvides de aplicar una crema con protector solar.

Tu tratamiento puede aumentar tu sensibilidad al sol, o sea que te puedes quemar fácilmente. 10

TB treatment makes you more sensitive to the sun. Your skin can burn a lot easier!

25

Tip #8 ejo Cons #8

I don’t drink during my treatment. I don’t want to make myself sicker.

Durante mi tratamiento, yo no tomo para no empeorar.

El alcohol, las drogas y el cigarillo te pueden debilitar, prolongar tu tratamiento y causar serios problemas de salud. Por tu bienestar, ¡no debes tomar alcohol (cerveza, vino o licor)! 11

Drugs, alcohol and cigarettes can make you weak, prolong your treatment and cause serious health problems. For your health, don’t drink alcohol (beer, wine or liquor)!

Tip #9 ejo Cons #9

Es recomendable que uses condones, junto con tu método usual para prevenir el embarazo.

To prevent pregnancy, it is recommended that you use condoms in addition to your regular birth control.

La efectividad de los anticonceptivos (píldoras, parches, implantes o inyecciones) disminuye cuando estás recibiendo tratamiento para la tuberculosis. 12

Your birth control (pills, implants, patches) is less effective when you are receiving treatment for tuberculosis! 26

Tip #10 ejo Cons 1 # 0

To successfully complete your treatment...

Para lograr exitosamente tu tratamiento...

¡Nunca dejes de tomar tus medicamentos!

13

...never stop taking your medicines.

I told my doctor as soon as I became pregnant...

Tip #11 ejo Cons 1 # 1

Avisé a mi médico cuando salí embarazada...

y mi bebé nació sano.

Para mantener tu bebé sano durante el tratamiento, avisa a tu médico tan pronto como sepas de tu embarazo.

and my baby was born healthy. 14

To keep your baby healthy during treatment, tell your doctor as soon as you know you are pregnant. 27

Tip #12

Your Medical Appointments

To avoid setbacks in your treatment, don’t miss any medical visits. Keep a calendar of your appointments!

Tus Citas Médicas

ejo Cons #12

Mantén un registro de tus citas y no faltes. Así evitarás atrasos con tu tratamiento.

Fecha de cita

Hora

Lugar/Sitio

Appointment/Date Hour Location 15

If you feel bad during your treatment, call:

Si tienes un malestar durante tu tratamiento, llama a:

Para cambiar la fecha u hora de tu cita médica, llama a:

To change your appointment with the doctor, call:

Para más información sobre la tuberculosis. llama a:

For more information about TB, call: © 2007. Producido por el Rural Women’s Health Project (El Proyecto de Salud en Pro de la Mujer Rural) contratado por el Southeastern National Tuberculosis Center (Centro Nacional de Tuberculosis del Sureste). CDC No. U52/CCU/40051.

Clinic personalization location 28