Reconciling our history for the health of our future

Tuberculosis isn’t an issue of Canada’s past; it is an issue of our present. I am hopeful, through honest reconciliation, we won’t let it continue to define our future. In most instances, a non-Indigenous person may not be aware of tuberculosis (TB) or its impacts in Canada. Ask an Indigenous person about the disease, you may learn it is experienced differently throughout families and communities. The rate of disease for non-Indigenous people born in Canada is 0.4 per 100,000 people. The rate of TB in Inuit communities and First Nations on-reserve populations is 300 times and 40 times higher, respectively. Indigenous people make up five per cent of Canada’s total population, but experience the highest rate of disease and TB-caused mortality. A question that often arises is: why in 2022 do we still have populations that continue to suffer from a treatable and preventable disease? When you look at the history, you understand why. Decades of systems-based discrimination and segregation with institutions such as residential schools, TB sanatoriums, and Indian hospitals have deprived Indigenous communities of the cultural, social, and economic tools needed to eliminate TB. TB disease is directly influenced by the social determinants of health. Many remote communities face inadequate housing conditions with poor ventilation, which can increase TB transmission. Nutritious food and access to safe drinking water are either unavailable or too costly, affecting the health of individuals. Communities are under-resourced to handle health-care demands and other priority programs may overshadow TB. Health-care providers may not be offered education on the historical treatment of TB and the continuing effects of the attempted colonization of Indigenous peoples. With this understanding, care can be geared towards a holistic, client-centred approach. For example, this may include mental health resources to work with clients who continue to experience intergenerational traumas. Like others who grew up in Canada, I was not aware that TB was still around or that it disproportionately affected communities in which I grew up. I learned about my grandmother’s and aunt’s experiences in TB sanatoriums and how connected TB was with my history. Working for nine years in Iqaluit, Nunavut, as a public health nurse in a TB clinic, I saw firsthand the impact the disease had on my community. Fast-forward to 2020 in a new role as a TB program adviser during a global pandemic with most resources allocated towards COVID-19, I found myself in the centre of co-ordinating response teams to support active TB outbreaks within First Nations communities in northern Saskatchewan. TB is the second-deadliest infectious killer in the world behind COVID-19. Unlike COVID-19, we’ve known about TB for hundreds of years. We have been able to come up with tactics to identify, screen, prevent, and treat the disease, and we’ve been able to apply that knowledge to achieve near pre-elimination targets for Canada’s non-Indigenous population. The same is possible for the Indigenous population if the political will exists. First, we need to bring together the experts and apply the tactics that have proven to work in jurisdictions across the country. The federal government should establish a National TB Elimination Oversight Committee to bridge the knowledge of TB experts, clinicians, TB-affected communities, and provincial, territorial, and Indigenous representatives. This body can establish a strategy, co-ordinate resources, and share best practices. Second, we need the tools to understand the disease, so the right resources can be deployed. This year, the Canadian Thoracic Society published a new version of the Canadian Tuberculosis Standards, which include a monitoring and performance framework. If implemented, this framework would produce performance metrics for all TB programs across Canada, and facilitate tracking progress towards the goal of elimination. Finally, on a local level, we need to embed the history of colonization in our conversations about TB. We need those in our health-care system to learn the history behind TB in Indigenous populations and approach TB-affected communities with understanding, patience, compassion, and a relationship focused on building trust. Historical treatment of TB and continuing effects are deeply connected. This is something I witness daily in the populations I work with. If Canada is serious about honouring the Calls to Action in the Truth and Reconciliation Commission report, we need to see urgency and the political will to act. Honest reconciliation requires action. Tina Campbell, RN, is an Indigenous woman of Cree ancestry, co-chair for Stop TB Canada and TB program adviser for the Northern Inter-Tribal Health Authority in Prince Albert, Sask. Campbell has spent her career focused on TB care in various Indigenous communities. This piece was authored in collaboration with Stop TB Canada and the Canadian Thoracic Society. The Hill Times