Time for new approach to TB outbreak, say some Pangnirtung, Nunavut, residents

For nearly two years, the community of Pangnirtung, in Nunavut, has been plagued by a tuberculosis outbreak. 

The disease attacks residents without warning and residents are calling for officials to adopt a different, more holistic approach.

Forty residents of the hamlet have been diagnosed with active tuberculosis since January 2021, according to the most recent update from the territory's Department of Health on Aug. 26.  And 187 residents have been diagnosed with latent tuberculosis.

The Nunavut health department declared a tuberculosis outbreak in Pangnirtung in November 2021. Outbreaks have also since been declared in Pond Inlet and Naujaat. 

Some residents say the government and public health officials need to take a holistic approach to combating the spread, one that combines testing and treatment with prevention as well as healing the trauma caused by past tuberculosis strategies.

It's been on the mind of Markus Wilcke, a former nurse who practiced in Nunavut for around 40 years and now serves as a municipal councillor in Pangnirtung and member of the community TB engagement committee.

Prevention is key to halting the spread of the disease, he said, sitting at his dining table sipping a cup of coffee, his eyes fixed on the horizon and a thoughtful expression on his face.

"I'm aware that there is posters and pamphlets and … public service announcements being made by the Department of Health," he said. 

"But in general, when I talk to the community, I'm really quite surprised how little factual and accurate information people know about TB."

For this reason, Wilcke said, he worries that the community-wide screening clinic taking place this fall won't test enough residents.

"When people have good information about tuberculosis, the implications and the importance of screening, then it is easy for them to make the decision to attend the screening program," he said.

Pangnirtung resident Nancy Anilniliak, who was taken from her family at the age of five and sent to a tuberculosis sanatorium in Hamilton in the 1950s, believes that the health department should be more proactive about prevention.

The information broadcast on the community radio station is a step in the right direction, she said, but it's not enough.

She thinks the government should give every home in the community an information kit to help them better understand the disease. 

Prevention also means sharing more information about the outbreak, she said, something Nunavut's information and privacy commissioner has also called for. 

"I know there's a privacy issue," she said. "But as the community and as Inuit, we like to know people with illness so we can help them." 

Ongoing trauma

Residents of Nunavut still live with the trauma associated with the Canadian government's management of tuberculosis from the 1940s through to the '60s. 

At the time, those infected were forced to leave their homelands and receive treatment in different cities across the country.  

Many never had the chance to say farewell to their families, and some never returned home. 

"The government has the responsibility to ensure that the nurses are aware of that," Anilniliak said, adding that she disapproves of many Western approaches to health care.

Nunavut Tunngavik Incorporated (NTI) offers cultural safety training to medical staff to help them better serve Inuit patients dealing with tuberculosis. 

It's not uncommon for people who have lived through trauma to develop coping mechanisms such as denial, according to Wilcke. 

He believes that one solution, in addition to training medical staff, is to create a program to address the trauma linked to tuberculosis so that people can have a space to "come to terms with their past."

"I think if there was a combination of good education and also addressing trauma, I would think that almost everybody in the community would be highly motivated to participate in the screening program." he said. 

Nunavut Health Minister John Main said one of the barriers to people seeking testing or following a treatment protocol is the stigma surrounding the illness. The community wide screening clinic in Pangnirtung is one part of the government's prevention strategy. 

"It's not just the clinical side of diagnosis and treatment," he said.

"It's also to create a focus space where meaningful conversations can happen. Where people can ask questions. Where maybe misunderstandings can [be] cleared up."

Solve the housing crisis, MP says

The MP for Nunavut, Lori Idlout, said tuberculosis won't be a thing of the past until governments solve the housing crisis, which is one of her top priorities. 

"Because just addressing the basic needs, the human needs, like making sure individuals have a home where they can help prevent the spread of the disease, that's not available at the moment," she said.

According to Statistics Canada, more than half of all Inuit in Nunavut live in overcrowded conditions. 

In Pangnirtung, 120 people were on the waiting list for public housing as of March 31, 2022, according to the government of Nunavut.

The Nunavut Housing Corporation's "Nunavut 3000 Strategy," which aims to construct 3,000 new homes by 2030, promised to build 85 in Pangnirtung.

But the government needs to address multiple issues simultaneously, Wilcke said.

"As long as we're only addressing one area at a time, like housing [...], nutrition, the importance of screening program, the education elements, housing will not fix the problem. It requires [...] a holistic plan. Tuberculosis has not been effectively dealt with ever since it first popped over a hundred years ago up here in the Arctic."

"We need to look at dealing with tuberculosis as an investment, not an expense," he added.