Water woes behind H1N1

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The handle of the communal tap at St.Theresa Point First Nation was cited as a possible instrument for the spread of the H1N1 virus in the spring of 2009. (JOE BRYKSA/WINNIPEG FREE PRESS ARCHIVES) Photo Store

Long wait for report

THE Free Press first asked Health Canada for the St. Theresa Point H1N1 study in April 2010.

Back then, Health Canada said the Public Health Agency of Canada had the report. The PHAC said Manitoba Health had the report. Manitoba Health said Health Canada had the report.

This went on for six weeks before Health Canada admitted it had the report. But Health Canada said the Free Press would need to file a formal access-to-information request to get it.

At the end of July 2010, Health Canada denied the Free Press's access-to-information request, saying the report was due to be published within 90 days so the paper would just have to wait.

Ninety days went by. No report was published.

Health Canada then said the study was submitted to the Canadian Journal of Public Health. If the government released the study to the media, the journal wouldn't publish it. The journal said it could be a year before the study would be peer-reviewed and published.

The Free Press filed a complaint with the federal information commissioner.

A year went by. No report was published in the journal. In October, staff at the journal said the report was still being peer-reviewed.

By then, a year after the original complaint was made to the information commissioner's office, staff there began making progress, negotiating with Health Canada to secure the document's release.

Twenty months after the original call to Health Canada, the report arrived at the Free Press.

It wasn't really worth the wait.

The government censored much of the critical data. Citing privacy concerns, Health Canada blacked out the number of people who died from H1N1 in St. Theresa Point, the number medevaced to Winnipeg for emergency treatment, the number admitted to the ICU and the ages of the victims. The government also blacked out the number of homes without running water, even though that figure has been reported dozens of times by the Free Press and other local and national media.

Health Canada even blacked out the name of the First Nation community, but sources confirmed long ago the research was done at St. Theresa Point.

-- Mary Agnes Welch

 

No running water

THE unusually high number of H1N1 cases in St. Theresa Point sparked a year-long Winnipeg Free Press investigation into the lack of indoor plumbing on many northern reserves. At the start of the global flu pandemic, photojournalist Joe Bryksa speculated the reason St. Theresa Point was an H1N1 hot spot was because people couldn't wash their hands using proper taps. That prompted Bryksa and assistant city editor Helen Fallding to apply for a Canadian Institutes of Health Research grant to investigate the issue. They found 1,400 homes on Manitoba reserves lack proper plumbing, especially at Island Lake. That shortcoming leads to a host of health problems, such as diarrhea, skin rashes and the flu.

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At the height of the H1N1 flu pandemic's first wave, an unusually large cluster of victims lived in one small, isolated Manitoba reserve where most homes don't have running water.

St. Theresa Point First Nation had a wave of 175 cases of likely or confirmed H1N1 in the spring of 2009, according to a study kept secret by Health Canada until now.

"It is likely that one contributing factor to this outbreak was the lack of running water in homes," wrote Public Health Agency of Canada epidemiologist Sue Pollock. "Without running water in the home, basic hygiene practices become a challenge, especially when the standpipe (communal tap) system is not easily accessible."

Not only could residents not wash their hands at home, the communal taps that serve the reserve may have been a nexus for H1N1 germs.

"The area around the pump was littered with garbage, posing a potential health hazard, and the pump handle could have served as a means of transmitting the novel H1N1 virus," Pollock wrote.

The heavily censored epidemiological study was released to the Winnipeg Free Press following an access-to-information request and a complaint to the federal information commissioner.

St. Theresa Point is one of four Island Lake reserves that have made national headlines for the last year. More than half the homes lack indoor toilets and taps and overcrowding is epidemic. Critics have called Manitoba's on-reserve water woes a national shame and study after study have detailed the damage dirty water and improper sewage disposal does to residents' health.

This latest H1N1 study is yet more evidence.

The study covered an eight-week period spanning April to June 2009 during the first wave of the global pandemic. That's when health officials were begging people to wash their hands often and to cough into their sleeves to control the virus.

Of the 175 people in St. Theresa Point with confirmed or probable H1N1, most were children. That's likely a very conservative number, Pollock wrote. It's likely many more were sick but didn't bother going to the nursing station for treatment.

During that period, 23 of the 175 H1N1 cases were confirmed by lab tests, usually because the patients were so sick they were medevaced to Winnipeg, where doctors could confirm the diagnosis.

Those 23 cases make up roughly five per cent of the 450 lab-confirmed cases reported in the entire province over the same time period in the spring of 2009.

St. Theresa Point represents only 0.3 per cent of the province's population.

Among those 23 cases, Pollock found 70 per cent got their water from a communal tap. And, they generally lived in overcrowded homes where flu viruses can spread easily.

Pollock did not return a call to comment on, or clarify, her study. Linda Poffenroth, the director of First Nations and Inuit health protection in Manitoba, and one of the officials who requested the study, also didn't return a call from the Free Press.

Media officials at Health Canada refused to allow anyone, including Poffenroth or Pollock, to be interviewed Wednesday and would not explain why.

"What else can I say except you will not get an interview?" spokesman Gary Holub said.

St. Theresa Point Chief David McDougall said it's obvious overcrowding and the lack of running water are key reasons his reserve became an H1N1 hot spot.

"When you have 17 people in one two-bedroom bungalow, you're asking for trouble," he said.

He said nearly 30 people were medevaced to Winnipeg during the H1N1 outbreak and one person died.

Another patient sent to Winnipeg was in hospital for 33 days, the report said.

It's not clear who carried H1N1 into the remote community. Pollock speculated it could have been carried in by someone arriving on a regular flight from Winnipeg, or a new nurse arriving to staff the health centre.

During the outbreak, the reserve's schools and daycares were closed, children normally outside enjoying spring weather were kept indoors and people in the devoutly Catholic community were advised not to go to church.

"It was almost like a ghost town," McDougall said.

Despite the band's water woes, which have lasted generations, McDougall said the federal government's response to the pandemic was impressive. An extra 10 to 12 nurses were dispatched to the reserve and there were half a dozen doctors on site every day.

"The nursing station reminded me of a M*A*S*H unit," McDougall said.

maryagnes.welch@freepress.mb.ca

Republished from the Winnipeg Free Press print edition December 15, 2011 A3