As of today, no case of COVID-19 disease has been reported in Nunavut. This is good news. But not far away in Nunavik, Quebec, nine cases of COVID-19 disease have been detected. With only limited testing and long delays in getting test results back, concerns about what will happen if COVID-19 reaches Nunavut are well-founded.
Communities in Nunavut are not waiting for the first case of COVID-19 disease to act and are already implementing emergency readiness measures. On 25 March 2020, the Baffin Island Hamlet of Clyde River demanded that the Chief Public Health Officer of Nunavut suspend all passenger flights to their community and provide COVID-19 testing for all. On the same day, the western Nunavut community of Kugaaruk invoked the Hamlets Act to declare a medical state of emergency and banned all passenger air and land travel into the community. Communities understand that the reality of life in Nunavut requires a swift and comprehensive approach to mobilizing against the virus.
From the experience of tuberculosis (TB) and other epidemic diseases, if the virus that causes COVID-19 reaches Nunavut, it could be devastating. Inuit Tapiriit Kanatami (ITK), the national voice of Canada’s 65,000 Inuit, stresses that Inuit are a high-risk group for respiratory infections and COVID-19. They are nearly 300 times more likely to get TB than any Canadian born, non-indigenous person. While knowledge about COVID-19 disease in TB patients remains limited, it is anticipated that people ill with both TB and COVID-19 may have poorer treatment outcomes, especially if their TB treatment is interrupted. People who are immunocompromised or who already have lung problems may be even more vulnerable.
Inuit have suffered from social and economic inequalities created by the legacy of colonialism and the ongoing marginalization of communities. This has caused widespread distrust which is a major barrier in addressing infectious diseases like COVID-19 and TB. Add to this the fact that communities in Nunavut are reachable only by air and have very basic medical care facilities, and it becomes clear that members are at an extreme risk in the face of COVID19.
The reality is that communities need to be engaged and mobilized from the outset of a health crisis. Evidence globally points out that defeating infectious diseases, like COVID-19 and TB, requires the community to drive the response. Reducing the risk of COVID-19 disease amongst TB patients requires decentralized treatment and ‘physically distant’ models of care.
Over the past two years, Ilisaqsivik and SeeChange have developed a unique collaborative community model which recognizes that coordinated public health approaches need to work closely with community leadership to effectively address health and social issues faced by uniquely vulnerable communities. Our Mamisarniq Method is a framework for community-driven health and wellbeing, co-created with the community of Clyde River. Mamisarniq means healing in Inuktituk, and this method ensures that the community has the control, the space and the resources to empower itself to address TB. It can do the same for COVID-19.
Through this partnership, the Clyde River Community held its first Community TB Empowerment Workshop in January 2020. Using narrative therapy, elders began to address their unresolved TB trauma; such trauma impacts health and wellness in Inuit communities and inhibits the family and social support that individuals need to be mentally well. In a safe space with professional support available, participants were able to address this intergenerational trauma. Elders gained technical knowledge on prevention and treatment of TB and designated themselves as “pijitsitiit” (TB Advocates) for their community. They expressed a desire to bridge the gap between the health centres and their communities.
The World Health Organization advises that we must urgently maintain continuity of essential services for people affected with TB during the COVID-19 pandemic using innovative people-centred approaches. In this spirit, Clyde River is now deploying the Mamisarniq Method to protect itself against COVID-19. Community leaders in Clyde River have:
– developed emergency readiness plans, procured donations of PPE and sourced hygiene materials to assist with infection prevention and control;
– developed collaborations with emergency humanitarian organizations and funders to act on COVID-19 in the event of a case;
– asked for online versions of the Community TB Empowerment Workshops specifically for Inuit communities to be adapted to include the prevention and care of COVID-19. These will be implemented in Inuktitut with terminology adapted to Inuit life and reflect Inuit qaujimajatuqangit (societal values);
– advocated that community members be trained to share in carrying out relevant healthcare tasks, as well as adopting telemedicine and software applications designed for mobile phones that can work in an internet-challenged setting; and
– organized a competition to normalize and incentivize mask wearing.
The Mamisarniq Method consistently and radically puts community at the centre, allowing them to be the owners, leaders and active participants in community health responses. By developing this approach at the “speed of trust”, we have created a unique Canadian North-South collaboration based on principles of dignity, humanity and solidarity.
Globally, communities who are trusted partners at the centre of prevention and containment strategies will win against COVID-19 and TB. Inuit communities will do the same.
Photos bySeeChange Initiative Clyde River residents