Pero mientras está aquí, Harrison está aprovechando las pruebas médicas gratuitas que son parte de una investigación sobre la .

“La gente ni siquiera piensa en la tuberculosis porque ya no la ves”, dijo Harrison, de 55 años. “No hay nada que te indique que está ahí, hasta que es demasiado tarde”.

Latente vs. activa

La tuberculosis es una infección bacteriana que se disemina por aire, que ataca los pulmones y puede ser mortal. Hay una prueba común de la piel para la tuberculosis, pero el Departamento de Salud de San Antonio dice que la prueba de la piel tarda de 48 a 72 horas en producir un resultado y es susceptible a falsos positivos. Un análisis de sangre es más preciso y requiere sólo 24 horas para obtener resultados.

Por esta vía se puede descubrir si una persona está portando la bacteria de la tuberculosis sin mostrar síntomas. A este escenario se lo denomina infección tuberculosa latente, una condición que pone a la persona en un riesgo mucho mayor de desarrollar tuberculosis activa, contagiosa si se vuelven a estar expuestos.

“Va a tus pulmones y por lo general se esconde allí inactiva durante años y años. Aunque suena aterrador, es completamente tratable”, dijo la , especialista en enfermedades infecciosas que forma parte de un programa llamado Breathe Easy South Texas (BEST). BEST es un ambicioso esfuerzo de $2 millones para hacerles pruebas a personas en riesgo en 20 condados de Texas, un área más grande que algunos estados completos.

El de Texas se asoció con el , con y con . Ofrecen pruebas en lugares como refugios, clínicas de diabetes y consultorios médicos que tratan especialmente a pacientes de bajos ingresos.

“No es un problema que esté en el lado sur o este. Es un problema en todo el condado de Bexar “, dijo Tommy Camden, gerente de servicios de tuberculosis del Departamento de Salud de San Antonio. Dijo que los casos de tuberculosis afectan tanto a las comunidades urbanas como rurales.

“No importa de qué color seas, o cuánto dinero ganas”, agregó. “Mientras respires, eres susceptible de contraer la tuberculosis”.

Sin embargo, algunas poblaciones están en mayor riesgo de portar la bacteria TB: las personas sin hogar, los consumidores de drogas intravenosas, las personas con diabetes y los nacidos en otros países. Para la mayoría de las personas que resultan positivas, el diagnóstico de tuberculosis latente es una sorpresa. Pero las pruebas son fáciles.

Una tercera parte de la población del planeta está infectada

“Tenemos grandes desafíos por delante”, dijo Camden, porque hay muchísimos casos de tuberculosis latente.

Texas, California, Florida y Nueva York tienen las tasas más altas de tuberculosis del país. Camden dijo que espera que esos estados puedan imitar el programa BEST, que analizó a 3.500 personas el año pasado. Se encontró que aproximadamente del 9% a 10% de ellas tenían tuberculosis latente.

“Es una condición que puede afectarle cuando menos lo espera”, dijo la enfermera Diana Cavazos, de University Health System. Cavazos dijo que a los que dan positivo se les hacen radiografías y un tratamiento de 12 semanas de antibióticos, e incluso se les ofrece transporte gratuito para ir a las citas médicas si lo necesitan.

“Pruebas, suministros, tratamiento, radiografías, todo está completamente cubierto”, explicó Cavazos.

Por el momento, el programa BEST es financiado a través de la exención del Medicaid que tiene Texas del gobierno federal. Pero la financiación futura es un interrogante. Las amenazas en Washington, DC para cortar el Medicaid han sembrado la incertidumbre precisamente en el momento en que el programa de pruebas para tuberculosis está planeando expandirse.

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But while he’s here, he’s taking advantage of free medical testing — a screening for dormant tuberculosis.

“People don’t even think about TB anymore because you don’t see it anymore,” said Harrison, who is 55. “There’s nothing that tells you, until it’s too late, that it’s there.”

Latent Vs. Active TB

Tuberculosis is an airborne bacterial infection that attacks the lungs and can be deadly. There’s a common TB skin test, but the San Antonio health department says the skin test takes 48 to 72 hours to produce a result and is susceptible to false positives. A blood test is more accurate and requires only 24 hours to get results. A vial of blood can be tested to see if people are carrying TB without showing symptoms. That’s calledÌý, a condition that puts them at much greater risk of developing active, contagious TB if they are exposed again.

TheÌýÌýteamed up with theÌý,ÌýandÌý. They offer testing at places like shelters, diabetes clinics and medical offices that treat mostly low-income patients.

“It’s not a problem that’s on the south side or east side. It’s a problem all across Bexar County,” said Tommy Camden, TB services manager with San Antonio’s health department. He said tuberculosis cases hit both urban and rural communities.

“It doesn’t care what color you are, how much money you make,” he added. “As long as you’re breathing, you’re susceptible to catching tuberculosis.”

Still, some populations are at greater risk of carrying the TB bacterium: the homeless, IV drug abusers, people with diabetes and those born in some other countries. For most people who test positive, the diagnosis of latent TB comes as a surprise. But testing is easy.

A Third Of The Planet’s Population Is Infected

“We’ve got some huge challenges ahead of us,” Camden said, because there is so much latent TB out there.

Texas, California, Florida and New York have the highest rates of tuberculosis in the U.S. Camden said he hopes those states can mimic the BEST program, which screened 3,500 people last year. Roughly 9 to 10 percent were found to have latent TB.

“I am passionate about this because this condition can affect you when you least expect it,” said nurse Diana Cavazos with University Health System. She said those who test positive are given X-rays and a 12-week course of antibiotics — even transportation to the appointments if they need it, free of charge.

“Testing, supplies, treatment, X-rays — it’s completely covered,” Cavazos explained.

At the moment, the BEST program is funded through the Medicaid waiver Texas has with the federal government. But future funding is a question mark. The threats in Washington, D.C., to cut Medicaid have sown uncertainty at precisely the time the testing program is planning to expand.

This story is part of a partnership that includes , and Kaiser Health News.

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Students and faculty at the have teamed up to operate one of the only student-run refugee clinics in the country.

The refugees who come seeking care are from the Middle East, southern Africa and Asia. They have fled violence and persecution. An estimated 5,000 refugees live within 3 miles of San Antonio’s .

Most who have resettled here receive temporary federal government health benefits that run out after six months or so.

“We really fill that gap before they can kind of get on their feet after they’ve lost their government benefits,” says Michael Tcheyan, a medical student who volunteers at the clinic. “We feel like it’s our duty, and it’s their right to get medical care and to be connected with services that are going to make their life better.”

Medical students from the Student Faculty Collaborative Practice of UT Health San Antonio help provide care along with students from the , the and the , which includes physician assistants, physical therapy and respiratory care.

Layla Mohsin, 52, came to the clinic for dental care. She’s a teacher from Iraq who came to the U.S. with her family of seven to escape the violence.

“We left Iraq and came to the United States because there is safety here. There, there is no safety,” Mohsin says as her son, Karrar Al Gburi, interprets for her. “The main concern? The lethal explosive cars. You can get caught by an explosive car at any place, any time.”

Laxmi Adhikari, a 65-year-old old man who fled Bhutan to a refugee camp in Nepal, is being treated for an itchy stubborn rash. He sports a T-shirt with a local high school team logo, a gift from one of the many people in San Antonio who he says have welcomed him.

“It’s far better than the refugee camp,” Adhikari says through Nepalese interpreter Dal Gajmer. “I trust and believe all of the nurses and doctors. They treat me very well.”

Dental student Eduardo Vela is originally from another country, too. He understands his patients’ challenges. “If you don’t know the language, there are a lot of cultural differences. I myself grew up in Mexico, so I know a little bit of the feeling of being an outsider and then trying to fit in,” Vela says.

The refugee population has many unmet medical needs, says clinic . “They are in search of people to manage their high blood pressure, their diabetes, their high cholesterol, thyroid disease, mental health issues,” Wayman explains. “For a lot of us that went into medicine, we went into it to help people. This is a population that needs help, and so it’s really a joy.”

Funding for the Refugee Health Clinic is provided through the and as well as the operations budget of the , part of the of the University of Texas Health Science Center at San Antonio. Endowment funds, individual donors and the university pitch in to cover other costs.

Texas will continue to be home to new refugees. But instead of giving financial assistance to the state, the federal will be giving that money directly to nonprofits.

The refugees don’t use the free clinic forever. The staff helps them find more permanent care. If patients need a referral to a specialist, they may have to find a way to pay for that visit.

The students and faculty also work to connect patients to whatever health coverage they might be eligible for, such as a financial assistance program for health care services through It’s available for Bexar County residents who do not have public or private health insurance. The cost is based on family size and income.

Navigating the health care system can be difficult even for Americans, says one of the clinic’s founders, Dr. an associate professor of emergency medicine at UT Health Science Center, so he says it is hard to imagine the difficulty for these refugees.

“You don’t speak the language, may not have a job,” Muck says. “And even though you’re in the midst of this robust health system, you can’t get in the door, can’t get over those hurdles.”

ºÚÁϳԹÏÍø News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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This story can be republished for free (details).