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A doctor looks at a x-ray of a patient during testing for tuberculosis.


The re-emergence of tuberculosis in aboriginal communities is a sign of other endemic problems, including overcrowding, mouldy housing and high rates of smoking. Although the federal government needs to tackle all of these social ills, it need not be so ambitious to stamp out TB, an infectious disease that is spread through the air and settles in the lungs.

There needs to be a national effort to emulate the success in the Northwest Territories, where the rates of TB among First Nations and Inuit have been dramatically lowered through a series of targeted initiatives.

The NWT undertakes careful surveillance and early detection among at-risk communities. It also adheres to the gold standard in TB treatment, known as "directly observed therapy" (DOT) to ensure patients take their medication properly for six to nine months. Instead of writing a prescription and sending patients home, health authorities use food vouchers to persuade them to attend a health clinic twice weekly so they can be observed swallowing their pills.

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This reduces the spread of TB, and the risk of developing a drug-resistant strain. "Anyone we find with TB, whether it is active or dormant, we treat," says Wanda White, a communicable disease nurse specialist based in Yellowknife.

The TB rate among aboriginals in the NWT is 32 cases per 100,000 people, compared to a rate of 157.5 per 100,000 among the Inuit. Of course, the rate in the NWT is still unacceptably higher than the national rate of 4.8 per 100,000. But the trend is downward, while rates among the Inuit elsewhere have escalated.

Nunatsiavut, the Inuit region of northern Labrador, plans to follow the NWT's lead, and introduce food vouchers to improve medication compliance among TB patients. Even with DOT, it can be difficult to keep track of patients who travel for work or go out hunting, says Gail Turner, the region's director of health services.

Food vouchers also help people maintain a better diet. A study in the Canadian Medical Journal last month found that 70 per cent of preschoolers in 16 communities in Nunavut do not have access to nutritious, affordable food.

Public health authorities from all four of Canada's Inuit regions will gather next month to share best practises on how to lower unacceptably high TB rates. They will lobby for improved access to health-care services and better housing. These are important issues to solve. But the experience in the NWT shows that access to the best treatment can also make a real difference.

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