Q+A | Nunavut's top doctor says early testing and awareness key to eliminating TB

Nunavut's health department has officially declared an end to years-long tuberculosis outbreaks in Pangnirtung and Pond Inlet and the territory's top doctor says that's thanks to diligent screening to catch the disease early, and awareness in the communities. 

Chief Public Health Officer Dr. Ekua Agyemang spoke with the CBC's Natsiq Kango about the success in the two communities and how people in Arviat and Naujaat can continue to manage ongoing TB outbreaks in those communities. 

This interview has been edited for length and clarity.

How are you feeling about declaring TB outbreaks over in Pangnirtung and Pond Inlet?

It's really exciting. I feel proud to have had the privilege to work alongside the leadership of Pond Inlet and Pangnirtung over the past two years to bring us to this point in time. The communities of Pond Inlet and Pangnirtung have worked really, really hard to come to this point where for about two years they have not had a new case of tuberculosis that is infectious in any of these communities.  

What do you think was effective in bringing down those cases?

It's about people understanding what this was about and overcoming the fear and stigma that we inherited from TB sanitoriums, and colonialism, and coming together to understand that if we found TB early, it could be treated in communities. 

And how has all this affected the staff?

Over the past four years for Pangnirtung and about two years for Pond Inlet, it's been a lot of hard work. We've had several nurses come in and out of communities to support screening. But much more importantly, what really worked in these communities were the community health representatives who lived in the community, who knew the people, who went on radio and spoke about TB and helped to break down the stigma, who built trust and relationships, who encouraged people who needed to take their medication. 

It is the hard work and diligence of these community members and the duty workers, people who help other people to take their medication as well as people who were doing those home visits and the leadership of the communities.

How many outbreaks are active in other communities?

We still have a TB outbreak in Arviat, and Naujaat, and we are working really hard. We are hopeful that sometime soon we can come to this point where we can be confident to close the outbreaks in those communities as well.

What should Nunavummiut continue to do, to eliminate TB in the territory?

Early identification and treatment. The symptoms of TB are coughing for more than two weeks, weight loss, loss of appetite. If we find TB early, we do not have to send anybody out like was done in the past. If people have sleeping TB, sometimes they will not have a cough, they will not have any sign or symptom, they will not feel sick. 

The other factors like housing, food security, education and awareness to bring down the stigma and the fear around TB.

What's the level of concern that you have for continued spread of TB in Naujaat and Arviat?

TB is not actively spreading there.

The outbreak is ongoing because we are still in the process of giving everyone in Naujaat and Arviat the opportunity to know their TB status through screening. 

If you have sleeping TB, you take care of it so that it never wakes up.

What is the health department doing to remove barriers to testing and treatment?

I believe that the first barrier is availability and access, so we are working hard to make sure that communities have public health nurses who are qualified to be able to identify a test and treat TB. But the most significant thing is being able to treat it in community and identifying it early.

Inuit Tapiriit Kanatami and the federal government are aiming to eliminate TB by 2030. What do you believe needs to happen to reach that goal?

Actions today will determine if 2030 will be possible or not. Like I said, early identification is key when it comes to elimination of TB and treatment, which means that people taking their medication, but also creating the environment and enabling people to be able to do that. 

So, pediatric medication that would be easy for the children who have, say, sleeping TB to take. Education and awareness is also a great thing. 

Teaching community members, teaching health-care workers, so all health-care workers, doctors, nurses, everyone knowing the signs and symptoms and thinking about TB at all times. Then as soon as someone comes and we suspect it could be TB, we could easily find and treat the person and they don't have to continue living in community and spreading when they don't know.

Moving to a different illness, pertussis, or whooping cough, outbreaks have been declared in Iqaluit and Pond Inlet. What would you like to share with Iqaluit and Pond Inlet residents on that?

The main thing we must understand is that pertussis is a vaccine-preventable disease, which means that if people are immunized, they do not get pertussis. We are seeing pertussis because we have pockets of people who are not immunized.

It is those who are not immunized or up to date, they haven't gotten the complete series of immunization for pertussis who are getting it. Let's think about other people, especially the babies who are not yet eligible to take the pertussis vaccine.

Pertussis is first given at two months, to a baby. So all babies less than two months, they will not have had opportunity to take the pertussis vaccine and are at very high risk.

For adults, they can help pertussis. It might not be deadly, but let's think about the babies and the children and let's get immunized so that we can protect their lives because they are the ones who really suffer, as well as our elders.