West Park’s tuberculosis clinicians are helping to turn around a TB crisis in Canada’s north.
Over the last several years, West Park clinicians have been spending time in northern communities as part of a co-ordinated effort to end TB.
Although the number of tuberculosis cases in Canada has declined over the last century, the same cannot be said for Canada’s north. In Nunavut for example, TB has been increasing at an alarming rate for years. The rate of TB is 261 cases per 100,000 people, far higher than the Canadian rate of about 4/100,000.
“As the rates of TB are so high in Nunavut, there is a Government of Canada initiative to eradicate TB by 2030 in the North,” says Jane McNamee, West Park Nurse Practitioner who is spending March 2019 in the Nunavut community of Cape Dorset. “Although many social determinants of health (e.g. overcrowding; food insecurity) play a part, screening and treating latent TB is a World Health Organization (WHO) recommended initiative,” added McNamee.
McNamee, who works primarily in West Park’s TB Service, will examine, assess and treat low risk TB cases (latent and active TB) working alongside other healthcare workers at screening clinics.
West Park Nurse Practitioner Jane McNamee in Cape Dorset
The Government of Nunavut is committed to screening communities for TB disease and TB infection (dormant TB). Cape Dorset will be the third such community to be offered this initiative. The hope is to screen the entire population and treat any active TB and latent TB. The TB screening clinic began on February 12, 2019 and will run in the Cape Dorset Community Centre for the next 12 to 14 weeks.
West Park has been at the forefront in the fight against TB since it was founded in 1904 as a TB sanitorium. It is the provincially designated treatment centre for difficult-to-treat cases of tuberculosis, and Ontario's only hospital with a dedicated in-patient TB unit.
In the past, TB patients from the north would often be relocated to treatment facilities in larger urban centres. More recently, the emphasis has been on treating patients in their own communities in the north.
Lucy Mgonja was a West Park TB Service nurse who made several trips to Igloolik beginning in the summer of 2017 to work in a program run by registered nurses designed to screen and treat individuals with latent and active TB. She recently moved there permanently to take on a role with the Government of Nunavut as a Public Health Nurse for the TB Program in Igloolik.
Like Cape Dorset, Mgonja says Igloolik also faces challenging issues that can contribute to the spread of TB in the 1,700 person community.
“There are issues with food security, alcohol, drugs,” Mgonja says. “We worked with social workers on these issues. But the staff in the program have strong relationships in the community which helped us screen and treat individuals successfully.”
The community also plays a critical role in treating TB in Thunder Bay as West Park’s Dr. Howard Song found last summer. Although not in the far north, Thunder Bay presented the infectious disease physician a set of challenges starkly different from those working in Toronto in West Park’s TB Service.
“I didn’t spend much time at all in the clinic. We spent the majority of our time travelling from one ‘favourite’ spot to another to locate the individuals and ensure their medications were being taken,” Dr. Song says. “It was definitely a different experience for me.”
Dr. Song was invited to Thunder Bay to help tackle an epidemic of 12 people diagnosed with TB. He helped provide follow-up on treatment plans, medications and supported the field work in the community.
Dr. Song was pleased to report that the last of the 12 individuals was cleared of TB recently. But another epidemic always seems to be around the corner. And West Park is trying to help arm local health practitioners, whether by directly working in the field with them or offering resources remotely.
Through the Ontario Telemedicine Network (OTN), Dr. Song and colleague Dr. Sarah Brode recently established a TB consultation service, enabling clinicians from afar to reach out for advice on treatment plans, medications and more.
West Park is also helping to educate front-line health officials in the north on how to best manage TB. Dr. Brode, a TB specialist who also manages West Park’s TB Service, will be speaking as part of a two-day course in Iqaluit, Nunavut April 29-30.
The course, hosted by the McGill International Tuberculosis Centre and the Department of Health Nunavut TB Program, will focus on the clinical and public health management of tuberculosis and will feature a faculty of TB specialists from across Canada. Dr. Brode will be speaking on the clinical management of TB in special situations: pregnancy, HIV, liver disease, kidney disease, diabetes.
“This course is a great opportunity for healthcare professionals and trainees in Nunavut to receive an intensive up-to-date review of the clinical and public health aspects of managing TB, in their own backyard,” Dr. Brode says. “It will also provide an amazing forum for the faculty to learn from local healthcare providers in Nunavut, and from each other, in terms of optimizing TB care and research in such diverse environments.”
The eradication of TB from the North, and all of Canada, is a monumental task but West Park’s TB experts are all up to it. It is after all, time to end TB.
Rally to end TB
World TB Day Rally on March 22
Join us at Nathan Phillips Square to acknowledge World Tuberculosis Day 2019.
Let's come together to increase awareness, reduce stigma and promote the elimination of TB around the world.
Date: March 22, 2019
Time: 1 to 1:30 p.m.
Location: Nathan Philips Square, 100 Queen St. W.
Meeting Point: Across from TORONTO sign, under the pedestrian bridge
Hear from TB patient advocates and join them in creating Toronto's World TB Day social media message in front of the TORONTO sign (banners will be provided).