On March 24 in 1882, Dr. Robert Koch announced the discovery of the infectious respiratory bacteria that causes tuberculosis, also known as TB. One hundred years later, World TB Day was established to commemorate the discovery and raise awareness for those impacted by TB.
This year, medical professionals like Elisabeth Hansen are using this day to reflect on the historical implications of TB treatment for Indigenous people in Canada.
“There's a terrible history of colonialism in tuberculosis. Many Indigenous TB patients were forcibly removed from their homes and communities, they were placed in sanatoriums very far away from home, often for years at a time,” said Hansen, a TB nurse at BCCDC.
European settlers first introduced TB to Indigenous people during their colonization of Canada. Indigenous people were disproportionately affected by the disease as it was foreign to their immune systems. Poor living conditions in residential schools greatly exacerbated the death rate among Indigenous children, and Canada’s mistreatment towards Indigenous people with TB continues to affect Indigenous people with TB to this day, said Hansen.
“Some Indigenous people may distrust the health care system because of the history of colonialism and TB,” said Hansen. “They may not seek care right away which means they're a little bit sicker by the time we've seen them.”
Hansen got into nursing over 26 years ago because of her desire to help people, and she acknowledges her responsibilities as a healthcare worker in an industry that has a history of neglecting the needs of Black, Indigenous and other people of colour (BIPOC).
“As a settler of European ancestry, I think it's my role to make sure that we don't repeat the past,” Hansen said.
“It's important to have conversations with your Indigenous clients, colleagues, friends to really hear from them about what makes a safe space and what safety means to them. Decolonizing health care is our work and responsibility to do.”
Hansen is currently working with colleagues at BCCDC and TB Services on implementing the feedback received from Indigenous people through the Making Spaces project in which STI clinics, TB clinics and online sexual health services participated in. The Making Spaces project included a review of educational materials and website, a mock clinic visit, and a walk through of each of the clinic spaces.
TB clinics now include universal washrooms, snacks and refreshments in waiting rooms, visible land acknowledgements and Indigenous art.
Today, TB continues to disproportionately affect Indigenous populations as well as immigrants coming from countries where there are higher chances of exposure to TB. In 2021, there was a reported 311 active TB cases in British Columbia alone.
“Many people think that TB has been eradicated, it hasn’t,” Hansen said. However, she is optimistic that projects like the Making Space initiative will encourage those with TB to feel safe accessing care at clinics. TB is curable, medication is free and only those who are very sick or not able to isolate at home are admitted to hospital.
While the impact of colonialism on TB persists, Hansen remains optimistic for the future of TB care in Canada.
“I'm hopeful when I see all the work that's going towards improving cultural safety in our clinic, at the BCCDC and PHSA.”