1. Practical Use of Migrant Clinician's Network (TB Net) in New Jersey Patricia Woods, RN, MSN New Jersey Department of Health 9/18/13

2. Case Study (Migrant Worker) 32 year old male from Guatemala arrived in US November 2011 Worked as a migrant worker in Florida (Fla) traveled from Miami to New Jersey Arrived at the NJ farm on June 17, 2013 Was admitted to the hospital one week after arrival with fever, cough x 3 months, weight loss, chest pain, SOB and hemoptysis Nine others drove in the van from Fla and were identified as contacts

3. Case Study (Migrant Worker) 2 Patient was hospitalized for 4 months due to infectiousness and high fevers The van that transported the migrant worker from Fla was leaving to return to Miami farm prior to the patient being discharged Patient was discharged from the hospital on 10/22/12

4. Challenges He was not sure of the address of the farm he worked at in Fla Language barrier The patient missed 4 months of work and was extremely distressed about not sending money home to his wife in Ecuador He had no resources to return to Miami and no longer had a place to stay in NJ

5. Overcoming Barriers (1) Contacted TB Net: Assisted with language barrier by providing a Spanish speaking case manager that filled out the paper work over the phone Faxed the paper work to the hospital for patient to sign Registered all nine contacts with TB Net to follow when they return to Miami

6. Overcoming Barriers (2) Getting patient back to Miami Found a bus company that goes directly to Miami that had a driver that speaks Spanish Funded ticket through the American Lung Association (ALA) Staff took up a collection of cash for patient to have some money when he gets to Miami Packed a cooler with some water and snacks for the ride Picked the patient up at the hospital in Cumberland County and transported him to the bus in Philadelphia

7. Outcome TB Net was able to get the address of where the patient had to go in Miami Helped coordinate with the family in Miami to meet the patient at the bus stop and take him to the farm Contacts informed TB Net when they were leaving NJ Followed the case and all nine contacts until treatment was completed

8. Case Study (Vacation to Turkey) 28 year old male that came to the US from Turkey in 2001 diagnosed with pulmonary TB When the patient was interviewed in the hospital he already had plans to return to Turkey for two months on vacation Patient was researching TB clinics on his laptop in the hospital Patient was very concerned about his care while away

9. Case Study (Vacation to Turkey) 2 Patient responded quickly to treatment and converted to culture negative before his trip to Turkey He was registered with TB Net to assist him on his vacation to Turkey

10. Outcome While in Turkey the clinic was able to communicate with the patient via TB Net TB Net provided locations of TB clinics patient could go in Turkey if he had experienced any problems or wanted to stay longer Patient went to Turkey for two months and completed treatment upon return with no complications

11. Who has been Enrolled? Migrant workers Leaving on vacation or permanently to another country Verbalize they may want to leave the country prior to the end of treatment Immigration and Customs Enforcement (ICE) ANYONE you suspect may not stay to finish treatment