TEACHER NOTES
Big Picture on Epidemics
Rationale
Tuberculosis (TB) is in the news – with rising rates of infectious TB in the UK and overseas.
It is a social disease, and that means that complex decisions need to be taken about the
best ways to prevent transmission and treat it, balancing the needs of individuals with those
of the wider community. There are particular groups of people who are more vulnerable to
the disease and this can lead to stigmatisation. At the same time these high-risk groups can
also be some of the most difficult to treat – their mental and emotional health can play an
important part in their treatment. There are many public health issues to consider, alongside
the biology of transmission and treatment.
Our approach
Drama brings the issues to life. People may be physically isolated, as well as feeling alone,
different and stigmatised. We want students to make a connection with the characters in the
drama and get a deeper understanding of how different factors interact when we are talking
about public health.
Learning goals
Overall, the lesson provides students with a framework in which they can learn about the
complexities of decision making about infectious diseases as well as providing deeper
insight into a specific bacterium, Mycobacterium tuberculosis.
By the end of the lesson, students should have:
 learnt how infectious TB is transmitted and treated, and identified the consequences of
non-compliance with treatment
 considered the need to balance the health, wellbeing and rights of an individual with the
health of the wider community
 learnt about the current legislation relating to the screening and treatment of TB
 discovered what makes certain groups of people particularly vulnerable to a disease, and
the way in which this can lead to stigma
 reflected on the impact of treatment on an individual's mental and emotional health (and
also the impact their mental health can have on compliance with treatment).
Suggested timescale
Twenty minutes' preparation, a one-hour lesson and a further one hour's homework.
Resources
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The Devil's Alliance (radio play)
The radio drama – available online – is a play in two parts, focusing on two men: Bounce
Maclaren and Micky Logan.
o Listen to part one (prison) and make notes on what it is about the two men's lifestyles
that has made them 'high risk' and vulnerable to catching TB.
o Listen to part two (hospital) and consider the impact of treatment for multidrugresistant TB on Bounce's mental and emotional health.
Activity sheet
This contains details of what students will be expected to complete during the lesson.
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Homework sheets
There are four homework sheets – students could be given a choice or could all receive
the same sheet.
Research information
o Web links
o Interview with the education officer of TB Alert
o Interview with the international office of TB Alert
o Interview with Paul Thorn about his personal experience of TB
Online poll
This is a chance for students to register their view. (Treatment for TB should be
compulsory: yes/no.)
Curriculum links
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AQA: Biology and Human Biology A, Unit 3 – Pathogens and Disease
AQA: Biology B – Unit 7, Microbes and Disease
Edexcel: Biology – Option A, Microbiology and Biotechnology
Edexcel: Biology (Human) – Microbiology and Biotechnology
Edexcel: Biology (Salter's Nuffield) – Topic 6 (Infection, Immunity and Forensics)
Homework/student preparation before the lesson
Lesson plan
Time
Activity
Suggestions
1 min
Introduce the
radio play
Explain that The Devil's Alliance is a radio play in two parts –
the first set in prison, the second in a hospital isolation ward.
It is about one man's personal experience of TB and the
emotional consequences of isolation. Invite students to listen
actively – and to make notes on what it is about the two
men's lifestyles that make them particularly vulnerable to
contracting TB in the first part. In the second part they should
list some of the ways in which Bounce's mental and
emotional health is affected by his isolation.
34 mins
Listen to the
radio play
Discuss
reactions to the
play
5 mins
Explain that Bounce was in an isolation room because he has
multi-drug resistant TB. Normal TB can be treated in the
community.
List some of the reasons both Micky and Bounce were
vulnerable to TB – but remind students that TB is a social
disease that can be transmitted to anyone. Health educators
have to be careful that their efforts to prevent the spread of
infection don't stigmatise certain groups.
Micky uses drugs and is a bit of a 'drifter'. Bounce has HIV,
so his immune system is compromised. He is also in a closed
prison environment – where diseases can spread more
rapidly and where people (like Micky) can be reluctant to ask
for treatment.
2 mins
Set the research
Talk through the way in which Bounce's treatment needed to
address his mental wellbeing as well as his physical health.
Students should work in small groups of four or five.
activity
Outline the following scenario
Several years have gone by since Bounce's time in prison
and hospital. He came out determined to change things.
Last year the hospital that treated him when he had multidrug resistant TB was threatened with closure. He was so
fired up about it that he stood for election as an independent
MP promising to do everything to save the hospital. (He was
allowed to stand as an MP despite his criminal conviction
because he had served a sentence of less than a year).
He won the backing of local people and was elected. And
now Bounce is discovering that the people he represents
have wide-ranging views on many issues. He must answer
their queries and follow up their complaints, even if he finds
some of their attitudes don't match his own.
Students should imagine they are working in his office –
helping with research and other matters. Bounce receives a
letter about TB and asks the students to carry out some
research for him.
They should read the letter and then look into some of the
points Bounce wants more information about.
At the end of the 15 minutes they should agree on one of four
recommendations for further action.
15 mins
Research
activity
Students should explore the following lines of enquiry. They
may want to take a question each and bring the results back
to their group.
 What do we mean by 'high risk' groups? What is the
current policy on screening people for TB?
 What is the feasibility of screening everyone who is
considered 'high risk'?
 How infective is TB and how is it passed on?
 What is the law on the treatment of TB? If someone has
the disease should they be isolated and forced to accept
treatment?
As an MP with a responsibility for the wellbeing of his
constituents Bounce can take further action. The students
should recommend what he does next. They have four
options to choose from.
a. Take the matter to the House of Commons to start a
national debate on whether the current law is
acceptable.
b. Write back clarifying the current position, but do
nothing more
c. Meet with the local TB team to find out more about
how the disease is treated at the moment
d. Head up a health education campaign to change
attitudes and behaviour
3 mins
Direct students
to the online poll
Direct students to the online poll, and explain that some
countries are considering compulsory isolation and treatment
for people with TB (that can be legally enforced).
Extension/home
work activity
There are four available activities to follow up this lesson.
You could ask students to do the activity relating to their
chosen recommendation. Alternatively you might want to
select one or more activity for everyone to complete.
There are four available activities to follow up this lesson.
You could ask students to do the activity relating to their
chosen recommendation. Alternatively you might want to
select one or more activity for everyone to complete.
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Activity 1: Ministerial speech
o
Follows recommendation to take it to the House of
Commons to start a national debate.
o
Bounce wants to make a speech arguing either for or
against compulsory screening, treatment and
isolation.
o
Students draft a five-minute speech, drawing on
Bounce's personal experiences of TB.
Activity 2: Newspaper article
o
Follows recommendation to do nothing, but to write
and clarify the current situation.
o
The issue is still in the news and the local paper wants
an article from Bounce explaining his experience of
TB, along with his thoughts on how to reduce the
rates of infection locally.
o
Students draft an article of up to 500 words.
Activity 3: Health briefing paper
o
Follows recommendation to meet with the local TB
team.
o
When Bounce goes to meet the local TB team they
tell him about a problem case – Annie keeps failing to
complete her treatment.
o
Students write a paper outlining why some people are
'hard to treat' and some of the options (including
legislation but also intensive support). They consider
the impact of approaches to treatment on an
individual's mental health and use Bounce's
experience to inform their arguments.
Activity 4: Health education leaflet/issue report
o
o
Follows recommendation to head up a health
education campaign.
Bounce wants to raise awareness of TB and help to
combat the stigma associated with the disease.
Students decide on their chosen target audience and identify
at least two key issues. They should include Bounce's
personal experience of TB as a case study within the leaflet.