The unknown source of the north

Tuberculosis is not ready to loosen its grip

ANDREW LODGE STAFF

Spring may be creeping across southern Manitoba, but in the North, winter is not quite ready to loosen its grip. Just the other day temperatures dipped to below minus 40.

Over the past two weeks I have found myself in a remote Northern Manitoba community, engaged in one of the ongoing research projects funded by the university. The town seems like so many towns in Canada’s hinterland. The winter road is still active at the moment, but it’s almost done for the year and then, for the next nine and some months, the only access is air, if you don’t count the treacherous multi-day boat ride that only those who know the rapids undertake, and that gets you to a dusty gravel road still hours from the closest town. There’s a Northern Store with obscenely inflated prices, a nursing station, a school, and of course the omnipresent Catholic Church. To be sure, all communities have their unique quirks, but, at least at first glance, this community is the prototypical northern community. And, sadly, this also means that tuberculosis, TB, is a serious health problem here.

Most of us assume that TB is one of those diseases of the past, sort of like the plague or leprosy or smallpox. Those that find some intrigue in reading about countries other than our own and our rich sister nations may know that TB remains a massive problem in many parts of the world. But, sadly, few are aware that TB remains a serious health concern in parts of Canada.

The World Health Organization reports that somewhere in the world a person is newly infected by the mycobacterium tuberculosis bacillus, which causes the illness, every second. A stunning one-third of all people on the planet are infected with TB.

The prevalence of TB on the world stage has skyrocketed in recent decades. Hopes of eradication were strong in the mid-20th century, but the advent of multi-drug-resistant TB and the emergence of HIV/AIDS have meant that TB is back with a vengeance. TB in those with HIV infection can be activated at a far higher rate than in those without the infection. Currently, the statistics are disconcerting at best. Over 1.5 million people a year die from TB. And the World Health Organization reports that somewhere in the world a person is newly infected by the mycobacterium tuberculosis bacillus, which causes the illness, every second. A stunning one-third of all people on the planet are infected with TB.

Here in Canada, the numbers are not quite as alarming. In 2002, the Public Health Agency of Canada reported that active infections numbered 5.2 per 100,000. While the numbers among the middle-class urban population are negligible, recent immigrants coming from TB-ridden regions contribute to the number, as does the aboriginal population.

The statistics tell the story. People of aboriginal descent in Canada are 23 times as likely to have TB as non-aboriginals. In Manitoba, roughly half of all cases are found among the aboriginal population, despite the fact that people identified as aboriginal make up only 14 per cent of the province’s total population. Many of the cases are found in the remote communities where access to services remains a severe problem. In fact, as one heads north in this country, TB becomes more and more prevalent. The Northwest Territories and Nunavut have the highest rates in the land if one measures by region, a whopping 94 per 100,000 in the case of the latter. Similarly, rates in Northern Manitoban communities are drastically higher than their counterparts in the south.

There is also a concern that HIV/AIDS will come to play a more significant role in the North. In much of the North, HIV infections have not yet been detected. But if — some public health officials say, when — HIV does find a foothold in the North, the prevalence of TB will make the situation that much more dire.

Even without HIV, conditions in the North come together to make a perfect epidemiological storm. Researchers have identified particularly virulent strains up here. There is also evidence that immune defenses among northern populations differ from those of European descent. The pre-contact lifestyle of hunting for food and living in disparate groups scattered over a large area has, it’s been suggested, configured immune defences to deal very well with parasite-type infections, but not so well with “crowd diseases,” like TB, that European populations have had to deal with for much longer.

However, it is housing, or lack thereof, that represents the most easily modifiable risk. While there is little that can be done about the virulence of the bug or the genetic basis of the response to bacterial invasion, the crowded housing conditions that make TB transmission, and the transmission of many other diseases, so much easier represent a public health crisis across the North that has yet to be addressed.

TB rarely makes the news in this country. Maybe that’s not all that surprising. Those afflicted by it aren’t exactly the folks that get lots of attention in the media, unless it’s some sort of sensational crime or something. In addition to aboriginals, they are also, more often than not, recent immigrants. Those born in foreign countries now account for over two-thirds of all reported cases of TB in Canada.

The effects of TB run deep in the communities up here. People are still getting sick and the latent infection — sleeping TB that can live in a person’s body without showing any outward signs — can spring to life under the right circumstances and make the person sick and permit transfer of the bug to others.

But the scars are not only from the physical ravages of the sickness. People are terrified of the disease and hold close the memories of what TB has done to them in the past. Back in the mid-20th century, when many people here were still living in camps scattered across the vast land, if

But, if — some public health officials say, when — HIV does find a foothold in the North, the prevalence of TB will make the situation that much more dire.

someone was identified by an “official” representative from the South, be it a priest or a cop or a nurse, as potentially being infected with TB, they would be taken to The Pas, Brandon, or Ninette, where they would be treated in a sanatorium. People still talk of having to survive in the unforgiving land as children after their parents were taken away, or, as adults, being whisked away by float plane for months or years on end, leaving their family vulnerable and alone, and not hearing any news as to whether they survived or perished. The anxiety of those years is etched in the collective memory of the people here.

No less traumatic is the experience in the sanatoria themselves. While not everyone has a negative story, the separation from family and the immersion in a place absolutely and completely alien forever changed many people. There are memories of being tied down to hospital beds for weeks on end, isolated spatially, culturally, and linguistically. People “lucky” enough to be left behind sometimes never saw their loved ones again and have no idea where they are buried.

Today in Canada, TB is less likely to kill you than in the past. But the drug regimen is a long one. Compliance with medication has become a problem, and this too makes people vulnerable. What’s more, it also contributes to the global problem of drug resistance which, in recent decades, has made TB so hard to fight.

It’s not surprising that there is reluctance on the part of some people to take the medication. The drugs can be hepatotoxic, meaning that they can be harmful to one’s liver. This is dangerously compounded by the use of alcohol or any other toxins cleared by the liver. Unfortunately, substance abuse remains a social and public health issue up here, which doesn’t make it any easier to take the TB pills for months on end.

The inclination towards non-compliance runs deeper than drug side effects, however. Past experience with the medical establishment — the sanatoria, the lack of access, and the broken promises — meld together into a larger picture, one that has generated mistrust of all institutions imposed from the outside. Contact has not been all negative, but, despite what the apologists for history say, the evidence overwhelmingly indicates that interaction between European and aboriginal societies has been far from benign for the latter. This simple but profound fact is not lost on anyone here.

The overall result is a considerable reluctance to engage the system, medical or otherwise. When this is combined with other circumstances inherent in northern communities, problems like TB persist with amazing and devastating tenacity.





Volume 94 Issue 24	The Official University of Manitoba Students' Newspaper Website	March 14, 2007

Home About Us Advertise Contact Staff Current Issue PDF Employment Letters to the Editor Meet the Staff Online Archives Personals Volunteer	Font Size Respond Email Print-Friendly The unknown source of the north Tuberculosis is not ready to loosen its grip ANDREW LODGE STAFF Spring may be creeping across southern Manitoba, but in the North, winter is not quite ready to loosen its grip. Just the other day temperatures dipped to below minus 40. Over the past two weeks I have found myself in a remote Northern Manitoba community, engaged in one of the ongoing research projects funded by the university. The town seems like so many towns in Canada’s hinterland. The winter road is still active at the moment, but it’s almost done for the year and then, for the next nine and some months, the only access is air, if you don’t count the treacherous multi-day boat ride that only those who know the rapids undertake, and that gets you to a dusty gravel road still hours from the closest town. There’s a Northern Store with obscenely inflated prices, a nursing station, a school, and of course the omnipresent Catholic Church. To be sure, all communities have their unique quirks, but, at least at first glance, this community is the prototypical northern community. And, sadly, this also means that tuberculosis, TB, is a serious health problem here. Most of us assume that TB is one of those diseases of the past, sort of like the plague or leprosy or smallpox. Those that find some intrigue in reading about countries other than our own and our rich sister nations may know that TB remains a massive problem in many parts of the world. But, sadly, few are aware that TB remains a serious health concern in parts of Canada. The World Health Organization reports that somewhere in the world a person is newly infected by the mycobacterium tuberculosis bacillus, which causes the illness, every second. A stunning one-third of all people on the planet are infected with TB. The prevalence of TB on the world stage has skyrocketed in recent decades. Hopes of eradication were strong in the mid-20th century, but the advent of multi-drug-resistant TB and the emergence of HIV/AIDS have meant that TB is back with a vengeance. TB in those with HIV infection can be activated at a far higher rate than in those without the infection. Currently, the statistics are disconcerting at best. Over 1.5 million people a year die from TB. And the World Health Organization reports that somewhere in the world a person is newly infected by the mycobacterium tuberculosis bacillus, which causes the illness, every second. A stunning one-third of all people on the planet are infected with TB. Here in Canada, the numbers are not quite as alarming. In 2002, the Public Health Agency of Canada reported that active infections numbered 5.2 per 100,000. While the numbers among the middle-class urban population are negligible, recent immigrants coming from TB-ridden regions contribute to the number, as does the aboriginal population. The statistics tell the story. People of aboriginal descent in Canada are 23 times as likely to have TB as non-aboriginals. In Manitoba, roughly half of all cases are found among the aboriginal population, despite the fact that people identified as aboriginal make up only 14 per cent of the province’s total population. Many of the cases are found in the remote communities where access to services remains a severe problem. In fact, as one heads north in this country, TB becomes more and more prevalent. The Northwest Territories and Nunavut have the highest rates in the land if one measures by region, a whopping 94 per 100,000 in the case of the latter. Similarly, rates in Northern Manitoban communities are drastically higher than their counterparts in the south. There is also a concern that HIV/AIDS will come to play a more significant role in the North. In much of the North, HIV infections have not yet been detected. But if — some public health officials say, when — HIV does find a foothold in the North, the prevalence of TB will make the situation that much more dire. Even without HIV, conditions in the North come together to make a perfect epidemiological storm. Researchers have identified particularly virulent strains up here. There is also evidence that immune defenses among northern populations differ from those of European descent. The pre-contact lifestyle of hunting for food and living in disparate groups scattered over a large area has, it’s been suggested, configured immune defences to deal very well with parasite-type infections, but not so well with “crowd diseases,” like TB, that European populations have had to deal with for much longer. However, it is housing, or lack thereof, that represents the most easily modifiable risk. While there is little that can be done about the virulence of the bug or the genetic basis of the response to bacterial invasion, the crowded housing conditions that make TB transmission, and the transmission of many other diseases, so much easier represent a public health crisis across the North that has yet to be addressed. TB rarely makes the news in this country. Maybe that’s not all that surprising. Those afflicted by it aren’t exactly the folks that get lots of attention in the media, unless it’s some sort of sensational crime or something. In addition to aboriginals, they are also, more often than not, recent immigrants. Those born in foreign countries now account for over two-thirds of all reported cases of TB in Canada. The effects of TB run deep in the communities up here. People are still getting sick and the latent infection — sleeping TB that can live in a person’s body without showing any outward signs — can spring to life under the right circumstances and make the person sick and permit transfer of the bug to others. But the scars are not only from the physical ravages of the sickness. People are terrified of the disease and hold close the memories of what TB has done to them in the past. Back in the mid-20th century, when many people here were still living in camps scattered across the vast land, if But, if — some public health officials say, when — HIV does find a foothold in the North, the prevalence of TB will make the situation that much more dire. someone was identified by an “official” representative from the South, be it a priest or a cop or a nurse, as potentially being infected with TB, they would be taken to The Pas, Brandon, or Ninette, where they would be treated in a sanatorium. People still talk of having to survive in the unforgiving land as children after their parents were taken away, or, as adults, being whisked away by float plane for months or years on end, leaving their family vulnerable and alone, and not hearing any news as to whether they survived or perished. The anxiety of those years is etched in the collective memory of the people here. No less traumatic is the experience in the sanatoria themselves. While not everyone has a negative story, the separation from family and the immersion in a place absolutely and completely alien forever changed many people. There are memories of being tied down to hospital beds for weeks on end, isolated spatially, culturally, and linguistically. People “lucky” enough to be left behind sometimes never saw their loved ones again and have no idea where they are buried. Today in Canada, TB is less likely to kill you than in the past. But the drug regimen is a long one. Compliance with medication has become a problem, and this too makes people vulnerable. What’s more, it also contributes to the global problem of drug resistance which, in recent decades, has made TB so hard to fight. It’s not surprising that there is reluctance on the part of some people to take the medication. The drugs can be hepatotoxic, meaning that they can be harmful to one’s liver. This is dangerously compounded by the use of alcohol or any other toxins cleared by the liver. Unfortunately, substance abuse remains a social and public health issue up here, which doesn’t make it any easier to take the TB pills for months on end. The inclination towards non-compliance runs deeper than drug side effects, however. Past experience with the medical establishment — the sanatoria, the lack of access, and the broken promises — meld together into a larger picture, one that has generated mistrust of all institutions imposed from the outside. Contact has not been all negative, but, despite what the apologists for history say, the evidence overwhelmingly indicates that interaction between European and aboriginal societies has been far from benign for the latter. This simple but profound fact is not lost on anyone here. The overall result is a considerable reluctance to engage the system, medical or otherwise. When this is combined with other circumstances inherent in northern communities, problems like TB persist with amazing and devastating tenacity.


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