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Federal health officials have drawn up emergency plans to prevent SARS from racing through native reserves, warning that overcrowding and disease make reserves breeding grounds for outbreaks.

Conditions "are ideal for the rapid spread of the disease," an internal Health Canada document says. "There is a lack of easy access to hospitals for many reserves. There is also crowding and other housing issues which would make quarantine and isolation on reserves challenging."

The document, which was prepared by the department's First Nations and Inuit Health Branch, notes that severe acute respiratory syndrome spreads rapidly in settings where people are in close contact.

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Obtained for The Globe and Mail by Ottawa researcher Ken Rubin, the document also says that "people with underlying medical conditions such as diabetes or chronic lung disease are at higher risk of complications if they get SARS."

Natives suffer from a higher-than-average incidence of adult-onset diabetes, it says. Canada's highest rates of tuberculosis exist on reserves.

"Every reasonable effort must be made to reduce the chances of SARS from getting into the reserves, and to also ensure that there is some guidance and assistance to the regions in preparedness for the eventuality a case or cases of SARS occur on reserves," the report says.

The document outlines a series of requirements for nursing stations and medical officials on reserves. For example, Health Canada provides an exhaustive list of items that each reserve should ensure it has in adequate supply. The list includes disposable waterproof gowns, face shields, surgical masks, hand sanitizers and germicidal surface wipes.

Each community also is being asked to identify houses or other buildings that could be used to isolate patients.

Federal official Al Garman said the department is keen on doing all it can to prevent SARS from reaching reserves because conditions there are ripe for the disease.

In the report, the department recognizes that most SARS patients likely would have to be transferred to off-reserve hospitals because of a lack of good housing.

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"For any suspect case to be isolated at home, the home needs to meet specific requirements (eg. separate bedrooms with windows that can open, a telephone, not in an apartment, preferably a separate bathroom for the case and be within a very short distance to a major hospital), and these requirements do not often occur on reserves."

The document notes that removing individuals from reserves may be risky because of the possibility that health personnel could be infected.

Reserve officials would need to identify and train staff members in order to help with following up contacts.

A health official with the Assembly of First Nations said yesterday that the group began meeting with Health Canada in April but is not convinced that enough has been done to contain possible outbreaks.

Elaine Johnston, the AFN's director of health, said the federal government is right to be concerned about potential outbreaks on reserves.

She said it is not uncommon for several families to live together in one dwelling, with many people sharing a bedroom. She said that many homes lack proper ventilation and plumbing. "Handwashing techniques can often be a problem."

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Ms. Johnston added that the high incidence of tuberculosis on reserves demonstrates how easily a disease can race through a native community.

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