Tuberculosis outbreaks revive memories of an earlier epidemic
Dark days for the Inuit
Tuberculosis outbreaks revive memories of an earlier epidemic
The Lord shall smite thee with a consumption, and with a fever, and with an inflammation . . . and they shall pursue thee until thou perish.
— Deuteronomy 28:22
Between sips of coffee in a restaurant in the Baffin Island community of Iqaluit, Elisapee Quassa talks about her recent brush with a disease that she, like many other Canadians, thought was a plague of the past. In the summer of 1994, Quassa’s brother-in-law, Joannie, was stricken with tuberculosis while living in a small Inuit hunting camp. Quassa accompanied Joannie to Yellowknife, where he spent the next three months in hospital. She soon found herself infected with a milder case of the disease and began eight months of drug therapy, which ended shortly before Christmas. Although the treatment was relatively painless, for Quassa it revived some very painful memories. In the 1950s, as a tuberculosis epidemic raged through the Arctic, both of Quassa’s parents, her two older sisters and an aunt were sent away for years to sanato-
riums in Southern Canada. While Quassa’s relatives eventually returned, many other Inuit were not so lucky: they died thousands of miles from home, and often families were never told where their loved ones were buried. Last year, after being told that she had tuberculosis, Quassa thought: “Oh, my goodness, is it still going around?” It was, she recalls, “really scary stuff.”
It’s back. Or, more to the point: it never went away. The ancient scourge of tuberculosis—the greatest killer of all time—is wreaking havoc once again. Known for centuries as consumption and thought to be virtually eradicated less than a decade ago, tuberculosis today kills about three million people a year worldwide, most of them in Asia, Africa and Latin America. While Canadians generally enjoy one of the lowest rates of tuberculosis infection in the world, there are pockets where the disease is flourishing: on Indian reserves, among newcomers to the country, in the North. In the latter case, local health officials are battling against recent outbreaks that have driven infection rates in the Northwest Territories to 10 times the national average. And given the disease’s horrific history in the region, the struggle has taken on a special poignancy. “It has an aura here that,
like the poor in the Bible, it will always be with us,” says Dr. Richard Bargen, regional health officer for the eastern and central Arctic. “But it doesn’t have to be that way.”
After a dramatic drop in tuberculosis rates starting in the 1960s— the result of the evacuation efforts and of new antibiotics that replaced extended bed rest as the main therapy—the numbers in the Northwest Territories have been on the upswing since 1985. Last year, there were 51 active cases recorded in the territories, which translates to a rate of 75 per 100,000 population—compared with only seven per 100,000 nationally. Local health officials blame the resurgence on laxer surveillance and the fact that some of the victims from the epidemic years are suffering relapses in their old age. Overcrowded housing, alcoholism and poor nutrition—all still common in the North—also increase the likelihood of infection. And once it appears in one of the tightly knit northern communities, the tuberculosis germ—which is transmitted through prolonged exposure to a diseased person’s coughs or sneezes—can spread like brush fire. In the most recent outbreak, a man in Lutselk’e, a community of only 300 people, took ill last April; by the time he showed up at the local nursing station in August, over 30 other residents had been infected. It is a phenomenon not restricted to tuberculosis: last week the hamlet of Arviat, on the western shore of Hudson Bay, declared a state of emergency after 24 babies were struck with a potentially deadly respiratory virus.
Health officials said the babies only started getting sick in January and blamed the rapid spread of the virus on poor housing conditions.
A similar snowballing effect fuelled the tuberculosis epidemic that swept through the Canadian North four decades ago. By the mid-1950s, one in seven Inuit had been taken south for treatment and the largest single Inuit “community” in Canada could be found at the Mountain Sanatorium in Hamilton. Most of the patients eventually recovered and returned home, but those who did not often ended up in unmarked graves reserved for indigents. Authorities tried to contact the relatives, but were not always successful. Even when they were, the terse radio-phone message, relayed through the local RCMP detachment, stated the name of the deceased but often gave no details on their death or place of burial. As a result, some northerners are still searching for relatives who seemed to vanish without a trace.
Until recently, Ann Meekitjuk Hanson was one of those searchers. A freelance writer and former deputy commissioner of the Northwest Territories, Hanson was five years old and living in a hunting camp near the Baffin Island community of Cape Dorset when her mother, Josie, and several other Inuit were airlifted out in the early 1950s. The family heard vague reports that Josie was in a hospital in a place called Hamilton, but that meant little to them. “We had no idea where she was,” recalled Hanson, in a recent interview at her home in Iqaluit. “We didn’t know anything about Southern Canada.” In 1958, Hanson’s family received word that Josie had died, but nothing about where she was buried. Then, some 30 years later, Hanson, while reading Inuktitut magazine, recognized her mother’s name among a list of Inuit who were buried in Hamilton’s Woodland Cemetery. In 1991, she was finally able to visit her mother’s unmarked grave and hold a service in her honor.
Over the next few years, Hanson lent her support to a project aimed at erecting a fitting memorial for the 36 Inuit—ranging in age from eight months to 80 years old—who ended up in the pauper’s section of the Hamilton graveyard. Last June, about three dozen relatives of the deceased travelled to Hamilton for the unveiling of a $50,000 granite monument inscribed with the names of their loved ones.
Among those who attended that emotional service was Joanasie Salomonie, a 57-year-old social services counsellor from Cape Dorset whose father died at the Mountain Sanatorium in the mid-1950s. At the age of 14, Salomonie was himself shipped south with tuberculosis and spent the next six years in hospital, mostly at the Mountain Sanatorium—where, for a time, he stayed in the same ward as his father. Following his father’s death, the deeply depressed and homesick teenager decided he would walk back to Baffin Island. He did not get very far. “I didn’t know which direction was home,” he says, laughing at the memory. “They saw me on the road. I guess I should have hid in the bush, though I’d probably still be there now.”
Even though he had been in the same hospital, no one told Salomonie where his father was buried. “I guess nobody cared too much,” he says. “Maybe they thought I was just a little Eskimo boy
who doesn’t have much sense.” Thanks to a program launched by the territorial government in 1989 to track down the records of lost tuberculosis victims—an effort that, to date, has unearthed the whereabouts of more than 70 bodies—Salomonie finally traced his father back to Hamilton. For him, last summer’s memorial marked a turning point. “I buried something there,” he says. “I buried all my negative feelings and thoughts. I felt a lot of anger for a lot of years. But I’m OK now; it cured me of the negative things. I’m satisfied.”
First introduced by foreign whalers, tuberculosis had reached crisis proportions in Northern Canada by the mid1940s. Ottawa responded with an ambitious program aimed at X-raying the region’s entire population. In the Western Arctic, patients were usually flown out, most often to Edmonton’s
Charles Camsell Hospital. But in the even more remote Eastern Arctic, the medical surveys, in the early days of the epidemic at least, were hurriedly conducted aboard the C. D. Howe, a department of transport vessel whose main mission was to bring mail and supplies to the hunting camps and settlements dotting the Arctic coastline during the brief months of summer breakup.
Robert Williamson, now a professor of anthropology at the University of Saskatchewan, worked as a researcher in the Arctic during the 1950s and was a frequent passenger aboard the C. D. Howe. Fluent in Inuktitut, he was sometimes pressed into service as a translator. Williamson recalls how the Inuit were lined up and processed for Xrays. Those who had active tuberculosis were sent immediately to a forward hold of the ship; those who tested negative were sent back on shore. There were no chances for goodbyes, or for packing up belongings or making provisions for loved ones left behind. “In the rush and flurry, families were sometimes separated and never really knew what happened to a mother, a father, a grandparent or a child on board the ship,” says Williamson. “It was all done rapidly and very insensitively.” On board the C. D. Howe, the mood was grim. Patients often had no idea where they were going, or when they would see their families again. The older people were especially apprehensive. In fact, as
the medical role of the C. D. Howe became known in the Arctic, many older Inuit, some of them quite sick, would flee when the ship arrived. “As kids, we used to get excited about any ships coming in,” says Hanson. “But the older people dreaded it If they were taken away, they didn’t know if they were coming back.”
The prolonged stints in southern hospitals also took a heavy toll.
Used to a nomadic life on the land, many patients hated the months, and even years, of total bed rest that they needed to get better. The staff sometimes had to resort to harnessing patients to their beds or plastering casts on both legs.
On a more positive note, hospitals like the Charles Camsell and the Mountain Sanatorium offered school classes for children and provided materials so that the Inuit men could continue to create soapstone carvings while the women sewed mukluks, mittens and parkas.
When it came time to go home, it was not always clear where that might be. According to Williamson, who later worked for a federal department that tried to reunite Inuit families, the patient’s names were often misspelled on their records. And as patients got shipped from one hospital to another, those records sometimes went missing.
That families got reunited at all was sometimes a matter of happenstance. Williamson recalls one telling example that occurred while he was living along the Arctic coastline of Quebec in the mid-1950s. One day, a single-engine plane landed on the sea ice. The door opened and a pair of hands lifted a little Inuit boy, perhaps six years
old, onto the ice. The pilot then took off without a word. The boy was dressed in sandals, stockings and shorts, a cutaway jacket, a bow tie, gloves and a cap. The boy, who had been sent to southern Quebec as a baby, could speak only French. Luckily, Williamson also spoke some French and helped the boy make the transition by moving into his family’s igloo. ‘The boy had been passed from hospital to hospital, but someone obviously knew where he was supposed to be,” says Williamson. “They had heard of a plane flying up there for geological purposes and agreed to take him along as a good deed, I guess.”
While Williamson, among others, believes that Ottawa’s response to the tuberculosis epidemic was badly hampered by paternalistic attitudes, there is no doubt that in strictly medical terms the mission succeeded in taming a disease that threatened to wipe out an entire race. Now, northerners are determined never to return to a dark chapter from their past. People who contract tuberculosis are usually sent no further than Yellowknife for two weeks of hospitalization, followed by drug therapy in their home communities. At the same time, health officials are stepping up their screening measures—last year, for instance, all 3,000 schoolchildren on Baffin Island were skin-tested. Hanson, who also serves as chairwoman of the Baffin Regional Health Board, speaks for many when she says that eradicating tuberculosis is “a high priority because we’ve lost so many people to it. I would like to see it gone for good.” □
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