Standing in the waiting area of the newly established tuberculosis screening clinic in Kangiqsualujjuaq, I watch as Louisa, a 43-year-old Inuk mother of three, explains the testing process to her teenage son. “When I was your age, we didn’t talk about TB like this,” she tells him. “Now we understand it’s better to know early.“
The quiet determination in her voice captures the spirit behind Nunavik’s ambitious new tuberculosis screening program, launched this month across the region’s 14 northern Quebec communities. This initiative comes in response to an alarming rise in tuberculosis cases throughout 2023, with rates in the region now 40 times higher than the Canadian average.
“We’ve seen a concerning pattern of transmission that suggests community spread,” Dr. Marie-Claude Lacasse, the regional public health physician coordinating the effort, explained to me during my visit to the clinic. “What’s different about our approach now is we’re moving from reactive testing to proactive community-wide screening.”
The Nunavik Regional Board of Health and Social Services has partnered with Inuit organizations to deploy mobile clinics staffed with both medical professionals and local community health representatives. Their goal: screen up to 90% of residents in communities with active tuberculosis outbreaks by year’s end.
For perspective on why this matters, tuberculosis – a bacterial infection primarily affecting the lungs – has persisted in many Inuit communities despite being largely eliminated in southern Canada. The disease thrives in conditions of overcrowded housing, food insecurity, and limited healthcare access – social determinants that have deep colonial roots in the North.
Minnie Annahatak, an elder who serves as a community health representative in Kangirsuk, has seen TB’s impact firsthand. “Many of our elders still carry memories of being sent south for treatment in the 1950s and 60s. Some never returned home,” she told me as she helped translate information pamphlets into Inuktitut. “That history creates fear around TB testing even today.”
The current screening program addresses these cultural barriers by centering Inuit knowledge and leadership. In each community, local health representatives conduct door-to-door outreach, explaining the purpose of screening and addressing concerns in culturally appropriate ways.
Inside the clinic, the process is straightforward but comprehensive. Participants complete a symptom questionnaire, undergo a tuberculin skin test (which requires a return visit to read results), and those with positive results receive chest X-rays and further evaluation. What’s remarkable is how the clinics have been designed to feel welcoming rather than institutional – with local artwork on walls and elders present to provide emotional support.
Dr. Sarah Hoffman with Indigenous Services Canada says the approach reflects growing recognition that effective public health must be community-led. “The medical system hasn’t always respected Inuit healing practices or cultural contexts,” she acknowledged during our phone interview. “This program was designed with and by Inuit leadership from the beginning.“
The statistics motivating this intervention are sobering. According to Nunavik Regional Board of Health data, tuberculosis rates have increased by approximately 35% since 2019. In some communities, recent outbreaks have affected multiple households, particularly concerning health officials who note the disease’s rapid spread in overcrowded homes.
“You can’t separate tuberculosis from the housing crisis,” explains Jeannie Arreak, who coordinates housing advocacy with Makivik Corporation, the legal representative of Nunavik’s Inuit. “When you have three generations living in a two-bedroom home, respiratory infections spread quickly regardless of prevention efforts.”
Indeed, the average home in Nunavik houses 4.7 people compared to the Quebec average of 2.3, according to Statistics Canada. Waitlists for public housing in many communities extend beyond five years.
While I’m visiting the clinic in Kangiqsualujjuaq, a young man named Paulusi receives his screening results – negative for tuberculosis but showing evidence of previous exposure requiring preventative medication. The nurse practitioner explains the six-month medication protocol in Inuktitut, carefully addressing his concerns about side effects.
“I came because my cousin got sick last year,” he tells me afterward. “He didn’t know he had TB until he coughed blood. By then, he had already exposed many people.“
This preventative approach – identifying and treating latent tuberculosis before it becomes active and contagious – represents a key strategy in the screening program. Active cases require extensive antibiotic treatment and isolation periods, creating significant disruption for families and communities.
The program has faced logistical challenges typical of northern healthcare delivery. Weather delays have affected supply shipments, and the high cost of flying medical personnel to remote communities strains budgets. Yet innovation emerges from necessity – the clinics utilize portable X-ray technology and rapid molecular testing that weren’t available during previous TB control efforts.
Dr. Gonzalo Alvarez, a respirologist who has worked on tuberculosis elimination in Nunavut, believes Nunavik’s approach could become a model for other regions. “What’s happening in Nunavik demonstrates how public health can work in partnership with communities,” he noted in our email exchange. “The combination of advanced screening technologies with community ownership is powerful.“
The federal government pledged in 2018 to eliminate tuberculosis in Inuit Nunangat by 2030. While progress toward that goal has been uneven and complicated by the COVID-19 pandemic, which diverted resources from TB programs, the current Nunavik initiative represents renewed momentum.
As I prepare to leave the clinic, I notice Louisa and her son in conversation with an elder. They’re laughing together – an unexpected moment of warmth in a place dedicated to detecting disease. It strikes me that beyond the medical intervention happening here, something equally important is taking place: a community reclaiming authority over its health narrative.
“TB has been part of our communities’ story for too long,” Minnie Annahatak had told me earlier. “But how we respond to it today – that’s our choice to make.“
