Indigenous peoples particularly vulnerable to surge of TB
TORONTO – Tuberculosis is back.
Once on the wane, thanks to antibiotics and eradication programs, it has now re-emerged as a worldwide epidemic.
As public health agencies became complacent and the funds for TB control were slashed, TB rates soared. A global effort to eradicate the disease by 2050 started in 2000 with the formation of the Stop-TB partnership.
But indigenous peoples have been identified as particularly vulnerable. The TB rate for aboriginals in Canada, both on and off-reserve, is almost 30 times higher than among Canadian-born non-aboriginals, while for Inuit, the rate is an astonishing 90 times higher.
Pacific Islanders and Maoris are at least 10 times more likely to contract TB than other people living in New Zealand and the indigenous people of Kalaallit Nunaat, Greenland are 45 times more likely to get active TB than Danish-born residents.
Stop-TB experts and indigenous leaders from 60 countries, including India and China, met in Toronto in November for a two-day conference on tuberculosis hosted by two Canadian organizations, the Assembly of First Nations and the Inuit Tapiriit Kanatami.
“For me, it’s a human rights issue,” said Kenyan lawyer Thuya Soipan.
The conference was the result of a resolution at the April 2008 meeting of the United Nations Permanent Forum on Indigenous Issues. Work has begun on an indigenous-led solution that will be presented to the UNPFII and Stop-TB in 2009.
Tragically, tuberculosis is easily cured. But if left untreated, it’s highly contagious, debilitating and often fatal.
TB flourishes in poor housing and sanitation, overcrowding, malnutrition, remoteness and lack of access to medical services.
The disease played a role in a shameful chapter of Canada’s history, infecting thousands of aboriginal children held in appalling conditions in residential schools, with untold numbers dying, many quietly buried without any notification to their families.
In the early decades of the 20th Century, Canada responded to a terrible TB epidemic in indigenous communities. In the 1960s, nearly 8 percent of the Inuit population was hospitalized in Southern Canada. (The relocation so far from home was traumatic for the patients and for families and communities.)
It was thought that the disease had been conquered but in the 1990s, tuberculosis rates started to climb back up. A major source is the re-activation of latent TB in elders who may not have been fully treated decades previously or among former residential school students.
Canada has contributed $30 million to the global fight against TB, Dr. David Butler-Jones, Canada’s chief public health officer, told reporters at the conference. Health Canada is working with the provinces, spending $6.5 million a year on TB prevention and the Indian Affairs department spends $272 million annually on housing, he added.
“The solution is not simply a medical one,” he said, nor is it just about finances. It’s a question of working with communities so people feel comfortable coming forward and are supported.
TB activist Winston Zulu of Zambia said he was surprised to learn of Canada’s role on the world stage in the fight against tuberculosis. Canada should first take care of its own indigenous peoples, Zulu said in an interview.
“When it comes to us First Nations people, we’re treated like third-world citizens,” Chief Alex Robinson of Pimicikamak (Cross Lake) First Nation in Manitoba, told reporters. “It shouldn’t be the case.”
An outbreak of active TB affects 19 people in his community of 6,700 people, mostly Cree along with Metis and others, where there’s a chronic housing problem and acute shortage of medical staff.
Ann Kacilius, of the advocacy agency Manitoba Keewatinowi Okimakanak, said there has been a failure to listen to the community in the Health Canada response to the outbreak.
It’s a problem that reinforces the fears community members have of being diagnosed with TB, she said – both because there’s a stigma to the symptoms that resemble HIV/AIDS, and because the three-week isolation and hospitalization is onerous for families.
Angus Toulouse, Ontario regional chief for the Assembly of First Nations, said aboriginal communities are ill-prepared for such emergencies. “One in five First Nations have no doctor or nurse available in their area,” he said. “And one in three patients encounters long waiting lists.”
Jurisdictional wrangling between federal and provincial government on issues like who will cover the cost of hospitalization often stand in the way of meeting the needs of patients, he added.
That’s something that led to Jordan’s Principle, named for a special-needs boy from Norway House Cree Nation, who spent two unnecessary years in hospital because neither level of government would pay for his care in his community. He died in the hospital in 2005 at the age of 4.
Noting that tuberculosis is “a disease of poverty,” Toulouse emphasized that “the best cure for poverty is employment.”
That’s not so easy, said Gail Turner, an Inuit from Happy Valley-Goose Bay who’s a registered nurse and director of health services for Nunatsiavut, the Inuit government in Newfoundland and Labrador, noted the bureaucratic obstacles to escaping from poverty.
She described a young man with TB whose malnutrition and inadequate housing were an obstacle to healing. She suggested he get a job and he said he couldn’t because he didn’t have a government social insurance number. The reason for that was that he had no birth certificate, because he couldn’t afford the $100 to get one.
Turner said she tried every social agency she could think of to get $100 so her patient could get a birth certificate.
Not one would help, she said. “It wasn’t part of their mandate.”
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