Tension between people and nurse treating TB

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Ominayak evicts nurses, 'not cooperating,' he says

Provincial health nurses, involved in treating the recent tuberculosis epidemic at Little Buffalo Lake, are being evicted by the band.

"The way things are right now, we can't get any substantial approach going to deal with the problem," said Lubicon Lake Band Chief Bernard Ominayak, explaining he feels the government health nurses are not cooperating with the band.

Ominayak has requested a "full time community health nurse" be provided by federal health authorities to replace Peace River Health Unit nurses who visit the community twice a week to dispense medication and perform tuberculosis skin testing. He called the attitude of health unit personnel "offensive, condescending and unacceptable" in a letter to the unit's executive director Hildegard Camsell, adding "our concerns flow directly from your people not doing their jobs."

At present, 38 residents have active tuberculosis and 80 are receiving preventative therapy. Because some have become sick from the medication, and don't know what to expect from the disease and its treatment, they have become distrustful of medical staff, according to Ominayak.

At an Oct. 19 meeting between the band and medical and provincial medical officials Ominayak said: "We knew there was tension between the givers (of the medicine) and the takers. We felt a liaison worker would fight this problem."

It was agreed that a Cree-speaking Community Health Representative (CHR) and a community-based "lay dispenser" would be hired. Ominayak believed the lay dispenser would receive in-service training by working in the community which would help ensure that people take their medicine and are informed of any complications.

A week later he was informed by Camsell that her unit did not have the staff to provide the planned field experience for the lay dispenser. She recommended that the dispenser get field experience at Lac La Biche before working in Little Buffalo.

Ominayak asks why the lay dispenser would be trained elsewhere instead of in the community where emergency conditions exist. A week ago he asked the visiting community health nurse what kind of training is required to give prescribed pills to sick people and make sure they are taken, but says he received no answer. "They don't feel we're capable of giving pills to someone," he said.

However, Dr. Graham Clarkson, consulting medical officer to the Peace River Health Unit, maintains "we are concerned that everybody takes the drugs so we supervise. You've got to be careful in dispensing medication . . . it is a major job to dispense it." He said the health unit must operate all treatment programs according to high medical standards and ensure that lay dispensers get adequate training.

Ominayak is also concerned that the provincial health nurses sit in the "health office" trailer all day and wonder why people don't come in for their medication and skin tests. He feels that the medicine should be taken to sick people, but has gotten little cooperation from the nurses to do this.

In his letter, he also questions why the head community health nurse arranged for a cab to take a sick band member to the Peace River hospital, 65 miles away, when he had already arranged for transportation to be provided by the community health representative. Health unit personnel have complied by routing all transportation requests through the band office.

Concern over side effects to the medication rose due to conflicting advice given to the band by health officials. Because the band is visited only twice a week by nurses, those receiving medication receive a higher dosage than they would if they received the drugs each day.

Dr. John Waters, director of Communicable diseases at the Aberhart hospital in Edmonton told the band the side effects are normal and to be expected. But, at the Oct. 19 meeting Dr. Anne Fanning, director of the provincial tuberculosis services, indicated if side effects occur te dosage must be adjusted or the medicine changed.

Dr. Clarkson explained that the younger a person is the less likely he or she will experience serious side effects. Since, of the 38 active tuberculosis cases in Little Buffalo, 37 of the sick people are 29 years old or under, he indicates perhaps the side effects concern may be overblown. He added it makes little difference whether the drugs are taken twice a week at higher dosages or every day at lower dosages.

"A vast majority can take the medicine without side effects. Some may become irritable and get a rash on their skin, but by and large only one or two per cent will have serious side effects," he explained.

Responding to allegations of a lack of cooperation on behalf of Peace River Health Unit staff, he explained the tuberculosis epidemic in Little Buffalo had taken priority over the 40,000 people the unit serves around Peace River.

"Since the outbreak we've seconded people to help. We are there to be as helpful as possible and we are trying to fit in with the wishes of the band, national health and welfare and the provincial government," he explained, adding if there are problems it means communication lines must be re-opened between the provincial health personnel and the band.

Ominayak maintains his band has never been given adequate health care by the province. The present nurse "used to come out and give needles to the kids once a month. There was an optometrist from High Prairie who wanted to use the trailer to examine eyes, but she wouldn't let him use it." He explains the lack of cooperation in the tuberculosis emergency reinforces his frustration with the lack of consideration his band has been shown by the province and has asked that Lubicon medical files be transferred to a federal representative.

At press time, Windspeaker learned the federal government has responded to Ominayak's letter by sending a team of three nurses to deal with tuberculosis treatment in Little Buffalo. It is not know what kind of long term arrangements will be made regarding the replacement of the provincial nurses.