TB making a comeback

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Aboriginal health care workers must be trained to deal with the re-emergence of tuberculosis in their communities, say experts.

"It is absolutely crucial that we not only have enhanced training, but enhanced re-

training," said Dr. David Penman, an epidemiologist with Health and Welfare Canada.

Penman spoke on the issue at the annual meeting of the Aboriginal Nurses Association of Canada, held recently in Brantford, Ont., approximately 75 km southwest of Toronto.

"Tuberculosis is re-emerging as a major health epidemic," warned Penman.

The advent of effective antibiotic treatment in the 1950s heralded what many people saw as the death of tuberculosis, a bacterial disease which usually infects the lungs and can be fatal if untreated.

But it festers on in Native communities and urban ghettos, and the steady decrease in the overall national incidence of the disease has now been reversed.

In 1989, for the first time in decades, Statistics Canada noted a 4.5 per cent increase in the rate of tuberculosis. Almost one-fifth of those cases are found among Aboriginal people.

Some communities are seeing rates of infection which are reminiscent of the 1940s, when tuberculosis reached epidemic levels among Native people.

For example, Penman said 42 cases of TB were detected last year in the remote Cree community of Fox Lake, northern Alberta. And Black Lake, an isolated Chipewyan community in northern Saskatchewan, has levels comparable to the Third World, he said.

The increasing rate of tuberculosis may be due in part to the emergence of a drug-resistant strain of the disease which has startled medical workers across North America. The new strain is linked to improper use of antibiotic treatments and HIV. The World Health Organization reports that more people with the immunological syndrome in Africa die of TB than of AIDS-related complications. Health Care workers need to learn how to deal with the new strains of tuberculosis, said Penman. That includes treating the disease with a combination of drugs.

"Never, ever treat a case of tuberculosis with one drug, because it will rapidly become resistant to that drug."

Since Native people are 10 times more likely to contract the disease than non-Natives, Penman believes training must be a high priority among Native nurses and health care workers.

"You solve the problem in Aboriginal areas, or you don't solve the problem at all," he told the audience of nurses.

The statistics both frighten and frustrate Jean Goodwill, from Standing Buffalo Reserve, Sask.

Goodwill, who has been awarded the Order of Canada for her efforts to improve health care among Aboriginal people and the Inuit, suffered from tuberculosis as a young girl.

"I'm very disturbed about the fact that TB is on the rise," she said, because it shows Native people are still living in poor conditions and getting poor nutrition.

"What is happening to the so-called millions of dollars that have been spent on Native people? How and why has this come back? It's dreadfully disturbing, and it should be disturbing our leaders, too," Goodwill said.

Lea Bill, a Cree from Carsland, Alta. who recently retired from the health field, shares Goodwill's fear. Her grandmother spent five years in a sanitarium in the 1950s after being diagnosed with tuberculosis.

"We are revisiting a disease that devastated many of our communities. I believe many of us will try to get our band councils and people who are leaders in our communities to revisit this as well," Bill said, to make sure everyone is aware of the risks and work together to combat them.

The disease can be transmitted through airborne bacteria or through the blood. It is most often found among people living in over-crowded conditions who don't have proper nutrition.