Fight against TB goes door-to-door
Nunavummiut have rates 62 times higher than the rest of Canada
Michele LeTourneau
Northern News Services
Published Monday, July 21, 2014
NUNAVUT
Tuberculosis (TB) in the territory has a history that dates back to the 1950s, when Inuit stricken by the disease were sent to the south and sometimes never heard from again.
"In fact, in the 1950s we saw some of the highest rates of tuberculosis ever recorded in the world," says Taima TB team leader and respirologist Dr. Gonzalo Alvarez.
Through the decades, TB was brought under control, but around 2003 the numbers rose again, with a current infection rate in Nunavut 62 times the national average.
"That's what triggered us to be more interested in tuberculosis and to see ways that we could prevent the disease," said Alvarez.
Taima TB, meaning Stop TB, is a program spearheaded by Alvarez in partnership with Nunavut Tunngavik Inc. (NTI) and the Government of Nunavut (GN) which ran between 2011 and 2013. The goal was to find the best ways to end the strangle-hold of the disease. The results of the study were published July 17 at PLOS ONE, an open-access Internet site.
How to stop TB? Turns out it's simple. One-on-one engagement with Nunavummiut at risk by using Inuktitut-speaking "TB Champions."
"We were focused on three things. One, we wanted to raise awareness about TB and wanted to take into consideration Inuit culture, language and history. And number two, we wanted to concentrate our efforts in high-risk TB geographical areas and communities. And we also wanted to provide in-home screening and treatment," said Alvarez.
During the highly active and public study, Nunavummiut accessing public health for screening, in response to Inuit-led engagement, doubled in number. Once the active part of the study was done, numbers declined again.
Natan Obed, director of social and cultural development for NTI, worked with Alvarez.
"It will need an active public health outreach that's sustained over a number of years to fully eradicate active tuberculosis," Obed said.
TB has two forms - latent and active. Latent is a sleeping form of the disease, where no symptoms are evident but the germ is present in the body. Active TB can exhibit symptoms such as a bad cough that lasts three weeks or longer, pain in the chest, coughing up blood, weakness or fatigue, weight loss, loss of appetite, chills and fever. Once infected, the germ will always live in the body.
"The disease is also linked to a number of socio-economic outcomes and factors, so we're going to have to do better in a number of different areas," said Obed.
Not surprisingly, those areas are the usual culprits for so much of what ails Nunavummiut - poverty, food security, mental health, overcrowding and education.
"We're doing a lot of things across the spectrum of social and cultural issues. Specifically, on tuberculosis, we have continued to work with Dr. Alvarez on a number of projects ... all aimed to improving identification and treatment, and then outreach and public information," said Obed.
"Then people are better informed of how the disease spreads and what to look for. If a person does have active TB, what they do to treat it. Then all those are positive. All those will bring the overall numbers down."
Although it is a Nunavut-wide problem, not all communities have the same rates. Some communities have very low TB rates but there are hot spots. Identifying and focusing on those hot spots was a goal of the study.
"There are some places where the Taima TB type of approach could work, if we had the capacity and the funding. The major sustainability issue on Taima TB is the human capacity to go door-to-door, and not just respond to active cases and contact cases within that person's social network, but to go to high risk areas for tuberculosis and to actively try to engage one-on-one."
There is a general lack of understanding - no matter how educated or uneducated you are on how the disease presents itself, what sort of treatment is necessary and what to look for in terms of symptoms, Obed said. People have a lot of gaps in knowledge of how it presents itself.
The Taima TB model is very different from the usual way of doing things - going to an English-speaking health clinic and trying to speak with a non-Inuk, said Obed.
Fear is a factor in the experience of TB.
"There are fears in contracting TB and what happens after," said Obed.
The disease is curable. But the drug course is nine months long.
"My two-year-old son was exposed to active TB and had to go on nine months of treatment, so he'll always test positive for latent TB. But we have no fear, as parents, for his overall health. And we know that if he is in situations where he exhibits some of those symptoms, we know to alert medical professionals," Obed said.
Obed said in Nunavut, that's just the way life is right now.
However, all the factors that contribute need to be addressed - as well as continuing community engagement in ways that actually speak to Nunavummiut.
