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Admitted on refugee status, Souvannarath was most likely screened for TB upon arrival to the United States as is standard operating procedure, Gallegos said. Thus, he said, any supposition that she had been infected in a refugee camp is “ludicrous.” One third of the world’s population -- close to 2 billion people -- are infected with Mycobacterium tuberculosis. Ten to 15 million of them are in the United States, according to the National Institutes of Health. Though more than 8 of 10 of those infected don’t get sick, the disease still kills three million people a year, mostly in developing countries. In the United States, most cases occur among minorities: In 1993, Asian Americans accounted for 17.5 percent of active cases; blacks and Latinos comprised 54 percent. “Tuberculosis is the No. 1 killer of all communicable diseases,” said Betty Tarr, division manager for Fresno County Community Health’s communicable diseases department. “People forget we are part of the whole world. We can’t just look in our own backyards,” Tarr said. “People travel. And because of family reunification in the 1980s, people from those populations came with health issues that need to be addressed with sensitivity.” Though Southeast Asian immigrants represent only 12 percent of Fresno County, Tarr said they make up 75 percent of the 114 tuberculosis cases logged last year. Treatment can last anywhere from six months to two years, depending on the strain of TB involved. “It is difficult to be compliant,” Tarr said. “There are side effects, and often a person will go through a honeymoon period three to four months into treatment, where they feel better and wonder why they still have to take the drugs.” If patients fail to complete their medication regimens, the bacteria can become resistant and harder to treat. Seven such cases of resistant strains were identified, all among Southeast Asian immigrants. Souvannarath was reportedly one of them. For some multidrug-resistant tuberculosis strains, no cure exists. “It will kill you and is a significant danger to the community,” Tarr said. What Souvannarath has “is a little scary from the public health perspective, and you can’t mess around,” said health official David Hadden. “How do you protect the public? You can’t put a sign around her neck telling everyone to steer clear of this woman because if she sneezes she could be spewing out a deadly disease.” Though she declined to comment specifically on Souvannarath’s case, Tarr said jail is a rarely used last resort. Of the 100 to 125 cases of TB per year in Fresno County, only one to two people are contained in jail. Under California law, counties have the responsibility to safeguard public health and safety, and someone with TB can be detained if local health officials establish that he or she has an active case and refuses to take medicine. Patients are first treated at the county hospital, Tarr explained. If deemed non-compliant or in denial but “not ill enough to fit the medical criteria of an acute-care center,” they are taken to a board-and-care facility. Only if no spaces are available are they taken to the jail’s medical wing, she said. There, she said, “they have their own room, television, telephone. A medical assistant will make sure they are taking their medications until they are free from the disease.”
Yet so far, many have remained disconnected from the mainstream and in poverty. Thirty-four percent receive public assistance. “Southeast Asians come as refugees,” said Lue N. Yang, director of Fresno Center for New Americans. “They don’t come with education. They have limited English skills and have minimal basic job skills. It’s very difficult.” Yang, who has worked at the Fresno County Health Department, knows of two other Southeast Asians jailed last year. Though the health department has programs to reach out to the community, such as educational presentations in Southeast Asian languages, they must do more, Yang said. “They need to go on Hmong radio and talk to leaders to make sure the community understands the disease in order to go beyond control,” Yang said. “It is very complicated. If a person has never been to school and is not educated in health issues, they are not going to comply.” Yang said the county needs to persuade those who command respect in the community of the disease’s dangers, so that they can “convince” the person with TB to keep taking the medicine. “I don’t think the interpreter is the problem,” he explained. “People in our community don’t trust the county. Even if the county tells them to take their medication, they’re not going to take it if they don’t see the disease and feel good.” Schneider said that after more than two decades of dealing with Southeast Asian refugees, the county still fails to grasp their fears and misunderstandings of Western medicine. “We are challenging the county’s policy of jailing people with tuberculosis. Everything the county has done has been totally illegal,” said Schneider, who added that he believes that at least one other Laotian immigrant is now in jail, but county officials won’t release more information.
“What do you think the damages would be for spending 10 months of your life away from your children in a jail, unable to speak English, unable to get access to an attorney, lied to?” Campbell asked. “Of course we’re seeking damages because that’s what the law provides for people who have suffered this kind of injury at the hands of the state.” Though the California Health and Safety Code allows counties to detain TB patients who won’t comply, it adds that “individuals detained through tuberculosis control, housing, and detention, shall not reside in correctional facilities.” Schneider said the county is also required to give notice and hold a hearing before isolating a person, and it cannot keep someone in custody for more than 60 days without a court order. All those protocols were violated, he said, and “with this lawsuit, we hope to find how many people were illegally jailed.” Even after all this, Gallegos said lawyers are not entirely convinced Souvannarath had an active (contagious) case of TB and are seeking a second opinion. “Right now, only county health records have established she had TB,” Gallegos said. Although Souvannarath lives with three daughters and has another daughter and granddaughter who live close by, all have tested negative for TB, according to Sonexay. Furthermore, Souvannarath says that while she was jailed, she was never isolated. Workers never covered their mouth or had her mouth covered when they brought her food or gave her treatments, as they did when interacting with other TB patients. “I’m not sure if I had the disease,” Souvannarath says now. “I never cough. People [with TB] -- something is always in their throat.” Now, Souvannarath wears an electronic tether on her ankle. She is under house arrest pending a July 15 court appearance where she will be required to show that she is following the treatment regimen. Seventeen-year-old Thongsavane said the family is not used to the attention they have gotten since her mother’s story broke in the Los Angeles Times last week. “It feels awkward, but my mom has always been strong,” she said. “She is very brave.” But Souvannarath said she didn’t feel brave enough to attend her daughter Sonexay’s high school graduation last week. “I would love to go; I decided not to go,” Souvannarath explained. “I worry something would happen to the monitor and they would accuse me of something I do not know and take me back to jail. When I was in jail they would chain me and they still chain me in my own house. Why should I leave this place?” Sonexay also says she is wary. “The first time my mom entered prison, I was really angry and wanted to yell at them,” she said. “Now I think they had to do what they had to do. But they shouldn’t have kept her in that long after she said she’ll take the medication at home. “One thing I’m really mad about is they didn’t give us a second chance. They didn’t trust us at all. They didn’t believe us.” The Associated Press contributed to this report.
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