Latent TB positive in the U.S. war on tuberculosis: manufacturing the international student as a public health threat

• Main Author: Takáčová, Ivana
• Other Authors: Rigal, Laura, 1958-
• Format: Others
• Language: English
• Published: University of Iowa 2015
• Subjects: colonialism; culture; immigration; international students; stigmatization; tuberculosis; American Studies
• Online Access: https://ir.uiowa.edu/etd/5859; https://ir.uiowa.edu/cgi/viewcontent.cgi?article=7337&context=etd

This dissertation investigates the institutional practice of screening newly-arrived international students for tuberculosis on U.S. college and university campuses from the 1980s through 2015. It is a critical analysis of this public health measure from the point of view of U.S.-American cultural studies and includes a sample of 21 interviews with international students who underwent this compulsory, on-campus, TB screening procedure. As such, this dissertation contributes to social scientific and cultural studies of racialized practices and discourses in U.S. public health as well as to scholarly literature on the experience of international students in the U.S. In the mid-to-late 1980s, U.S. public health authorities declared a "war on TB" in response to rising TB incidence in the country. The intensified measures of TB control conceptualized the category of the "foreign-born" as invariably "high-risk:" Foreign nationals in the U.S. were to be skin tested for latent TB infection and preventively treated by isoniazid (INH) - even as the U.S. medical community was aware that INH potentially had toxic side effects and that the TB skin test as a diagnostic tool for latent TB was imprecise. The liabilities of the skin test are especially marked in persons inoculated against tuberculosis by the BCG vaccine because the skin test does not distinguish between residues of BCG and actual human TB infection. Yet, despite the fact that, according to the World Health Organization, around 90 per cent of the world population is BCG-vaccinated, the U.S. public health authorities opted to deploy the TB skin test. I argue that, given the difficulties of TB skin test interpretation in BCG-vaccinated individuals, the system of TB skin testing the foreign-born erased the medical history of TB prophylaxis of foreign nationals vaccinated for TB even as the CDC publications and peer-reviewed literature clearly demonstrate that U.S. medical community was aware of the impact of TB prophylaxis on the TB skin test. Citing peer-reviewed articles, CDC and campus orientation documents, this dissertation demonstrates that the erasures amounted to declaring up to fifty per cent of TB skin tested foreign nationals as latent TB positive, thus misdiagnosing latent TB infection on the scale of 76 to 90 per cent. By giving a voice to international students who were subjected to the procedure, this dissertation considers the larger cultural imperatives of such epidemiology. Written by an international student who completed 9-month INH treatment for a non-existent diagnosis and contracted neurological side effects, this dissertation is also a meditation on (self-)forgiveness.