Medical officer: TB badly diagnosed and treated

DWANE WILKIN
Nunatsiaq News

IQALUIT – An outbreak of tuberculosis infections in Cape Dorset points to serious shortcomings in the way the potentially fatal respiratory disease is diagnosed and treated, the NWT’s chief medical officer warned this week.

Dr Ian Gilchrist said that TB outbreaks in Cape Dorset and other NWT communties are the direct result of poor case management and a lack of vigilance on the part of patients following treatment for infection.

“We need to get much better at making sure everybody is picked up, that everybody gets a full course of treatment and is cured,” Dr Gilchrist said.

“It’s always quite a big chore, because there could be a lot of people infected, and to find them all and to treat them all is not so easy.”

A total of 13 new cases of tuberculosis have been diagnosed in this south Baffin community of 1,200 residents since December.

The Cape Dorset outbreak is believed to be among the most serious since the disease hit the western NWT communities of Rae-Edzo in 1994 and Lutselk’e in 1995.

Another 20 people at risk of infection have been placed on medication to prevent them from developing full-blown symptoms of the disease, which include prolonged coughing, weight loss, fever, fatigue and cold sweats.

Because TB preys on people whose general well-being is already weakened by poor diet, smoking and alcohol abuse, such outbreaks tend to be a particular threat in aboriginal communities.

Crowded housing also encourages the spread of the disease.

Dr Gilchrist suspects the decline of tuberculosis as a major killer has also made northeners complacent.

That could explain, in part, why health programs to treat people infected with TB bacteria are faltering: some patients don’t take all their medication, and health workers don’t or can’t always follow up on those under their care.

Improvements in living conditions since the 1950s and a program of screening and drug treatment virtually eradicated the disease in most of southern Canada, but Canadians aren’t immune from new drug-resistant strains of TB emerging elsewhere in the world.

Inadequate treatment could promote the emergence of drug-resistant strains right here in the North.

“One of the reasons for us being concerned about it in the NWT and trying to really get these cases early and make sure they are treated and cured is so that we don’t, down the road, have somebody who gets the infection, doesn’t get treated properly and develops a resistant disease – in which case we’ll all be in a bad situation.”

Most people infected with the tuberculosis bacillus, or germ, don’t become ill. The germ can lie dormant in a person’s lungs for years, even decades.

When the body’s own defences are down, the germ begins to create a little sore, and the bacteria are spread to other people through breathing or coughing.

Without treatment, tuberculosis can eventually kill its host by gradually eating away the lungs or, in rare cases, by spreading to other organs.

Dr. Gilchrist said there is a need for more emphasis on the prevention of such diseases, and for less dependence on drug treatment.

“Health people tend to say, well, the way to treat disease is to give them drugs. Well, it isn’t. The way to deal with these situations is to try to prevent them in the first place.

“One way we’ll get there is, instead of placing so much emphasis on waiting until people get sick, then treating them in hospitals, is to try to keep them from getting sick in the first place.”

The NWT Department of Health and Social Services recorded a total of 31 TB cases in 1997, 11 of them in Nunavut.