inuit tb: a view from the ground and the air…. tb - a view from... · no casual staff nunatsiavut...
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Inuit TB: A View from the Ground and the Air….
Inuit Nunangat
3
Nunatsiavut: Location
• Located at the northern tip of the Province of Newfoundland and Labrador, on Canada’s East coast.
• Covers a geographically diverse area of approximately 72,000km2 of land and 48,690km2 of sea.
• Home to 7200 + Inuit and Kablunangajuit.
TB Control In Canada, Public Health is the mandate of the provinces and territories Nunatsiavut Department of Health and Social Development Labrador Grenfell Health Newfoundland and Labrador, Department of Health and Social Services, Chief Medical Officer of Health, St. John’s First Nation Inuit Health, Atlantic Region Nunatsiavut has to dance with many partners….(Dr. Edward Ellis, PHAC )
Challenges in TB Control Confusion Negative pressure rooms Communication Hospital Infection Control Adherence Laboratory Capacity
Setting the Context
In 2009, there were 12 active cases of TB in Nain
TB History
Concern over Latent TB
Staffing Challenges
Changing Epidemiology
Changing Technology.
Tuberculosis has been endemic in Nain, Nunatsiavut since the
1950s. The reasons are historical, geographical, and
perpetuated by determinants such as colonization, poverty,
overcrowded housing, food insecurity and access to health
care.
TB treatment
TB records….. “TB Bibles”
The people remember
They and loved ones had to go away for treatment of TB to
the south, some never returned, TB treatment has left an
emotional scar that still aches across generations.(The State
of Tuberculosis in Inuit Nunangat, 2011).
The stigma of TB remains, much of it a feeling of lack of control
Nanilavut
Latent TB Infection According to the World Health Organization, each person with active TB can infect 10 to 15 people a year , on average…. Endemic TB Lack of follow up Research project on Latent TB Co-morbidity Smoking rates Paper silos.
People have to fly to Goose Bay for chest x-ray……….
Staffing Challenges In 1996, the Labrador Inuit Health Commission* (now Nunatsiavut Department of Health and Social Development) assumed control from the health authority for public health nursing in Nain Staffed with two positions for nursing
In 2009, both positions were vacant No casual staff Nunatsiavut nurse managers provided public health nursing on a fly in basis.
Shifts in Epidemiology Changing TB picture Social Network Analysis “Nain “ style. Genotyping Accepting the “unknown”.
Changes in Technology PACS System for x-ray Telehealth Robotics
).
Rosie the Robot….
Chronology of Digital X-ray in Nain September, 2009 The Medical Officer of Health made the case with Labrador Grenfell Health and the province for chest x-ray in Nain Rationale Advocacy Champions Planning Partnership Funding November, 2010 First ever digital x-ray clinic in a remote community in Newfoundland and Labrador September, 2011 Second x-ray clinic held in Nain
Success outcomes:
300 chest x-rays taken in Nain!
Human:
The service came to the people
Ground support came from the community(interpreters,
drivers)
The backlog was cleared allowing a go forward
approach to TB control
Financial
No lost time from work
Savings to NIHB
No need for replacement for health care staff affected
Cultural Sensitivity:
LGH staff who went into Nain left with a better
understanding of the people and their realities.
TB Follow up Clinics X-ray Physician assessment Treatment plan Collaboration
Community Health Aides History Change in staffing mix Role in TB Training
Continued Challenges TB Database Capacity Staffing Think TB