Disease that ravaged territories is back again
Jorge Barrera
Northern News Services
Yellowknife (Jan 29/01) - Twice a week at Jimmy Bruneau School in Rae, the kindergarten class gets a visit from the tuberculosis (TB) nurse.
The children know the nurse is coming and they get a little scared anticipating the test -- a mosquito bite-quick prick with a needle to inject serum under the skin of their forearms.
"Sometimes we have to tell them a story," said Anna Beals, director of health and social programs.
The tests are the front line effort in a battle to control the virus which plagued the Northern communities for much of the last century.
TB was once a leading cause of death among aboriginal people. Between 1937 and 1941, tuberculosis killed Dene in the North at the rate of 761.4 per 100,000 and Inuit at a rate of 314.6 per 100,000.
At one time, almost all Inuit were infected with TB. Medical authorities attacked with a long and aggressive testing and treatment program. Testing was suspended 25 years ago, in the belief that TB was vanquished.
While no one was watching, the disease made a comeback. Last year Nunavut recorded 50 TB cases and the NWT recorded 24.
"TB has not disappeared," Dr. Andre Corriveau, chief medical officer for the NWT.
"We need to maintain a high degree of vigilance."
Fight continues
There are new measures to combat TB in the North and medical authorities believe they have the upper hand in the fight to prevent a serious outbreak of the disease.
In the NWT, school screening is done in mostly Dogrib communities and Lutselk'e where TB is still prevalent. Children in kindergarten, grades five and 10 are tested.
Screening in schools is back and all reported cases of tuberculosis are regularly monitored, said Dr. Ann Roberts, chief medical officer for Nunavut.
Most Baffin Island communities now test children in two grades, usually grades 6 and 11, but it varies across Nunavut. The Kivalliq and Kitikmeot regions are just now implementing school screenings.
Roberts said testing school children accurately gauges the rate of the disease communities.
"Almost every home has a child or children visit it," she said.
"If a high portion of children tested have TB it means there is a problem; if tests come back negative it's unlikely the disease is in the community," she said.
Staff are trained
New nurses and doctors in the North are given tuberculosis training because the disease is rarely seen in the south.
"One of our biggest challenges is the turnover in staff," said Corriveau.
"We have to make sure (medical staff) think about TB."
At the management level, both Nunavut and the NWT have people specifically assigned to handle TB.
Seventy per cent of Nunavut's TB cases are on Baffin Island and last year the health department assigned a TB co-ordinator to the region.
The NWT employs two communicable disease consultants and TB cases consume most of their energy. Corriveau and Roberts trace the return of TB to the withdrawal of the federal Medical Services Branch from the Northwest Territories in 1986 and the outbreak of AIDS.
"Historically, when a problem goes away attention is diverted to the most pressing disease which was HIV in the 80's," said Roberts.
Past epidemics and socio-economic levels are also responsible for the resurgence of TB.
Since not all who contract TB develop an infection, it can remain in the body until the immune system begins to break down with aging. Overcrowded housing and malnutrition also contribute to a weakening of the immune system.
Susan Strader, TB co-ordinator for the Baffin region, said a healthy lifestyle is a good form of prevention.
"Eating three square meals a day is important," said Strader. "Parents with kids have to make sure they eat well and don't burn the candle at both ends."
