Tuberculosis in Aboriginal People

Introduction

Tuberculosis is caused by a bacterial infection triggered by Mycobacterium tuberculosis, generally from the lungs, though it was also transmitted until lately through the intake of infected milk and meat (Douglas, 2013, p. 155). Also, TB was regarded as a chronic condition as infection remained permanent until antibiotic therapy schemes developed after World War II (Douglas, 2013, p. 156).  In the past, TB was one of the deadliest epidemic diseases affecting the Aboriginal population (Douglas, 2013, p. 156). The chance of developing active TB is very small for most individuals in Canada. But, the levels of active TB among Indigenous individuals born in Canada are greater. In Inuit Nunangat’s TB incidence among Inuit was more than 300 times the prevalence of non-Indigenous Canadians born in 2016 (Government of Canada, 2019). In other words, a lot of Aboriginal people are affected by this disease. Furthermore, the TB incidence among First Nations residing on the reserve is more than 50 times greater than non-Indigenous Canadians born in Canada (Government of Canada, 2019). Since most of the Aboriginal people dealt with this epidemic illness there are factors that contribute to the prevalence of pulmonary tuberculosis, the pertinent nursing implications will provide interventions that can improve the facets of overall health and wellness of the Aboriginal peoples, tackling the available resources from the federal government to reduce and aim a total eradication of TB among the First Nations communities.

Contributory factors of Tuberculosis

TB was mainly ignored in the Aboriginal population and it was partially due to unawareness and in part to selfishness with Aboriginal people’s health care funding (Douglas, 2013, p. 158). This goes to show that TB became rampant as these people do not have the support that can help them prevent the occurrence of TB. Aside from lack of funding, there are other aspects that lead to the prevalence of TB among the Aboriginal population and these are; direct contact with individuals with unmanaged active TB, overpopulated area, inadequately ventilated housing, food insecurity, other conditions like diabetes or HIV and smoking (Government of Canada, 2019). Through this, it really made a great impact in the lives of Aboriginal people, their poor status made it even difficult for them to live a better life as they are still struggling in making a difference in their way of life. Moreover, because of the insufficient health care facilities, poverty, extremely crowded housing, and the remoteness of many groups, the illness continues undercurrents in the Aboriginal people (Douglas, 2013, p. 160). Because of these determinants of health, there are more possibilities that this illness will spread in the whole community as there is not much treatment and support given to the Aboriginal people. As per Lonnroth et al., (2010), some health determinants boost the amount and length of infection exposure, while others may decrease the immune system of an individual, reducing the probability of infection (as cited in Health Canada, 2012).

Treatments, Diagnosis and Nursing implications of TB

Until the 1970s, Sanatoria have been the recommended technique of treating TB. It was thought that the illness could be regulated and reduced more efficiently by isolating clients and managing the environments (Douglas, 2013, p. 157). As future psychiatric nurses, it is important that we educate the Aboriginal people about the signs and symptoms of an individual with tuberculosis such as coughing for more than two weeks, coughing up phlegm and sometimes blood, lack of energy and chill (Government of Canada, 2019). Through this, they will be more aware and have a better understanding of this sickness. Furthermore, it is vital for us to explain to them that TB is preventable and curable and there is diagnosis provided to further detect TB like tuberculin skin test, blood work, sputum testing and chest x-ray (Government of Canada, 2019). Moreover, when an individual has a TB infection, antibiotics may be provided to avoid TB from becoming active. This can take up to 9 months for the therapy. Taking all medicines correctly is very crucial (Government of Canada, 2014). They must be handled with antibiotics if they have TB illness to destroy all the germs and heal TB. Treatment generally requires 6 to 9 months to complete. TB medicine is generally provided by a qualified health care worker who watches every dose of medication that should be taken, this is known as Directly Observed Therapy (DOT) (Government of Canada, 2014). Through this, TB will be controlled and manage, as long as we educate the Indigenous people to be compliant with the treatment plan, they will have a better outcome. In addition, as nurses, when we work with Aboriginal people, we can teach them to speak about their own probability of TB with their healthcare provider, they should have knowledge about TB and know the disease symptoms and be conscious themselves and others (Government of Canada, 2014). If you have illness symptoms, you will be inspected as quickly as possible. The faster you find and treat tuberculosis, the less it can transmit to your friends and family, and the better opportunity you have for proper treatment option (Government of Canada, 2014). Furthermore, it is also good to share information about tuberculosis with your family, friends and to the community as TB can impact anyone, but with the right medications TB can be cured (Government of Canada, 2014). Through this, Aboriginal people will be well informed about this illness that may possibly affect them. Additionally, according to Dr. Banerji, the treatment for TB requires a lot of time so once you find out what is susceptible to TB in a patient, it sometimes requires to be handled over a lengthy period of time with three or four distinct antibiotics as it is a slow-growing organism. It can also be more difficult to do in the North, particularly if it includes patients returning to isolated nursing stations or shipping drugs to remote places (as cited in Hogan, 2019). With regards to this, there is a challenge to be treating Aboriginal people living in remote areas as there is always a delayed treatment.

Government programs and plans to lower the risk of TB

As per the First Nations Health Authority (n. d.), they supported methods that can help alter the prevalence of TB like lowering the risk of TB disease by culturally informed and community-driven measures in First Nations societies and ensuring comprehensive screening, diagnosis and testing of TB illness to minimize the transmission process. This means that, the organization is doing something that can improve the life of an individual affected by this illness. Moreover, encourage holistic therapy through community involvement, along with home health care, traditional medicine inclusion, social, spiritual and physical health. Developing community ability, empathy and commitment via practice and support of Wellness Champions: community members who provide assistance, education and sharing of stories to people impacted by TB and their societies (FNHA, n. d.). With regards to this, Aboriginal people do believe in a holistic approach of treatment as well as their traditional way of healing and due to these objectives, it will provide them more awareness and understanding on how to prevent and control TB. Also, cooperate on community-level TB disease treatment and prevention with First Nations, provincial and federal government health, nursing and medical experts. Work with excellence by incorporating monitoring, information collection and assessment as well as community knowledge from First Nations and Aboriginal education program growth, execution and assessment (FNHA, n. d.). This goes to show that the government is willing to do something that can reduce the occurrence and incidence of TB not only to the Aboriginal people, but also to other non-Aboriginal people affected by this disease. In addition, Aboriginal Affairs and Northern Development Canada (AANDC) continues to support First Nations, Inuit and Métis Aboriginal peoples and Northerners in their efforts to increase cultural well-being and economic stability; create safer, more stable societies (Health Canada and the Public Health Agency of Canada, 2014, p. 7). These programs and projects entail income support and facilities for citizens of limited income, the provision of culturally suitable prevention and protective services to First Nations children (Health Canada and the Public Health Agency of Canada, 2014, p. 8). In addition, Aboriginal people on-reserve populations will have access to safe and affordable housing (Health Canada and the Public Health Agency of Canada, 2014, p. 8). Furthermore, a distinctive collaboration strategy that brings together all levels of government, urban Aboriginal communities and the private and non-profit sectors to recognize urban Aboriginal peoples’ needs (Health Canada and the Public Health Agency of Canada, 2014, p. 8). This means that these projects focus on the improvement of the Indigenous population’s prevention and control of acquiring TB. These projects will definitely make a difference and it will help these people to have more possibilities and chance to take all the necessary support that will lead them to a better health care outcome.

Conclusion

Therefore, if the factors that contribute to the prevalence of TB will improve and manage, there will be a chance to lower the risk of Aboriginal people from acquiring this illness. The nursing implications and interventions will certainly guide these people to be more aware of TB and be more cautious to further prevent the incidence of getting and spreading TB. Lastly, with the support coming from the government and the programs created, time will come that the Aboriginal people’s rate for TB will reduce and they will gain more benefits and advantages to having better access in the health care system. As future psychiatric nurses, we played a vital role in the life of Aboriginal people as we will serve as their voices so that all the issues they are facing will be addressed and one of our goals is to provide a safe and secure environment free from any discrimination and judgment as well as maintaining a good quality of care.

References

• Douglas, V. K. (2013). Introduction to Aboriginal Health and Health Care in Canada: Bridging Health and Healing. New York, NY:  Springer Publishing Company
• First Nations Health Authority. (n. d.). Tuberculosis Services. Retrieved from:
• http://www.fnha.ca/what-we-do/communicable-disease-control/respiratory-infections-tuberculosis
• Government of Canada. (2019). Tuberculosis in Indigenous Communities. Retrieved from:
• https://www.canada.ca/en/indigenous-services-canada/services/first-nations-inuit-health/diseases-health-conditions/tuberculosis/tuberculosis-indigenous-communities.html
• Government of Canada. (2014). Tuberculosis Resources. Retrieved from:
• https://www.canada.ca/en/indigenous-services-canada/services/first-nations-inuit-health/diseases-health-conditions/tuberculosis/tuberculosis-resources-first-nations-inuit-aboriginal-health-health-canada.html
• Health Canada and the Public Health Agency of Canada. (2014). Tuberculosis Prevention and Control in Canada a Federal Framework for Action. Retrieved from: http://www.phac-aspc.gc.ca/tbpc-latb/pubs/tpc-pct/assets/pdf/tpc-pcta-eng.pdf
• Health Canada. (2012). Epidemiology of Tuberculosis in First Nations Living On-Reserve in Canada, 2000–2008. Retrieved from:
• http://publications.gc.ca/collections/collection_2012/sc-hc/H34-244-2011-eng.pdf
• Hogan, S. (2019). Tuberculosis rate among Inuit is 290 times higher than for non-Indigenous people in Canada. Here’s why. Retrieved from:
• https://www.cbc.ca/news/health/cbc-explains-tuberculosis-banerji-tb-1.5046336