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Northeastern Spotlight
Fall 2017
Volume 12 - Number 3

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TB Limelight - Diana Nilsen, MD

Dr. Diana Nilsen is the Director of Medical Affairs in the Bureau of Tuberculosis Control (BTBC) at the New York City Department of Health and Mental Hygiene where for the past 13 years she has overseen medical care received by patients at the TB chest centers and in the field. Using her extensive knowledge of complex TB issues, she lends her expertise to the provision of medical consultation to providers and the development of policies and procedures related to TB. She also sees patients once a week at the Fort Greene Chest Center in Brooklyn and continues to be active on the weekend intensive care unit (ICU) attending service at the Veterans Administration (VA) New York Harbor Healthcare System Manhattan Campus.

If you have had the opportunity to work with Dr. Nilsen, it becomes evident very soon that not only is she brilliant, but also has a great sense of humor! This makes her very approachable and one cannot help but feed off her enthusiasm and energy for the work she does in TB.

It is quite clear that she has a full plate, especially considering her newest role as the incoming president of the National Tuberculosis Controllers Association (NTCA). Regarding this position, she says “NTCA is the leading group representing the issues that are most relevant to TB controllers in the United States. I have been on the board of NTCA on and off for almost a decade and I am very excited about this new opportunity.”

Dr. Nilsen took a unique path to a career in medicine; before starting medical school, she worked as an ICU nurse. She liked the challenges of this fast- paced job, which fueled her interest in the field of pulmonary medicine. Dr. Nilsen graduated from SUNY Health Science Center at Brooklyn (Downstate)1989 and went on to complete her internal medicine residency at the New York University (NYU)/Manhattan VA. She completed a pulmonary and critical care fellowship at NYU/Bellevue, including a rotation on the renowned chest service at Bellevue Hospital. She was a faculty member at NYU’s Division of Pulmonary and Critical Care Medicine for more than a decade. When asked about the barriers she faced as a female physician in the 90s, Dr. Nilsen comments, “I was a married female physician and the tide was against us at that time. Navigating the medical profession for a woman of childbearing age was a challenge! Having a child as a medical resident was just unheard of. Luckily, some other things were in place for me. I have a supportive family and my husband was willing to shoulder a lot of the responsibility of raising a family. I am also grateful to my parents who were always available and helped me with my children. I would not have been able to do it without their help.”


In the photo above: Dr. Diana Nilsen and her family enjoying her son’s college football game.

One wonders what drives Dr. Nilsen. In her words, “I am a child of immigrants, my family emigrated from Lebanon. Being a first-generation American, the stakes are really high and you want to succeed and make your family proud. I always aspired to be a doctor. I viewed nursing school as a stepping-stone to going to medical school at a later point. For anyone who chooses medicine as a profession, you have to want to do it for the right reasons. The desire to advance intellectually and being passionate about it is key.”

Reflecting on the long history of working in NYC at the height of the TB epidemic where Bellevue was at the epicenter, Dr. Nilsen has been witness to the significant decrements made by the Bureau of TB Control. Dr. Thomas Frieden, who was the Director of BTBC at the time, and later went on to become Director of CDC, instituted substantial measures that allowed NYC to lower TB rates through directly observed therapy, case management, improvements in infection control, and medical management. Dr. Nilsen notes the changing demographics of TB over the years, including a decline in drug resistant TB and TB-HIV co-infection, as well as a lower burden among US-born persons. This shift in epidemiology requires different strategies to address TB in specific populations and to also engage new partners in TB prevention and control. Dr. Nilsen notes that one of the biggest challenges currently facing efforts toward TB elimination is the lack of adequate funding. “Many patients are undocumented and don’t have the means to pay for their care. Lack of access to care or loss of access to care is a big concern. We have to do everything in our capacity to shape the TB infrastructure in order to provide care to patients.”

Simply put, Dr. Nilsen loves her job. “I am consulted in my bureau for any medical issues related to TB treatment and care. I also have the opportunity to outreach and lecture at other institutions. My job is interesting as I wear many hats. The freedom to delve into different topics is very stimulating.” In addition to serving as a regular faculty member for RTMCC trainings, Dr. Nilsen is involved in helping to impart the basic tenets of TB control and medical management when BTBC hosts delegations from all over the world.

Like other experts in the field, Dr. Nilsen has put a lot of thought into the future of TB. She feels that it is getting harder to engage young medical professionals as TB is a complex health issue that is often unrecognized. Physicians need to be taught how to maintain a high index of suspicion for TB, in addition to how the disease affects the patient’s personal and social life. The goal of the TB clinician is to try and take care of patients in the best way possible while minimizing the side effects of treatment. This makes the care of TB patients nuanced as there are several factors that play a role in why individuals accept treatment and remain invested through completion. Dr. Nilsen encourages young medical professionals to “get involved as TB people are very accommodating and the complexities of TB will keep you on your toes!”

Dr. Felicia Dworkin, Deputy Director of Medical Affairs at BTBC, reflects “I have witnessed firsthand Diana’s commitment to her patients, the doctors and staff we supervise but foremost to the NYC Bureau of TB Control. She also has long-standing involvement with the New Jersey RTMCC and several NTCA and other national working groups. Most recently, she has been involved in working on the essential components of TB control, the LTBI and MDR TB guidelines. She has enriched many lives with her work.”

Our own Dr. Lee Reichman, a long-time friend and colleague to Dr. Nilsen, says “Diana Nilsen is one of the most knowledgeable physicians dealing with TB that I know. I was particularly delighted to note that she has been elected Chair of NTCA. With her kindness and sense of humor she will undoubtedly score major advances not only for the TB Controllers, but for our patients as well as the entire TB community.”

Clearly, Dr. Nilsen is well respected and liked by her colleagues and those who have had the pleasure of working with her over the years. She understands not only the clinical components of TB but also recognizes the key role of staff working in the field and the importance of education and training. Despite all her accomplishments, she remains humble and approaches patients with this sense of humility in seeking a meaningful connection and achieving a work-life balance.

When Dr. Nilsen is not in TB mode, she is definitely spending time with her family. “I have been married for 35 years and have 3 kids, so it has been busy. I love spending time with family so if I am not working, I am just hanging out with my family. But I have to mention, I also love the beach!” remarks Dr. Nilsen.

Submitted by Arpita Jindani, MSW, MA – Health Educator

 

Training Highlights

If you are interested in any of our training opportunities, please click here for a list of upcoming trainings.

New England TB Intensive Workshop


In the photo above: Dr. Lynn Sosa and Dr. Alfred Lardizabal addressing questions from participants at the New England TB Intensive Workshop

In conjunction with the New England TB Consortium, GTBI held a three-day clinical intensive workshop on June 27-29, 2017 at the University of Massachusetts Medical School in Worcester, MA. Participants had the option of attending the first day as a stand-alone training focused on TB infection or the full 3-day workshop.

The topics were selected based on the collaborative effort of the planning committee. The course reviewed principles for the diagnosis, treatment and management of TB infection and TB disease and also addressed special topics such as extrapulmonary TB, TB and pregnancy, and TB in children and adolescents. Speakers were carefully selected based on their area of expertise and experience with treating and managing TB. Case presentations were included to address challenges in the management of TB and demonstrate teaching points.

Attendees included physicians, nurses, and public health professionals from Massachusetts, New York, Connecticut, Rhode Island, Vermont, and New Hampshire. There were 53 individuals who attended the one-day TB infection-focused training, most notably a large number of clinicians working in primary care settings. 28 participants attended the full three-day workshop. Feedback from the evaluations were positive; participants indicated that the content was informative and the case discussions assisted in understanding the complexities of TB infection and disease.

Submitted by Shwata Suresh Kumar, PGDM (Public Health) – Health Educator

TB Comprehensive Course

In the photo above: Course participants from American Samoa along with the faculty and planning committee

On August 7-11, 2017, GTBI collaborated with CDC Division of TB Elimination and the Mayo Clinic Center for Tuberculosis to offer a TB Comprehensive Course in Pago Pago, American Samoa. This course provided a unique opportunity for physicians, nurses and public health professionals from the island to dive deep into TB and get all their TB related questions answered by the team of experts from CDC, GTBI, the Mayo Clinic Center for Tuberculosis and the Southeastern National Tuberculosis Center.

The course covered current concepts in TB diagnosis, treatment, and management while ensuring that the content was tailored for local relevance. Case studies were dispersed throughout the course to provide participants with practical examples for application of key principles. A role play was incorporated to engage the audience as part of a session on the importance of patient education.

The 37 course attendees included physicians, nurses, lab personnel, and other health professionals working in TB. The participants strongly felt that the training expanded their knowledge of TB and they valued the opportunity to ask the faculty relevant questions after each lecture. The case studies were quite popular among the attendees as these included interactive questions using an audience response system. With regard to anticipated changes in practice, participants plan to incorporate TB testing for diabetes patients, provide more TB education to their patients, initiate screening for TB infection, and improve communication with partners. Inspired by this course, participants also expressed interest in initiating an annual TB update hosted locally in American Samoa.

This training was also gratifying for the faculty and planning committee members, who had the opportunity to immerse themselves in the local culture and experience the warmth and generosity of TB colleagues in American Samoa. It is fair to say that, the entire visiting team left a piece of their heart in American Samoa!

Submitted by Arpita Jindani, MSW, MA – Health Educator

TB Intensive Workshop

In the photo above: TB Intensive Course participants along with the faculty and planning committee

The Fall TB Intensive Workshop was held during September 12-15, 2017 in Newark, NJ. Over the four-day period, the workshop covered a wide range of topics including, current concepts in the diagnosis and treatment of TB Infection and TB disease, management of drug resistant TB, molecular epidemiology, TB contact investigations and the role of the nurse in TB treatment and care. Special topics included TB in children, extrapulmonary TB, working with immigrants and refugees, and TB in the correctional setting. Our thanks to Ellen Murray from the Southeastern National Tuberculosis Center who herself is a force of nature and braved hurricanes to travel to NJ and share her expertise in TB and corrections. The mother of a young child with TB along with the treating physician presented a unique patient perspective. She spoke about the hardships of having a young child with TB meningitis due to multiple missed opportunities for diagnosing TB and the emotional toll that it had on her family. The course also highlighted the experience of public health staff on the front lines for TB, including video depictions of a day in the life of field staff who interact with patients in their homes and the community setting. The course participants had the opportunity to ask questions of the field staff as part of a panel discussion.

The 31 attendees included nurses, physicians (including panel physicians from Egypt, Burundi, Philippines and Nepal), and other health professionals working in the field of TB. The participants strongly felt that the training expanded their knowledge of TB; they especially enjoyed the diverse topics and the opportunity to interact with speakers and fellow participants. The patient perspective was well received and left an indelible impression on the participants. Some attendees even suggested making it a five-day workshop as they loved every minute of the training!

Submitted by Arpita Jindani, MSW, MA – Health Educator

                                         

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News and Announcements

Massachusetts TB Program: Outreach to Dental Practices

The Massachusetts TB Program was recently approached by dental practitioners in the State requesting lectures on TB. The TB program staff presented first to a large dental practice and then to dental public health, doctoral and masters degree students from universities in the Boston area. The talks covered regional TB epidemiology, TB infection, TB disease, common transmission dynamics, TB testing, treatment options, best practices for TB prevention and infection control practices in dental healthcare settings. Approximately 50 current or prospective dental practitioners received TB education. The audience was very receptive and engaged. Many participants had patient populations that were representative of communities of increased TB risk. The Massachusetts TB program was excited about this opportunity to broaden education outreach and work with new partners to reach at-risk populations and advance TB elimination. The visibility garnered through the TB educational sessions has led to TB Program staff receiving invitations to speak at other venues.

 

GTBI TB Consultation Service

GTBI has over 25 years of experience in offering TB clinical care, prevention and education services. Our experts are available to answer a wide variety of TB-related questions, including clinical, nursing, public health, and programmatic issues. Consultants can be reached by calling the TB Info-line (1-800-482-3627) or by email (mc_gtbi@njms.rutgers.edu).



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