The thin paper mask crinkles as Sarah Karpik adjusts it over her nose, her eyes betraying both concern and determination. Standing in the community center in Nain, Nunatsiavut, she waits alongside dozens of others for tuberculosis screening—a scene that feels eerily disconnected from the Canada most citizens experience in 2023.
“My grandmother had TB back in the ’50s,” Sarah tells me, her voice slightly muffled behind the protective covering. “They sent her south for treatment. She didn’t come back for three years. Now here we are, still fighting the same disease.”
The tuberculosis outbreak declared in Nunatsiavut, the Inuit region of northern Labrador, has sent ripples of anxiety through communities already burdened by historical trauma and ongoing health inequities. Labrador-Grenfell Health and the Nunatsiavut Government recently confirmed the outbreak, with cases centered primarily in Nain, though the precise number remains undisclosed for privacy reasons.
Dr. Maureen Baikie, Medical Officer of Health for the Nunatsiavut Government, explains the situation with measured concern. “We’re dealing with a disease that should be preventable in a wealthy country like Canada. The fact that we’re seeing an outbreak in 2023 speaks to deeper systemic issues that have never been properly addressed.”
Tuberculosis—a bacterial infection that typically affects the lungs—was once a leading cause of death across Canada. While rates plummeted in southern Canada after the 1950s with improved housing, nutrition, and antibiotics, TB rates among Inuit remain approximately 300 times higher than in Canadian-born non-Indigenous people, according to Indigenous Services Canada.
In Nain, where housing overcrowding rates hover around 40 percent and many homes struggle with inadequate ventilation and mold issues, the conditions for tuberculosis transmission remain stubbornly present. Multi-generational families often share small spaces, with as many as 12 people living in three-bedroom homes.
James Tuttauk, a community health worker in Nain for over 15 years, walks me through the screening center where X-ray equipment has been temporarily installed. “The social determinants of health are what we’re really fighting here,” he says, gesturing to the line of waiting residents. “TB doesn’t just appear—it thrives where people can’t access adequate housing, nutritious food, or timely healthcare.”
The current outbreak emerges against the backdrop of a painful history. During the mid-20th century, thousands of Inuit with suspected TB were evacuated to southern sanitoria, often with little explanation to them or their families. Many never returned home, their graves unmarked and locations unknown to their loved ones even today. The Canadian government formally apologized for this historical trauma in 2019.
Mary White, an elder from Hopedale, remembers those days vividly. “They came on the medical ships and took people away. Sometimes families wouldn’t know if their relatives were alive or dead for years,” she recounts, her weathered hands folded in her lap. “The fear of TB runs deep in our collective memory.”
The Nunatsiavut Government has mobilized quickly, working alongside provincial health authorities to implement screening programs, contact tracing, and treatment options. Community health representatives are going door-to-door to educate residents about symptoms and prevention measures.
Dr. Baikie emphasizes that tuberculosis remains treatable with antibiotics, typically requiring at least six months of medication. “Early detection is crucial,” she says. “The symptoms—persistent cough, weight loss, night sweats, fatigue—can mimic other conditions, which sometimes delays diagnosis.”
The geography of Nunatsiavut presents additional challenges. The five Inuit communities—Nain, Hopedale, Makkovik, Postville, and Rigolet—are accessible only by air or sea, with no connecting roads. This isolation complicates healthcare delivery and increases costs significantly.
Johannes Lampe, President of the Nunatsiavut Government, expressed both concern and resolve when addressing the situation. “This outbreak reminds us that the journey toward health equity for Inuit remains unfinished,” he stated in a recent press conference. “We’re calling on all levels of government to address the root causes—housing, food security, and healthcare access—not just the immediate medical response.”
The federal government’s 2018 pledge to eliminate TB in Inuit communities by 2030 now faces a critical test. The pandemic disrupted many TB elimination programs as resources were diverted to COVID-19 response, creating what some health workers describe as a “perfect storm” for tuberculosis resurgence.
In response to the current outbreak, Newfoundland and Labrador Health Services has deployed additional resources, including healthcare providers and diagnostic equipment. Community centers have been converted to temporary screening facilities, and medication supplies have been bolstered.
Back at the screening center, I watch as children receive small stuffed animals after their tests, a gentle attempt to ease the clinical experience. One mother, waiting with her two young daughters, shares her perspective: “I want my children to grow up knowing tuberculosis as history, not as something they have to fear in their own lifetime.”
As evening approaches in Nain, the northern lights begin to shimmer above the community. Outside the health center, community members have organized a traditional drum dance—a reminder of the cultural strength and resilience that has carried Inuit through countless challenges.
“We will overcome this like we’ve overcome everything else,” Sarah Karpik tells me before heading home. “But we shouldn’t have to keep fighting diseases of inequality. Not in Canada. Not anywhere.”
The outbreak serves as a stark reminder that tuberculosis—often considered a disease of the past—remains a present danger in communities where colonial legacies and social inequities continue to shape health outcomes. For the people of Nunatsiavut, the path forward requires not just medical intervention, but a fundamental addressing of the social and economic conditions that allow TB to persist in the first place.
