TB commentary harmed the morale of GN health workers

This is a close-up of a Mycobacterium tuberculosis culture, showing the bacteria that lead to TB, which infected Nunavummiut in 2016 at a rate nearly 180 times greater than among non-Indigenous Canadian residents. (PHOTO COURTESY OF THE CENTRE FOR DISEASE CONTROL/DR. GEORGE KUBIC)

Dr. Sarah Giles’ recent commentary contains much accurate, factual information and could have been a reasonably good basic introduction to the issues surrounding the tuberculosis crisis in Nunavut.

However, the overtly lecturing style and the context of the piece seem to imply that the people managing this tragedy aren’t aware of the severity of the epidemic and are not practising all of the complex TB protocols she mentions. Guess what? They are!

Just because screening, contact tracing and diagnosis is logistically complex and time-consuming and is not yet complete, doesn’t mean that it isn’t being done.

Unfortunately, there is no platoon of trained, Inuktitut speaking, culturally sensitive health workers that can be parachuted in at a moment’s notice. Despite that lack, the GN, together with its partners, managed to pull off, in very short order, the screening of almost every person in Qikiqtarjuaq—one of our hardest hit communities.

If Giles had talked to her medical colleagues here in Nunavut, she would have learned much, and could have relayed that information to your readers. So much for educating and advocating for the people of Nunavut.

Instead, she gave the impression to readers that we are bumbling idiots that need to be saved by some “experts” from away.

Secondly, Giles makes conclusions that are not warranted by the evidence she presents. Giles concludes that “the real crux of Nunavut’s TB problem is the … incomplete database.”

Unquestionably, the database issue is important and is newsworthy along with the “embedded” access to information scoop.

Is it the “crux” of the problem? How can the reader know, if no other opinions were referenced in the article?

Is it not possible that completing that particular database with near perfect accuracy in the short term was nigh on impossible and that—ethically and practically—screening, diagnosis, and treatment can and must continue with the imperfect but still useful information that has been collected in other databases?

Giles spends considerable time attempting to persuade the reader of her expertise by listing her accomplishments, and with the concluding attestation of her non-affiliation with organizations that would seek to profit from our tragedy.

While she is undoubtedly accomplished, as far as I am aware, Giles has no specific expertise in managing a TB epidemic, nor has she described having experience working in Nunavut.

Rather than persuade us of her expertise and selfless advocacy, she could have used that time to seek and present good evidence-based arguments for the conclusions she both makes and implies. You don’t even need to be a doctor to do that kind of public advocacy reporting.

Finally, I simply do not accept that Sarah Giles couldn’t find a source to go on the record or, at least, to provide “background.” The northern medical community, in which she claims membership, is very small. It should have been dead simple for her to get an introduction to someone who had valuable knowledge and insight to add.

When notable advocate Stephen Lewis came here on a fact-finding exercise, he was able to gather a fully nuanced view of our crisis by talking with: people in communities, elders, healthcare workers, nurses, doctors, Canada’s most accomplished TB researchers, Natan Obed and NTI, our medical officer of health, GN managers, politicos and Government of Canada experts.

He didn’t, despite his considerable experience in TB treatment in Africa, lecture us. He listened. And when he spoke to the Globe and Mail, local and national news organizations, he was knowledgeable, eloquent and generous to the dedicated hardworking crew here in Nunavut, while still advocating strongly for a substantial response from our Government of Canada partners. Now, that was effective public advocacy!

Nunatsiaq News is the newspaper of record for Nunavut and TB is one of our most pressing public issues.

I do not think Giles’ commentary was intended to harm the morale of those who are working towards the eradication of TB, nor cause additional mistrust among those who require testing and treatment, but it did. You dropped the ball on this one. I hope that you will do better in the future.

Mike DeMaio
(a.k.a. Luuktaap Nulianga)
Iqaluit

Editor’s note: Sarah Giles’s TB commentary was first published online in The Conversation on April 8. CBC North published a similar opinion piece by Sarah Giles on April 25.

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