Omar: Good to see you Warsame. Are you coming from home as you know we could have traveled here together?

Warsame: Thank you, I would have enjoyed that. But no, I am not coming from home. I am coming from my doctor.

Omar: I hope you are well!

Warsame: Yes, I am very well. Thank you. However, I am not happy. My doctor thinks that I am sick. He told me today that I am sick. I went to see him two days ago in order to have my Green Card screening. He needed me to come back today. Today he said he wants me to take medicine yet I don't feel sick. In fact, I know I am healthy. I don't think I want to go see him or any doctor here again because I don't think I can trust him, or anyone.

Abdi: Yes, you are clearly in good health (thanks be to God). We can thank God for that. But why is your doctor telling you that you are sick when you feel healthy? And why does he want you to take medicine? What did he say the medicine was for?

Warsame: He said that I have TB and I know I don't. There is absolutely no way I could have TB. I mean look at me, I feel fine, I'm not coughing and I haven't been coughing before this, but he tells me I need to take TB medicine! Foolish!

Muktar: Did he have you take the TB test, the x-ray?

Warsame: Yes! He had me take a new x-ray today even though I told him I had an x-ray back in Nairobi before coming. I just don't understand it, today he told me my x-rays were negative, normal, but still he told me I have TB. I have now proven twice that I don't have TB yet this doctor says I need to take medicine for nine months because of something to do with TB. Nine months! That's crazy. I am not sick and I am not going to agree to take the medicine.

Omar: You know, I had the same thing happen to me. My doctor tried to tell me the same thing! My x-rays were negative too! They did that arm test, the one that they say is also a TB test. This arm test made a red bump on my arm. They told me I needed to take the medicine because the red bump meant that I had TB even though my x-ray was negative like yours. Even though that didn't make sense to me, I wanted to do what my doctor recommended so I started the medicine, but I stopped after a couple of months. I figured that was enough time, I mean I wasn't sick when I started the medicine and I still wasn't sick when I stopped. The thing is I know I don't have TB, no one in my family has had TB, I am a good Muslim and so is everyone in my family, you all know that. So I figured, even though my doctor is kind and seems to sincerely care about me, why should I still take that medicine!

Abdi: Ah, I think I understand the doctors. Warsame, you are right, you are not sick now. You don't have a cough and you are right that your normal chest x-rays tells you that you aren't sick with TB. That is important and relieving to know. But, let me explain why your doctor now tells you to take medicine. Chest x-ray tests are performed to try and find people who are sick. And that is why yours was negative - because you are well. But this arm test, called a PPD, is performed to find people who are healthy now but who have a chance of getting sick with TB at some time later on in their life.

Ruqiya: But I still don't understand it. Why would your doctors say you need medicine for TB if you aren't sick with TB?

Muktar: You know, what Abdi says is right. It is how I understand it too. I too had a PPD test that caused my arm to have a red bump. Then I too had a negative x-ray like you Warsame, and you Omar. And I also was told that I should take medicine for TB for nine months and I did. Because the way Abdi has explained it is correct, that the medicine I took and the medicine your doctors want you to take is for someone who is not sick with TB. This medicine is for someone who is well, who does not have a cough or fevers and is not losing weight. It is to protect you from getting sick with TB later.

Abdi: When your PPD test is positive, that means you have the TB germs inside of you. Even though you have a positive PPD test, if you have an x-ray that is negative this means that there are germs inside your body but that they are not harming you now. Anyone who has the germs inside them may get sick in the future even though they are very healthy now. It is only the medicine that your doctor recommended to you that can kill the germs so they are no more in your body, so that they won't be around to make you sick later.

Ruqiya: But, nobody in my family ever had TB! Not my father or mother, nor my grandfathers (lineage). So why would I have TB germs inside me? Why would I or my children need to worry about getting TB in the future. The doctor says my brother and sister have PPD tests that are negative. But mine is positive. I figure that if they don't have to take the medicine, then I don't either. We lived together for a long time and none of us are sick.

Abdi: You are right, Ruqiya, in knowing that if a family member is sick with TB, he or she can give the sickness to people around him.

Group: Yes, that is true.

Abdi: But did you know also that you can get the TB germs from people outside your family, too? If you sat close to a sick person on a crowded bus anytime in the past, you could have gotten the germ from that person if he or she coughed near you. And we know that people were sick in the refugee camps in Kenya, too. If you got TB germs from someone in the camps, or from someone on a crowded bus, you could have them inside you, like your doctor says. They aren't making your sick now, but they could later in the future.

Ruqiya: But, we all know that TB is a disease that God created. You can have it as a test or as a punishment. People who are bad, who steal or do really bad things we know will get TB.

Abdi: Yes, of course, what you have said is true, we all believe that any illness, especially TB is ultimately God's way of testing or punishing, but it is important to understand about TB germs and how they can be passed when someone who is sick with TB coughs as I said before.

Omar: I see that what your are explaining to me makes sense. But, still, I know that everyone in my family was vaccinated with the BCG vaccine, and BCG protects you against TB. So even if I was around people sick with TB in the past I would be protected.

Abdi: You are right, Omar, the BCG vaccine that you and your family and most Somalis received helps protect against getting TB. BCG is an important vaccine because it is very effective in preventing the serious types of TB in young children. But BCG doesn't work for all types of TB and it doesn't provide protection against TB forever. We all know that in Somalia and Kenya, a lot of people do get sick with TB, even people who have been vaccinated with BCG.

Warsame: But why did my cousin tell me that the red bump on my arm from the TB test was from having been vaccinated in the past? He said the vaccine causes the positive test, not that I have TB!

Muktar: My doctor told me that sometimes it is true that the vaccine can cause a positive TB test on the arm but only if someone was recently vaccinated, and we all know that we received BCG when we were babies. Also, he reminded me that even people who are vaccinated with BCG can still get TB, in fact TB is most common in the same parts of the world where the BCG vaccine is given. And it is the people like us coming from these parts of the world that most need this medicine that your doctor recommended for you that will provide us with protection against TB.

Omar: Again, I guess what you say makes sense. But do I have to take all 9 months of medicine? Wasn't the couple of months I already took enough medicine to protect me?

Abdi: No, unfortunately, TB germs are stubborn, it is true that some of the germs in your body have surely already been killed by the medicine, but it takes an entire 9 months to make sure that all of the germs, even the strongest are killed so that you are protected in the future. Without the full nine months there is still a change remaining that you will get sick with TB sometime in the future.

Omar: I guess I should talk to my doctor about taking the medicine again and taking all of it.

Abdi: Yes, that is the best thing to do. That is important to protect you against TB.

Ruqiya: Muktar, you took all the medicine right? So does that mean that now your PPD test is negative and you will not get TB, right?

Muktar: You are right Ruqiya, the medicine has protected me from getting TB in the future. The TB germs that were in my body are dead. But my PPD test will always be positive. Like you are thinking, when I finished the medicine, I thought my doctor would do another PPD test and it would be negative. I thought this would be the way they check whether the medicine worked. I know now that this isn't so. I will always test PPD positive that is why anyone who has a positive PPD test never needs to be tested again.

Ruqiya: But why will you always test PPD positive? I don't understand. You took the medicine.

Abdi: I will try to explain this to you. What Muktar has said is right. The test is a way of asking your body if it has ever come in contact with the germ that causes TB. A positive PPD test means that your body knows the TB germ. Only people who have been in contact with TB in the past can recognize this germ. People who have never had the germ inside their body will test PPD negative. If someone has a negative test, they may be asked again in the future to have a new PPD test. This is to make sure that in the time since the last negative PPD, this person has not come in contact with someone with TB. Once someone has a PPD result that is positive, they no longer need to be tested, even if they take medicine to protect them from getting sick with TB in the future. The medicine does not make a PPD test turn negative, as remember the test is a way of finding out if your body recognizes the TB germs, not if it has TB germs in the body. Even if you have killed all the TB germs that were in your body by completing all the medicine, your body will still be able to recognize them, because it has a record of them having been in your body in the past.

Muktar: Yes! That is what I learned too!

Abdi: Warsame, what do you think you will do now?

Warsame: Thank you for helping me understand. I understand now the difference between the chest x-ray test and the PPD test. The chest x-rays told me I am not sick with TB, and the PPD skin test told me even though I am not sick with TB, I do have the TB germs inside me and they could make me sick later. So maybe my doctor isn't foolish when he told me to take medicine. Maybe he was looking out for my health all along and I should trust him. I don't want to get sick in the future. I always put my trust in God to keep me healthy but maybe God is working through this doctor's hands.

Abdi: Warsame, you are right to trust God to help you stay healthy. God will be good to you because you are a good Muslim, a good person. Here in America there is good medicine that with the Will of God will protect your health. It shows respect to God when you take the medicine and stay healthy because it is God's Will that the medicine is available to you.

Ruqiya: You are right, Abdi. I understand now that it is right and helpful to take the medicine and stay healthy. We thank God for our health.

Whole group: Yes, we thank God for our health.