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YONGSAN GARRISON, South Korea — Base health officials opposing a new, more lenient tuberculosis testing regulation will take their case to the Korea Regional Office commander this week.

The regulation, signed in December, allows most South Korean employees to begin work before they have been cleared of tuberculosis.

On Jan. 17, Col. Philip Volpe, 18th Medical Command commander, hand-delivered to Brig. Gen. John MacDonald a memo saying the rule change wasn’t a good idea, said Lt. Col. Lee Hee-choon, chief of clinical preventive medicine.

This week, Volpe’s office likely will brief MacDonald.

“We hope it will change. We hope we do the right thing for the protection of our workers,” he said.

The rule says most Korean national employees are not required to submit an X-ray showing they are free of tuberculosis before they start work, said Dennis Bohannon, KORO spokesman. However, food handlers must show proof before they start work, he said.

All other employees must schedule an X-ray — one way of detecting TB infection — within 90 days, he said.

TB infection rates in South Korea are 20 to 30 times higher than in the United States, Lee said. His office is pushing to require chest X-rays before an employee begins work, then yearly exams thereafter, Lee said.

The requirement was loosened to help ease base worker shortages, Bohannon said.

People on base are not at risk of infection if an employee has TB, Bohannon said, because they will not be in a place where it usually is spread.

“That’s their position,” Lee countered. “We don’t concur.”

Health officials are concerned about more than food handling, Lee said, noting that TB also can be transmitted through the air, in droplets expelled in a cough.

Seven TB cases have been reported to the 18th Medical Command. Six involved South Korean employees, and one involved an American. Health records show one Dragon Hill employee contracted the disease three years ago and was treated, said Rich Gorman, Dragon Hill general manager. The woman still works at Dragon Hill, he said.

Andrew Yi, who works with Korean national employees at Yongsan’s Civilian Personnel Office, said Morale, Welfare and Recreation department vacancies can take at least a month to fill. Scheduling a physical can take from 10 days to two weeks, he said, because military personnel have priority at the Occupational Health Clinic.

The clinic is overworked, Lee said.

“The commanders for the areas have had difficulties in getting positions filled for a long time. The effort is to get people in place working as quickly as possible,” Bohannon said.

The new rule followed months of debate over whether nonappropriated-fund South Korean employees — such as those who work for MWR — were required to have any TB test before starting work.

The confusion was rooted in U.S. Forces Korea health regulations, said Helen Chang, chief of the occupational health service of the preventive service directorate. Regulation 690-1 requires a chest X-ray every three years for all employees and a physical for food handlers.

The regulation states it applies to appropriated-fund South Korean employees only. But an August memo from the deputy assistant chief of staff said requirements for pre-employment medical clearance and X-rays apply to all employees.

Last year, MWR Director Jerome J. Konieczny argued against testing food workers at all, writing in a July 20 memo that “TB transmission does not occur unless there is close, intimate contact over a long period of time.”

“Almost always, this means people sleeping in the same bed,” Konieczny wrote in the memo, which was addressed to 8th Army’s director of civilian personnel.

TB transmission is particularly likely “with several people in one bed as is the custom in many developing countries, or similar situations with extreme overcrowding over many months or years,” he wrote.

To the same office, Wilson wrote that a chest X-ray every three years is inadequate and an annual one is prudent.

“Korean employees often incorrectly perceive a serious disincentive to reporting their illnesses for fear of losing their employment,” Wilson wrote.

An employee who contracts TB is not fired, Lee said, but put on a treatment regimen.

The preventive medicine office does a trace investigation of an infected person, checking family members and co-workers who may have had contact with the infected person, Lee said. That group is tested right away, and again three months later, Lee said, to ensure they have not been infected.

“This is not something that we take lightly,” he said.

Tuberculosis bacteria can stay latent in a person’s lung, meaning an infected person may show no symptoms. But when a person’s immune system is stressed, the bacteria can start replicating, causing active TB, Lee said. Symptoms include coughing blood, fevers, night sweats and labored breathing.


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