Nunavik doctor calls for more resources in TB fight

Updated on Tuesday, Aug. 12 at 2:47 p.m. ET.

Nunavik’s health board is activating a plan to slow the spread of tuberculosis, but doctors say there’s a critical need for more resources.

The region reported 79 TB cases as of Aug. 7 — approaching last year’s total of 94 cases, which was a record for Nunavik, says Dr. Yassen Tcholakov, clinical lead on infectious diseases for the Nunavik Regional Board of Health and Social Services.

Six communities are experiencing outbreaks. The health board does not identify affected communities, citing privacy concerns.

“At the current time, we’re receiving no additional resources,” Tcholakov said in an interview of the need for help from the Province of Quebec.

“There are very few places that have rates that are anywhere near what we have in some of the communities in Nunavik.”

The board is updating its five-year regional tuberculosis elimination plan and developed another plan to address “urgent short-term needs,” says a Nunavik health board document provided to Nunatsiaq News.

A TB treatment regimen such as 3HP, which combines two antibiotics, was introduced last year for infected people who are not yet sick. It’s given once a week for 12 weeks and seen as a way to head off the illness before symptoms develop.

“TB treatment is a long process. People who are sick with TB, their treatment is usually a minimum of six months, sometimes longer,” Tcholakov said.

Nunavik health centres face a shortage of staff, lack of clinical spaces, and also lack access to new TB medications that are in limited supply in Canada, he said.

The health board is in talks with Santé Quebec, the provincial agency that co-ordinates Quebec’s health and social service networks, and federal partners, to see if health professionals can be borrowed from other regions.

The board is also trying to recruit more Inuit public health workers to communicate with patients in Inuktitut.

Measures to support patients during treatment are being implemented.

Patients in need can receive a coupon to buy food while they undergo treatment. It’s offered on a case-by-case basis but there’s a plan to expand it regionally, said Jessika Huard, the Nunavik’s infectious diseases co-ordinator.

There’s also the vDOT program, short for Video Directly Observed Treatment, launched a few months ago so people don’t have to attend a clinic to take their medication. People who are ill with TB must take their medication daily in front of a health professional.

The program is only available in Puvirnituq, but the board hopes to secure funding and hire more nurses to offer it across the region.

Dr. Faiz Ahmad Khan, director of the tuberculosis clinic at McGill University Health Centre’s Montreal Chest Institute, said Nunavik needs community-wide screenings to curb the spread of TB but that requires resources and support.

“To date, there has never been a provision of these types of support resources in Nunavik,” said Khan, who also works as a respirologist offering care in Nunavik since 2013.

In Nunavut, by contrast, several communities have seen community-wide tuberculosis screenings, including Arviat, Naujaat, Whale Cove, Pangnirtung, Qikiqtarjuaq and Kinngait.

In a French email, a spokesperson for Quebec’s Ministry of Health and Social Services said the ministry drafted an action plan including a working group made of representatives from Santé Quebec, the Nunavik health board and other departments.

“Meetings have already taken place. Work is being organized, and the group is structuring its approach to supporting the [Nunavik board’s] action plan,” said Marie-Claude Lacasse, the ministry’s media co-ordinator.

However, Tcholakov said he isn’t aware of the details of the ministry’s plans for support.

Ahmad Khan called the lack of response from the provincial government “unfortunate.”

“This will now be the third year in a row of record number of people being diagnosed with TB in Nunavik. Where is the provincial government plan for this region of Quebec to address this public health emergency?”

Correction: This article has been altered from its originally published version to correctly identify the source of some information as a Nunavik health board report, and to clarify Dr. Yassen Tcholakov’s comment about not being aware of the details of the Health Ministry’s plans for support.