Dr. Carrie Bourassa on tuberculosis among Indigenous Peoples and her personal story with the disease
What does World Tuberculosis (TB) Day represent to you?
Every year, March 24 provides an opportunity to raise awareness of TB, which is a serious infectious disease that affects people’s lungs. TB is still not eradicated in Canada and in particular in the North among Inuit communities. Overall TB rates in Canada are quite low (around 4.9 per 100,000 people), but for Inuit Peoples the TB rates are 300 x higher, comparable to rates in developing countries.
How have you personally been affected by TB?
World TB Day touches very close to home. My grandfather had TB twice – once in his lung and once in his kidney. He was very lucky to survive. When I was 28 and had a one-year-old daughter, I contracted TB. They never caught it until the third sputum test, and it has impacted my health greatly in the long term. I was diagnosed with lupus in 2010. It is an autoimmune disease with no cure. Because I had TB, it compromised my lungs, in particular my left lung. I also have asthma (which I had from childhood) and because the TB was caught so late, I have extensive scarring. Combine lupus, asthma and a scarred lung I have to be very careful. A common cold can turn into pneumonia. Now with COVID-19, I am immuno-compromised and having had TB puts me at higher risk because of the scarring in my lungs and my other co-morbidities.
Is TB an important issue facing Indigenous Peoples in Canada?
First Nations, Inuit and Métis Peoples in Canada continue to be disproportionately affected by TB, with the highest TB rates in the North. It is important to note that the social determinants of health (lack of housing/overcrowding, poverty, lack of access to culturally safe care) have contributed to this serious situation facing Indigenous Peoples. Moreover, stigma, discrimination and historic trauma all impact TB incidence rates. In 2016, rates of TB were:
- 0.6 per 100,000 among Canadian-born, non-Indigenous Peoples;
- 23.8 per 100,000 among all First Nations Peoples;
- 170.1 per 100,000 among Inuit;
- 2.1 per 100,000 among Métis Peoples. (Jetty, 2020)
Is CIHR investing in TB research?
Yes. From 2009-10 to 2019-20, CIHR invested over $70.7 million towards TB-related research, with average funding amounts reaching $6.4 million annually.
To give you some specific examples, tuberculosis was one of the four priority areas for the Pathways to Health Equity for Aboriginal Peoples (Pathways) initiative that is now in its final stages of funding. In 2019, under Component 3 of the Pathways Initiative (Implementation Science Team Grants), CIHR provided $1.5M over five years to researchers at the University of Alberta to improve control of TB disease, and most significantly, commit to the aspirations of self-determination among Indigenous partners.
In that same year, CIHR supported a three-year Transitions to Leadership Fellowship award to Stephanie Law to work with the Nunavik Regional Board of Health and Social Services to develop, implement and evaluate an Inuit-specific community health worker pilot program in TB, and a video-based training program on cultural safety for all health care workers in TB prevention.
More recently, in 2020, researchers from the University of Winnipeg received $500,000 to advance and mobilize Indigenous tuberculosis knowledge in Manitoba.
CIHR has been working directly with Inuit Tapiriit Kanatami (ITK) to support the implementation of the National Inuit Strategy on Research and meet the needs of Inuit communities. In February 2020, ITK and CIHR also co-hosted a roundtable on research to support tuberculosis elimination across Inuit Nunangat.
How can we address TB and improve the health of First Nations, Inuit and Métis Peoples?
I think we must address the social determinants of health, including addressing stigma, discrimination and ensuring access to culturally safe care and patient/family-centered care. Research can play a very important role. It is vital that Inuit communities lead the research and that the research translates into beneficial services that remain in the communities.
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