Inuit TB: A View from the Ground and the Air….

Inuit Nunangat

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Nunatsiavut: Location

• Located at the northern tip of the Province of Newfoundland and Labrador, on Canada’s East coast.

• Covers a geographically diverse area of approximately 72,000km2 of land and 48,690km2 of sea.

• Home to 7200 + Inuit and Kablunangajuit.

TB Control In Canada, Public Health is the mandate of the provinces and territories Nunatsiavut Department of Health and Social Development Labrador Grenfell Health Newfoundland and Labrador, Department of Health and Social Services, Chief Medical Officer of Health, St. John’s First Nation Inuit Health, Atlantic Region Nunatsiavut has to dance with many partners….(Dr. Edward Ellis, PHAC )

Challenges in TB Control Confusion Negative pressure rooms Communication Hospital Infection Control Adherence Laboratory Capacity

Setting the Context

In 2009, there were 12 active cases of TB in Nain

TB History

Concern over Latent TB

Staffing Challenges

Changing Epidemiology

Changing Technology.

Tuberculosis has been endemic in Nain, Nunatsiavut since the

1950s. The reasons are historical, geographical, and

perpetuated by determinants such as colonization, poverty,

overcrowded housing, food insecurity and access to health

care.

TB treatment

TB records….. “TB Bibles”

The people remember

They and loved ones had to go away for treatment of TB to

the south, some never returned, TB treatment has left an

emotional scar that still aches across generations.(The State

of Tuberculosis in Inuit Nunangat, 2011).

The stigma of TB remains, much of it a feeling of lack of control

Nanilavut

Latent TB Infection According to the World Health Organization, each person with active TB can infect 10 to 15 people a year , on average…. Endemic TB Lack of follow up Research project on Latent TB Co-morbidity Smoking rates Paper silos.

People have to fly to Goose Bay for chest x-ray……….

Staffing Challenges In 1996, the Labrador Inuit Health Commission* (now Nunatsiavut Department of Health and Social Development) assumed control from the health authority for public health nursing in Nain Staffed with two positions for nursing

In 2009, both positions were vacant No casual staff Nunatsiavut nurse managers provided public health nursing on a fly in basis.

Shifts in Epidemiology Changing TB picture Social Network Analysis “Nain “ style. Genotyping Accepting the “unknown”.

Changes in Technology PACS System for x-ray Telehealth Robotics

).

Rosie the Robot….

Chronology of Digital X-ray in Nain September, 2009 The Medical Officer of Health made the case with Labrador Grenfell Health and the province for chest x-ray in Nain Rationale Advocacy Champions Planning Partnership Funding November, 2010 First ever digital x-ray clinic in a remote community in Newfoundland and Labrador September, 2011 Second x-ray clinic held in Nain

Success outcomes:

300 chest x-rays taken in Nain!

Human:

The service came to the people

Ground support came from the community(interpreters,

drivers)

The backlog was cleared allowing a go forward

approach to TB control

Financial

No lost time from work

Savings to NIHB

No need for replacement for health care staff affected

Cultural Sensitivity:

LGH staff who went into Nain left with a better

understanding of the people and their realities.

TB Follow up Clinics X-ray Physician assessment Treatment plan Collaboration

Community Health Aides History Change in staffing mix Role in TB Training

Continued Challenges TB Database Capacity Staffing Think TB