Communities urged to be vigilant about tuberculosis

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You don't hear as much about it as AIDS or cancer these days, but tuberculosis is still a major problem among Aboriginal people across Canada. Tuberculosis occurs 18 times as often in Aboriginal people as in Canadian-born, non-Aboriginal people, a 1999 Medical Services Branch (MSB) report says.

Ann Raftery, the Tuberculosis Elimination Program Co-ordinator for Medical Services Branch, Alberta Region, provided Windspeaker with a copy of the Tuberculosis and Epidemiologic Review, released this year. That report also states reserves currently have about the same incidence of TB as is seen in immigrants to Canada.

TB is difficult to control because of delays in detecting and treating active cases, Raftery said. Also because many people do not stay with the lengthy treatment plan to the end and because incompletely treated people spread the disease to others. Other factors include substandard housing, overcrowded living quarters and poor diet.

In the early 1980s, the rate of TB in the Aboriginal community was at least 10 times higher than in the general population and three to four times as great as in the foreign-born. Treatment brought the rates down for a while, which prompted governments to pull money out of programs. But by 1992, TB was classified as "epidemic" by healthcare workers and leaders in many First Nations communities.

Even so, between 1991 and 1996, MSB statistics show the incidence of TB in First Nations and Inuit communities decreased from 58.1 per 100,000 to 35.8 per 100,000 population. (MSB data does not always include reactivated old cases, however.)

Dr. Richard Long, contracted with Alberta Health, is in charge of the TB program in Alberta and is on a national committee dealing with the problem.

"I am not convinced it's a sustained drop," Dr. Long said. "I am very worried about the Northwest Territories, which is not handled through MSB; the money is not as dedicated to TB control," he added.

According to the doctor, the rate of TB is highest right now in the Territories' Dene and Inuit communities and in Northern Saskatchewan.

In MSB regions in 1996, Saskatchewan saw 105 cases per 100,000 population. That year, the province reported seven outbreaks of between four and 20 cases in each.

Windspeaker located a N.W.T. community, Lutselk'e (formerly Snowdrift), population 321, that has had an ongoing battle with TB for several years. Their Community Health Representative, Alizette Tatsiechele, talked about the struggle the whole community has had to bring the problem under control.

"It started five or six years ago," she said, "when someone turned up with a positive test."

MSB sent five medical staff house to house. They contacted visitors to the community and they tracked down outside and part-time workers who had been in Lutselk'e. An array of x-rays, sputum tests and Mantoux tests were done. A lot more positive tests turned up.

At one point, Tatsiechele said, "150 to 160 in our community were on medication."

They got a lot of resistance from people who did not want to go for tests, who did not want to take medication. "Especially the old people." Tatsiechele said "it makes them sick and the disease is harder on them.

"Some wanted to quit meds," she added, "and after a while the TB came back. But the chief and council really gave support."

To make sure people completed their treatment, the community enforced Directly Observed Therapy (DOT). This treatment is used more than 90 per cent of the time, the MSB report says. In Lutselk'e it meant giving people their medication twice a week and observing them while they took it.

"We question them before they go on a plane," Tatsiechele said. "On the street and in their homes. Some would not come to the nursing station." There is only Tatsiechele and one registered nurse in Lutselk'e.

The CHR explained that if they get a call from the infectious disease unit that they've identified a positive test or active TB, the person is masked and escorted by plane tothe Yukon, where they are isolated. Usually they remain in hospital one to one-and-a-half weeks for tests. The escort does not leave them until they are admitted to the infection control unit of the hospital, where all visitors must wear masks.

They test every year in Lutselk'e now, and keep a close watch on the children, Tatsiechele said. It's paid off. Today, only three or four people are on medication.

In 1990, the Assembly of First Nations, the Laboratory Centre for Disease Control (LCDC) and MSB undertook a study of MSB's TB program and came up with a strategy to reduce the incidence of TB to fewer than one per one million by the year 2010. The interim target for the year 2000 is to reduce the incidence of TB to 20 per 100,000 population, and to see the number decline by 15 per cent a year.

To pay for the strategy, the Treasury Board approved an increase in TB program money of $2.8 million a year between 1994 and 1999, bringing annual TB program funding to $3.8 million.