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AFN Press Release - April 27

National Chief Denounces Government Inaction in Addressing The TB Outbreak in Garden Hill First Nations

            OTTAWA, April 27 /CNW Telbec/ - Assembly of First Nations National Chief Phil Fontaine commented today following a meeting with Garden Hill First Nation Chief David Harper regarding the deplorable lack of assistance provided to the Garden Hill First Nation which currently is facing more than a dozen cases of active tuberculosis (TB) in their community of 3,500. National Chief Fontaine stressed the need to raise national attention to the alarming situation in Garden Hill.

            "This community requires urgent assistance to protect further spread of this TB outbreak, a highly communicable disease that most Canadians would associate more closely with the Third World," stated National Chief Fontaine, "A strong commitment from federal and provincial governments is also immediately required to prevent recurrent outbreaks in Garden Hill and other First Nations communities in the longer term."

            In a 1999 report, Health Canada's First Nations and Inuit Health Branch recognized that: "TB is far more likely to occur in communities with higher levels of crowding (and) other risk factors for TB, such as poverty, substance abuse, remoteness, and various underlying medical conditions."

            77% of the homes in Garden Hill were built before 1979, and only 4% of those homes have access to running water. Compounding the problem, overcrowding is three times greater than the Canadian average.

            "When we first told of the presence of active TB in our community, doctors from Toronto and Vancouver were flown in," recalls Chief Harper. "They told us to cough with our hands over our mouths and then wash our hands. We had to tell them that in this community there is no such thing as turning on a tap and having easy access to safe water. Things other Canadians take for granted is not the reality in our community."

            Recurrent outbreaks in isolated communities such as in Garden Hill First Nation require new investments in housing and infrastructure, health human resources and public health. The Government of Canada committed in the 2005 budget and in the First Ministers Meeting in Kelowna to improve housing conditions.

            "The $600 million in housing and the $1.3 billion in health announced at the First Ministers Meeting must be honored by the new government," emphasized National Chief Fontaine, "Otherwise, situations such Garden Hill and Kashechewan First Nation will continue to bring shame to Canada. This is simply unacceptable in a country that is boasting of a surplus. If we do not invest now then Canada will continue to pay for the social and economic costs of this broken system. We hope that in the upcoming federal budget the new Government will recognize the need to work with us to build a better quality of life for First Nations."

            The Assembly of First Nations is the national organization representing First Nations citizens in Canada.

                   Backgrounder on Tuberculosis in First Nation Communities
                   --------------------------------------------------------

            - In 2001, the incidence of tuberculosis (TB) disease in First Nations communities was, on average, ten times higher than that of the Canadian population as a whole (6 per 100,000).

            - Between 1975 and 2002, there was a significant decline in the number of cases and incidence rate of TB among First Nations. Most of the positive impact was achieved by 1992.

            - Over the last ten years, there has been limited improvement in further reducing the incidence of TB among First Nations, especially in western provinces.

            - Health Canada's First Nations and Inuit Health Branch (FNIHB) implemented the Tuberculosis Elimination Strategy in 1992, with the goal of reducing incidence of TB disease in the First Nations on-reserve population to 1 per 100,000 by the year 2010. FNIHB underwent a major review of the Strategy in 2005-06. No results have yet been shared with AFN.

            - It is not uncommon for communities in western provinces to have 30-50% of their population infected with the bacteria that causes TB. In 2005, Manitoba overall had a total of 42 cases (down from 67 the year before) of TB disease reported on reserve.

            - People who are infected with these bacteria may or may not develop TB disease during their lifetime. Only a small minority (10%) of people with these latent infections develop disease.

            - Repetitive TB outbreaks in endemic communities contribute substantially to the national TB notification rate. In 1999, 40% of First Nations on-reserve cases of active TB disease occurred in only 5 First Nations communities.

            - The Canadian Lung Association states that "For Aboriginal peoples, the overall proportion contributed to the total Canadian TB case load continues to be substantial (...) TB continues to infect Canadians because there exists a reservoir for the disease among population groups considered "high risk". Individuals at high risk for tuberculosis fit into one of two groups: first are those whose immune system is compromised, such as patients with HIV; and second are those located in socio-depressed areas, which may include inner-city slums, reservations, or underdeveloped countries". (http//www.lung.ca/tb/tbtoday/resurgence/)

            - Housing is an important determinant of health. Inadequate housing can play role in the spread of tuberculosis and other diseases, according to many sources:

            - The 1999 Tuberculosis in First Nations Communities report from FNIHB states that: "TB is far more likely to occur in communities with higher levels of crowding. It is recognized that overcrowded communities may also be more likely to suffer from other risk factors for TB, such as poverty, substance abuse, remoteness, and various underlying medical conditions." In fact, housing density was seen as a significant predictor of TB incidence.
            - The Standing Committee on Public Accounts, Chapter 6, April 2003, page 3: "Poor housing conditions negatively affect the health, education, and overall social conditions of individuals and communities on reserves".
            - The Canadian Policy Research Networks Inc, December 2004, page 2 , "There is a growing body of evidence that housing circumstances effect the physical and well being of families and individuals. This relationship has important practical consequences for policy, as improving housing circumstances should improve health". "Housing Advocates must argue, with supporting evidence, that housing expenditures can reduce health care costs"
            - The Greenlining Institute. Housing: the foundation for individual and community health. San Francisco: The Greenlining Institute; 2002, page 23. "They note that poor physical housing conditions are associated with respiratory infections, asthma, tuberculosis, and injuries in children."

            - The Government of Canada committed, both in the 2005 budget amendments and in the commitments from the First Ministers Meeting in Kelowna, to improving housing for First Nations. The overcrowding at Garden Hill First Nation and in other First Nation communities, and the consequent effects on health, require immediate action to let those funds flow.

                                   Garden Hill First Nation
                                   ------------------------

            - Manitoba Health is currently reporting a new TB outbreak in 20 First Nations living in Manitoba. This includes both confirmed cases and suspected cases of TB. The majority are Garden Hill First Nation residents.

            - Garden Hill First Nation's total population living in the community is over 3,500 members. Garden Hill First Nation has only 504 dwellings. The town of Altona, Manitoba, by comparison, has a population of 3286 (1996 census), with 1455 occupied dwellings. No new housing units have been built since 1998 and 77% were built before 1979. Garden Hill's overcrowding ratio is 6.35 persons per room; this is nearly three times the Canadian average of 2.6 persons per room. Only 20 dwellings or 4% of the community has access to running water. Of the 504 units, 16% require a major repair which is twice that required by Canadians overall (8%). In fact, according to Indian and Northern Affairs Canada, only 59% of existing units can be termed as adequate housing.

            - Garden Hill First Nation has no year-round road access to a service centre and, as a result, experiences a higher cost of transportation. Distance, measured directly, to the nearest service centre is between 400 Km and 480 Km. Patients who need to be medically evacuated from the community must travel by boat from the health centre to the airport.

            - Manitoba Health and FNIHB (Manitoba Region) are conducting contact tracing activities in the community. However, since the first TB case was not diagnosed for more than eight months, the community's leadership has requested community-wide screening; however, they are not being granted this request based on the lack of resources made available to assist them.

            - While a full complement of nine (9) nurses is required in the community on an ongoing basis, this level of capacity has never been reached and the community relies on less than half the number of nurses. Due to the outbreak only, FNIHB has increased the number of nurses available in the community on a temporary basis. On April 18, a full time TB nurse for the community started. As well, 2 TB regional nurses and an X-ray technician have travelled into Garden Hill.

BRIEFING - Garden Hill First Nation Tuberculosis Outbreak - April 25, 2006

            Manitoba Health is currently reporting a cluster of tuberculosis (TB) cases in northern Island Lake communities. A total of 20 active cases have been detected to date. 14 of these cases are among residents of Garden Hill First Nation whose total population is over 3533.

            These numbers are not insignificant, and represent half of the total number of TB cases seen last year in Manitoba.

            Garden Hill First Nation requires immediate assistance to prevent further spread of the disease, as well as long-term investments to eliminate the threat of recurrent outbreaks.

Immediate Assistance Required

            The source case remained undiagnosed for over eight months. Health Canada's First Nations and Inuit Health Branch (FNIHB) and Manitoba Health are conducting contact tracing, but the community is requesting community-wide screening. This request has been denied by FNIHB due to the need for additional resources to be made available to the community. As well, community leadership is having difficulty accessing information on the number of active cases and those undergoing treatment in a timely fashion.

            Chief David Harper temporarily closed the elementary school and day care due to workers at these facilities having been diagnosed with the disease. The community leadership is seeking reassurance that more cases will not remain undetected and expose children to unnecessary risk.

            Additional nursing staff is required to support Directly Observed Therapy. While a TB nurse has been assigned to Garden Hill in the interim (since April 24) and 2 TB regional nurses and an X-ray technician visited the community, regular nurses are overburdened with dealing with new TB cases and the overall standard of care has been seriously compromised.

            The Northern Medical Unit of the University of Manitoba will be conducting a self-assessment of what led the TB source case to remain undetected for so long. This assessment should be conducted by an independent agency, selected by the Garden Hill First Nation leadership, since the Northern Medical Unit is responsible for service delivery in the community. There is a clearly a lack of objectivity.

Sustainable Solution

            In 2001, the incidence of tuberculosis (TB) disease in First Nations communities was, on average, ten times higher than that of the Canadian population as a whole (6 per 100,000). Between 1975 and 2002, there was a significant decline in the number of cases and incidence rate of TB among First Nations. Most of the positive impact was achieved by 1992. This is despite FNIHB's Tuberculosis Elimination Strategy, implemented in 1992, with the goal of reducing incidence of TB disease in the First Nations on-reserve population to 1 per 100,000 by the year 2010.

            Over the last ten years, there has been limited improvement in further reducing the incidence of TB among First Nations, especially in western provinces.

            The 1999 Tuberculosis in First Nations Communities report from FNIHB states that: "TB is far more likely to occur in communities with higher levels of crowding. It is recognized that overcrowded communities may also be more likely to suffer from other risk factors for TB, such as poverty, substance abuse, remoteness, and various underlying medical conditions." In fact, housing density was seen as a significant predictor of TB incidence.

            The TB outbreak in Garden Hill is no doubt rooted in a series of confounding factors: isolation, lack of community control over resource requirements and intervention strategies, poor housing conditions, lack of running water and lack of nursing capacity.

            - No new housing units have been built since 1998. The total number of units if 504 of which 392 (77%) were built before 1979. Garden Hill's overcrowding ratio is 6.35 persons per room; this is nearly three times the Canadian average of 2.6 persons per room.
            - Only 4% of units have access to running water. Despite this, INAC has not included Garden Hill First Nation, or any other Manitoba First Nation community, in its "high-priority" list of communities to be addressed in the newly announced First Nations Drinking Water Action Plan.
            - Of the 504 units, 16% require a major repair which is twice that required by Canadians overall (8%). In fact, according to Indian and Northern Affairs Canada, only 59% of existing units can be termed as adequate housing.
            - Garden Hill First Nation has no year-round road access to a service centre and, as a result, experiences a higher cost of transportation. Distance, measured directly, to the nearest service centre is between 400 Km and 480 Km.
            - Patients must travel by boat from the health centre to the airport when they require medical transportation. Often, the boat must turn around before reaching the airport due to the need to stabilize the patient.
            - FNIHB has defined the total complement of nurses needed in Garden Hill First Nation to be 9 nurses. This level of capacity has never been achieved and the community relies on 4 nurses or less than 50% of FNIHB's estimated capacity requirement.

            In light of the above, the elimination of TB in Garden Hill First Nation requires a commitment from the federal government to the following:

            - Investments in housing and infrastructure. INAC Region has expressed some support for new water infrastructure, but restricted it to the central part of the community. This will only reach 200 units.
            - Investments in nursing capacity, to ensure recruitment and retention of a minimum of 9 nurses, as determined by FNIHB to be required.
            - Improved sharing of data between First Nations leadership, FNIHB and Manitoba Health to ensure a coordinated and agreed-to approach to addressing public health issues and emergencies.

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/For further information: Don Kelly, AFN Communications Director, (613) 241-6789 ext. 320, cell (613) 292-2787; Ian McLeod, AFN Bilingual Communications Officer, (613) 241-6789 ext. 336, cell (613) 859-4335/