WINNIPEG - health officials are racing to contain a recent surge of tuberculosis infections that have cropped up in medical clinics and emergency rooms and helped Manitoba top the list as the worst-affected province.

Medical officer of health Dr. William Libich said doctors and public health nurses have seen a significant increase in the number of TB cases in Winnipeg -- particularly among the homeless and people who live in the inner-city. Provincial disease statistics show Winnipeg recorded 85 TB cases in 2009 -- up from 33 in 2006.

The spike helps explain why Manitoba recently recorded the highest rate of TB of any other province, but Libich cautioned the increase doesn't necessarily mean the TB problem is getting worse.

Libich said doctors and nurses are doing a better job of aggressively tracking down people who may have been exposed to infectious TB. He defended the TB-control program against attacks officials are missing cases, saying the Winnipeg Regional Health Authority inherited a program that was under-resourced and often lost track of patients who are now showing up as relapsed cases.

Number of TB cases per 100,000 people, 2008:

Canada Overall rate: 4.8 Aboriginal Canadians: 28.2 Canadian-born non-aboriginal: 0.8

Manitoba Overall rate: 11.7 Aboriginal Canadians: 51.2 Canadian-born non-aboriginal: 1.2

By Mia Rabson

OTTAWA -- The rate of tuberculosis among aboriginals in Manitoba is 51 times that of the non-aboriginal population, a new Health Canada report showed Wednesday.

The Public Health Agency of Canada released data from its Tuberculosis in Canada 2008 publication, revealing the rate of the airborne contagious disease among aboriginals in Manitoba was 51.2 per 100,000 people, compared to 1.2 for non-aboriginals.

Nationally, the rate for aboriginals was 28.2, compared to 0.8 for non-aboriginals.

By Mia Rabson

OTTAWA - NDP Health Critic Judy Wasylycia-Leis today demanded an emergency debate on tuberculosis after a new public health report shows rates of the disease among aboriginal Canadians is nearly six times that of non-aboriginals and climbing.

The Public Health Agency of Canada released some data from its "Tuberculosis in Canada 2008" report this week. The rate of tuberculosis among aboriginal Canadians hit 28.2 cases per 100,000 people in 2008, compared to 0.8 for non-aboriginal Canadians. In Nunavut the rate was an alarming 184.4.

Wasylycia-Leis said the report builds on the award-winning series on tuberculosis done by Winnipeg Free Press reporter Jennifer Skerritt last fall, and together they point to a “shocking, distressing alarming” problem that the government seems to be tuning out.

Medical experts like Dr. Earl Hershfield warned for decades that TB will never go away unless the standard of living among First Nations improves. The warning went unheeded, and the disease simmered under the radar and declined throughout the 1980s and '90s until it surged in the last few years. Annual TB cases reported in Manitoba:

1968 - 230 1977 - 160 1989 - 100 1996 - 97 2008 - 141 2009 - 156

NELSON HOUSE -- Lou Moodie is an optimist.

He knows tuberculosis and violence run rampant in Nisichawayasih Cree Nation. In one very bad week this summer two new cases of TB were diagnosed and 17-year-old Dakota Hunter's lifeless body was left beaten and half-naked on the side of the road.

Moodie knows there aren't enough houses for people to live in and as many as 15 people are sardined into dilapidated houses, some boarded up, with broken windows and burned-out cars in the front yard.

He sees too many young people buried in the local cemetery who took their own life. He knows that substance abuse is a huge problem.

Aside from improving housing, experts say there are a number of things that could help reduce the number of TB cases:

1) Treat people close to home

Experts such as Dr. Michael Gardam said there's no reason for infectious TB patients to be flown to urban hospitals from remote communities to be treated for TB. Other provinces like Ontario don't medevac patients -- TB experts in Toronto communicate with nursing station staff via phone and email and help them 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 at 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.

It's rare that a story falls into a reporter's lap.

Especially when you're talking about tuberculosis -- a subject nobody wants to delve into.

TB touches a particularly sensitive nerve because it's not just a medical disease. It's a marker for poverty and neglect. The Free Press began an investigation into TB on Manitoba reserves in spring 2008. But the story stalled when provincial officials refused to disclose the number of cases and which reserves are hardest-hit.

First Nations people don't want to talk about TB any more than the government does because of the disease's grim history. It wasn't that long ago that TB patients were removed from their families for years at a time and warehoused in sanatoriums. Many never came home, and their relatives have no idea what happened to them or where their bodies are. TB information is so hard to obtain, even the Assembly of Manitoba Chiefs don't know how rampant it is and what's being done to contain the spread of an old disease that's consumed communities for decades.

LAC BROCHET -- Catherine Moise never got to say goodbye.

The 68-year-old elder of Northlands First Nation sobs as she tells the story that has left her with a lifetime of questions.

Forty-five years after her daughter Agnes was taken from her arms, Moise still does not know what happened to the baby nor where she is buried.

Doctors in The Pas diagnosed Moise with tuberculosis right after she gave birth to Agnes in May 1964. She was moved to the Clearwater Lake Hospital in The Pas, without her newborn, for treatment. The sanatorium's strict regime of bedrest and isolation meant she couldn't do much. She wasn't allowed to stand up and walk to the bathroom, let alone contact family to find out what happened to Agnes.

BELMONT, MB -- Rodney Capon shuffles through the dense underbrush in Belmont's Hillside Cemetery, careful not to trip in the shallow indentations hidden beneath the tall grass.

"I'll show ya the exact locations of the ones we buried," he said. "This is all graves that we're walking on."

There's close to 200 aboriginals buried here, Capon said, lumped and dumped in unmarked graves at the back of the otherwise well-kept cemetery. They died of tuberculosis in the old Ninette sanatorium, he said.

Capon would know -- he dug some of the graves himself with a shovel when he was only 14 years old.

NELSON HOUSE -- Madeline Spence was just 16 years old in December 1950 when doctors diagnosed her with TB and sent her to the Clearwater Lake sanatorium in The Pas.

Spence suspects she was living at a residential school, away from her home in Nisichawayasih Cree Nation, when she was exposed to the disease. Historians say the schools, with their dormitories and crowded classrooms, were breeding grounds for TB.

Spence was forced to clean the spittoons and toilets with another girl who was diagnosed with TB.

"They sent her out and she died, and I never saw her again," she said.

WINNIPEG -- Dr. Earl Hershfield can see it falling apart.

It's been only six years since Hershfield retired as the longtime director of Manitoba's tuberculosis-control program, and already, he's watched the system he worked for 37 years to build, break down and lose track of patients.

He recently saw a woman in his downtown cityplace medical clinic who'd been prescribed enough TB medication to kill her.

Another woman who came for a checkup had been exposed to infectious TB, but no one did a skin test, chest X-ray or referred her for follow-up.

Blue rays of ultraviolet light cast an eerie glow on the half-dozen bodies curled up on foam mattresses scattered about the floor.

It's late morning at the Main Street Project, a downtown homeless shelter, and a handful of people has yet to stir from the cramped refuge where they found a spot to sleep last night. On any given night, executive director Brian Bechtel says 70 people sardine themselves in this one room -- row upon row of mattresses next to mattresses -- because they have no place else to go.

The blue UV lights shine around the clock on people clustered in the emergency shelter and detox unit because the protective rays kill or inactivate TB bacteria.

Former provincial TB-control director Dr. Earl Hershfield had them installed as a way to protect the homeless at high risk of contracting airborne TB.

He became the iconic face of the H1N1 outbreak earlier this year, but today toddler Peter Flett is more concerned with exploring the living room than wearing a tiny flu mask.

It's been several months since baby Peter was flown to Winnipeg with severe flu symptoms. His face became the symbol of the impact the H1N1 virus had on remote First Nations. Images of Peter were splashed across newspapers and television screens across the country the same day the World Health Organization took note of the severe illness H1N1 caused among aboriginal people in Manitoba.

Today, there are no signs of illness, or his notoriety, in Flett's Garden Hill home. He's made a full recovery and life is as normal as it gets in the small but tidy three-bedroom house he shares with 10 of his relatives.

The house sits at the bottom of a slight slope, next to a white van with smashed windows and a broken-down washing machine. Crushed cardboard boxes are strewn near the house's mud-caked front steps, beside empty soda cans and bits of scattered trash. Plastic covers the windows.