Daniel T'seleie
Northern News Services

Iqaluit (Aug 29/05) - Despite territorial-wide efforts to eradicate the disease, Nunavut still has the highest rate, by population, of tuberculosis infection in Canada.

Robin van der Vis holds a cup of tuberculosis antibiotic medication at the health centre in Iqaluit. Nunavut has the highest rate of TB infection in Canada. The disease is curable if patients stay on medication. Pills must be taken every day during the first two weeks of treatment, and twice a week after that. One dose is between four and 14 pills, depending on the patient and their condition. It takes a total of 72 doses of medication to fully cure TB.

Thirty-three new cases of TB have been diagnosed in Nunavut so far this year, mostly in the Baffin region.

The prevalence of TB in Nunavut is due to "socio-economic" reasons, said assistant chief medical officer of health doctor Geraldine Osborne.

Crowded houses and poor diets are major factors in the persistence of TB, she said.

"You can be infected with TB and never develop the disease," said Osborne.

A healthy person may carry TB germs in their body and never show symptoms of the disease.

If germs do become active, TB can affect any part of the body, not just the lungs.

When germs do infect the lungs, contagious bacteria can be coughed up. This is how the disease spreads, and can account for fluctuations in the rate of TB infection over the years.

Tuberculosis can be fatal, but Osborne does not know of a single TB-related death in Nunavut since she got here in November 2001.

If properly treated, TB is completely curable.

By treating and monitoring patients with TB, and tracing its spread, health care workers may be able to rid Nunavut of the disease.

"It's not just medication that's the costly part," Osborne said. "Each case of TB generates a huge workload."

Osborne estimates a cost of $7,000 for each TB patient who does not have to be admitted to hospital, and $30,000 for patients who are. About half of all TB patients are admitted to hospital. One patient's medication costs the government about $300.

The price of good health does not stop here.

On top of treating patients, every baby born in Nunavut is given a TB vaccine, which helps prevent the disease. School children are screened for TB in kindergarten, Grade 6 and Grade 9.

Each time a patient is identified with TB their friends, relatives and co-workers are tested for TB. Upwards of 50 people may be tested in this "contact tracing" process if the TB patient is infectious.

Being largely a Northern phenomenon, many nurses from down south must be trained to deal with TB when they arrive in the territory. They are at the front lines of the fight, seeing TB patients at least twice a week for upwards of nine months to monitor the disease and the treatment.

"We have to see people take (the medication)," said Robin van der Vis, a registered nurse in Iqaluit.

When patients are not well enough to visit a health centre nurses will make house calls.

Better housing, better diets, better health, a "better living standard," in general would help fight TB, Osborne said.

There is no time line for the elimination of TB in Nunavut, said Elaine Randell, Baffin regional TB co-ordinator. The effort must be global, she said, or germs will always exist somewhere and could be re-introduced to Nunavut or any other population.

"With a lot of public health measures you don't see things change overnight, and you won't with TB," Osborne said.