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On-site TB diagnosis and treatment showing benefits

Community-wide tuberculosis (TB) testing in Qikiqtarjuaq is running smoothly and faster than expected, Nunavut's chief medical officer Kim Barker said Jan. 8. The comments came on the fourth day of what was originally estimated to be a seven- to 10-week, $1 million medical effort to battle an outbreak in the hamlet.

The Department of Health has set up a mobile clinic in Qikiqtarjuaq's community hall, which includes sputum containment tents where patient cough to produce a sputum sample.
photo courtesy Dept. of Health

Barker says the cost seems high, but includes capital investments that will benefit other hard-hit communities facing TB or other outbreaks.

"The Ottawa Civic Hospital has a cost-benefit-analysis economic health expert that is actually currently up here and she's going to be assisting us with the cost benefit of having done this," said Barker on the phone from Qikiqtarjuaq. "I will tell you that already, within three days, I can see the benefit."

The mobile clinic, which includes about 24 additional local and imported personnel, is a marked difference from past government approaches to TB outbreaks among Inuit. The ravages of the 1950s and 1960s, when family members were taken away to the south – some never to be seen again – have not been forgotten.

And that's part of the message as a charter carrying Inuit leadership heads to the community for the afternoon and evening Friday.

Premier Paul Quassa, Health Minister Pat Angnakak, Inuit Tapiriit Kanatami president Natan Obed, Nunavut Tunngavik Inc. president Aluki Kotierk and Qikiqtani Inuit Association president P.J. Akeeagok will receive a tour of the mobile TB clinic, meet with local officials, and attend a community feast.

"I think the leadership really wants to communicate that acknowledgement of past wrongs, and new approaches to meeting community needs in the communities," said Barker.

Support from southern hospitals came quickly thanks to awareness of the TB task force created by Indigenous Services Minister Jane Philpott, who vowed last fall to eliminate TB in Inuit communities.

"When we reached out (to southern hospitals) saying we needed extra x-ray technician, extra people to take blood work, so on and so forth, I think it rang a bell because they were already familiar," said Barker.
With "a lot of partnership … (and) community buy-in", the Qikiqtarjuaq response gives hope "we can continue this process across the territory," she said, on the way to eliminating the disease.


Overcrowding, housing crisis must be addressed

Qikiqtarjuaq mayor Mary Killiktee, grateful for the help, is disappointed the Minister responsible for the Nunavut Housing Corporation Lorne Kusugak isn't on the charter's passenger list.

Overcrowding is cited, including by Barker, as a major contributing factor for the territory's high TB rate.

"He was one of the main people I was really hoping would come," said Killiktee. "The shortage of housing is an outrage. Some are living in a three-bedroom, nine people or more. It's just outrageous. It's a big struggle."

Killiktee was hoping to give Kusugak a tour, and "point out the situations and have a conversation with him."

Kusugak's executive assistant Michael Courtney said by e-mail he reviewed all incoming mail and e-mail and could not find an invitation from the mayor.

"So that would be one reason why the minister is not attending. As well, due to other commitments at this time it would be unlikely that he would be able to go there for the full day," said Courtney.

"From what I gather, as well, in discussions with the premier's office, the charter is full and is well-represented by our cabinet with the premier and the minister of Health, and I believe the leaders of the designated Inuit organizations."

Killiktee says her next step is to travel to Iqaluit and pay Kusugak a visit.


Mobile clinic proving successful

In the first three days, 65 people – 10 per cent of the 650 population – were tested. Latent and active cases have been identified beyond the already identified 10 per cent that triggered the community-wide testing. Barker would not disclose the number of cases for privacy reasons.

Aside from technical hiccups, mostly due to internet bandwidth needed for real-time analysis, the process is going faster than expected and should be done by mid-March.

"We're just so delighted the community members are being so patient, because they're literally spending a number of hours – three, four hours – in this screening process."

"They started Monday with families with small children," said Killiktee. "After sitting down with the doctor yesterday (Tuesday), nothing serious has showed up to make them worried. That was a good sign, I am very relieved and happy to hear that."

There are no travel restrictions, but if someone has scheduled medical travel, the medical escort is required to get tested before leaving the community.

"The school is open, they're in school. Everybody's working. We haven't had any closures."

Killiktee was busy running around buying up country food for the Friday evening feast the Department of Health will host for the community.

"I'm very grateful for the help and support our people are receiving from the Health Department, and the team that came. They're just amazing people," she said.