Fears of budget cuts to Nunavik health board based on 'misunderstanding,' official says

Nunavik's health board says there are no budget cuts to the organization, and the financial concerns raised by the region's 14 mayors are due to a "misunderstanding."

Last month, the mayors called on the provincial government to declare tuberculosis a public health emergency. They also alleged there were budget cuts to the health board and demanded for them to be reversed.

There are "optimization measures" across Quebec's health care network as the province tries to eliminate a $1.5 billion deficit, but Quebec's health ministry said that doesn't apply to Nunavik, and funding for the region's health board is actually being indexed up. 

The Nunavik Regional Board of Health and Social Services (NRBHSS) has also confirmed there are no reductions to its funding from the province. In a statement, a board spokesperson says there was "a clear misinterpretation and miscommunication" of what was reported at a meeting of the Tuberculosis Regional Committee in the spring.

During the NRBHSS's annual general meeting, executive director Jennifer Munick-Watkins made a plea to all leaders in the region to improve communication around tuberculosis prevention and elimination.

''It is by joining forces that we, as Nunavimmiut, can work to reduce the progression of tuberculosis and eliminate it in Nunavik,'' she said in Inuktitut.

The Kativik Regional Government, which released the open letter last month on behalf of the mayors, did not respond to several requests for comment by deadline.

Despite no budget cuts, the health board said the current funding is inadequate and the mayors' letters reinforced the need for more resources. The region is facing a possible third year of record tuberculosis cases, with outbreaks in six of Nunavik's 14 villages. 

"The absence of specific provincial funding, as well as local budget constraints, severely limit the ability of facilities to act in the field. It is these front-line shortages — staff, equipment and infrastructure — that are holding back the fight against transmission," a spokesperson said. 

Systemic inequities in Nunavik

Jessika Huard, NRBHSS' infectious diseases coordinator, said tuberculosis treatment can be a long process that can leave patients feeling alone and stigmatized. 

Treatment usually takes about six months, and it's mandatory for patients to take daily medication in front of a health professional.

"People often need to be isolated or flown away from their communities either for testing or for isolation for a few days or weeks. They're separated from their family, from the land," she said. 

"This can be deeply distressing, especially in the context where we already have mistrust towards the health system."

She adds that there is a systemic lack of resources for tuberculosis care in Nunavik, including the shortage of staff, X-rays, as well as training opportunities for Nunavimmiut to be able to deliver basic public health interventions.

"This limits our ability to build local capacity and goes against the spirit of self-determination and health," Huard said. 

Sarah Beaulne, executive director of the Inuulitsivik Health Centre in Puvirnituq, lamented the lack of hotels and other facilities for patients to isolate and get tuberculosis care. 

"We are trying our best to get a hold of them so that they can be utilized … we will have to be supported and funded by the government," she said in Inuktitut. 

Going to Manitoba for help

Earlier this year, NRBHSS said it needed 700 sputum test kits for diagnosing tuberculosis in mucus. 

But with the recent surge in cases, the health board said it doesn't have enough funding to acquire the necessary amount of test kits. It ended up asking the National Microbiology Laboratory in Manitoba for some of those kits. 

"The Ministry of Health has a responsibility for ensuring accessibility, quality and continuous care in Quebec, including Nunavik," Huard said. 

Both Quebec's Ministry of Health and Social Services and Santé Québec said they didn't receive a request for sputum testing kits. Nunavik's health board said there isn't specific provincial funding for tuberculosis care.

Santé Québec adds that it "will provide all necessary support" if the situation requires it. 

No health emergency for now

In a June 20 letter to Nunavik's 14 mayors, Luc Boileau and Horacio Arruda, two of Quebec's assistant deputy ministers at the Ministry of Health and Social Services, said the Nunavik health board is developing an action plan to control tuberculosis. 

Because of that, they are holding off from using emergency powers under the Public Health Act, but they said they will reassess the situation if needed.

"If it turns out that some of these obstacles can only be removed by the exceptional powers granted to us by the provisions of the Public Health Act, then you have our assurance that the necessary means will be implemented," they wrote in French.

"You can count on our commitment to supporting the work of the various sectors that will have to follow up on elements of the fight against TB in your region."