Tuberculosis: The Forgotten Disease / Part 6

1) Treat people close to home

Experts such as Dr. Michael Gardam say there's no reason for infectious TB patients to be flown to urban hospitals from remote communities for treatment. Other provinces, Ontario among them, don't medevac patients -- TB experts in Toronto communicate with nursing station staff via phone and email and help manage TB cases from start to finish.

Gardam's Toronto clinic has used that model to help communities such as Sioux Lookout. He says it works well in alleviating some of the historical fear associated with the disease. Getting patients started with drug treatment as soon as possible is key, he said, and most infectious patients can stay at home and wear a mask instead of being hospitalized.

The only patients hospitalized at his clinic are difficult drug-resistant cases and patients who are under court order to finish treatment.

"It's not ideal, but it's better than shipping them to another community," said Gardam, the director of infection prevention and control at Toronto's University Health Network, the country's largest research hospital.

"Why the hell does someone from Sioux Lookout want to come to Toronto?"

2) Encourage more patients with 'sleeping' TB to take medication.

While patients with infectious TB can't refuse medical treatment since they are a risk to the public, patients with sleeping TB aren't obligated to complete drug therapy. The drug treatment for both phases of the disease takes months to complete and comes with side-effects.

"That is one of the biggest challenges," said Dr. William Libich, medical officer with the Winnipeg Regional Health Authority. "Right now, we see contacts that have refused therapy and have gone on to develop TB."

Doctors don't know which patients will develop active TB disease. Certain risk factors -- HIV and diabetes among them -- increase a patient's likelihood of getting sick from TB. For that reason, researchers are working on a shorter treatment for sleeping TB.

3) Improve TB drugs

Dr. Dick Menzies, director of the respiratory division at the McGill University Health Centre, is testing whether four months of the anti-TB drug rifampin are as effective a treatment for sleeping TB as the drug that must be taken for nine months.

He said shortening the time it takes to complete the medication could help encourage more patients with sleeping TB to take the drugs.

"Even four months (of treatment) isn't great. It's a long time," Menzies said. "It's hard to get people through a week of antibiotics."

Because the disease typically manifests itself among marginalized people, Menzies said pharmaceutical companies haven't taken a keen interest in researching better medications. There is little financial incentive for major drug manufacturers to spend money on research since the vast majority of the world's TB patients live in poor, developing countries.

4) Combat racism

University of Saskatchewan TB researcher Paul Hackett said a lot of the problems in First Nations communities, including diseases such as TB and diabetes, are the fallout from decades of failed colonial policies. The problems stem from the federal government forcing First Nations people to abandon their traditions and live on reserves and in residential schools. The repercussions are huge, Hackett said, but he cautioned that government spending is a simple answer to very complicated social problem. He said the province needs to combat racism toward First Nations people if there's ever going to be a true solution.

Hackett met a man in Cross Lake who spent a lot of time in treatment for TB as a boy after he contracted the disease in a residential school -- a traumatic, defining event he suspects many Canadians would tell him "to get over."

"There's an undercurrent in the population that says, 'well, they get free education, free this, free that, they don't pay taxes and they should stop whining about what happened with the treaties, 100 years or so ago,' " he said.

"You're telling him to get over a defining moment in his life, and yet they wouldn't say that to other people. They're very quick to tell people to get over huge issues that aren't that old."

jen.skerritt@freepress.mb.ca

Republished from the Winnipeg Free Press print edition November 7, 2009 A9