A Long Way from Home: The Tuberculosis Epidemic among the Inuit (review)

Pat Grygier—a clinical psychologist by training, now retired from the Public Service Commission of Canada—has written a moving, sometimes shocking history of the Canadian government’s effort to combat tuberculosis among the Inuit (Eskimo) population in the Canadian Arctic since the end of World War II. Her account is based on extensive research in both published and archival sources and on interviews with surviving participants in the campaign.

The Canadian Arctic is a vast area of interspersed land and sea—peninsulas, islands, and inland seas, like Hudson Bay—extending more than 2,500 miles east to west, from the coast of Labrador to the Beaufort Sea, and a similar distance from the southern shore of Hudson Bay to the Queen Elizabeth Islands a few hundred miles from the North Pole. Along the shores of this immense land some ten to eleven thousand Inuit lived formerly in small hunting groups, dwelling through the short Arctic summer in skin tents and through the long, dark winter in igloos. The isolation of Inuit communities made them particularly susceptible to epidemics of infectious diseases. During the summer the arrival of a ship at a remote community was followed typically by an epidemic of colds and bronchitis, and sometimes of tuberculosis.

Following the arrival of a ship at Coppermine on Coronation Gulf in 1929, the government medical officer, Dr. R. D. Martin, watched tuberculosis spread rapidly among the neighboring Inuit groups, until by 1931 a quarter of the people were dying annually. Although he made strenuous efforts to isolate and care for patients with active tuberculosis, the epidemic was beyond his slender resources. The close confinement of Inuit families within igloos during the winter ensured the rapid transmission of the tubercle bacillus from an individual to other members of the family. When Dr. Martin appealed urgently to his superiors at Ottawa for a hospital at Coppermine in which to isolate tuberculosis patients, they ignored his requests and terminated his appointment. During the 1930s tuberculosis ravaged the Inuit throughout the Canadian Arctic, and tuberculosis mortality among them rose to the highest recorded level in the world.

Not until 1945 did the Canadian government act to control tuberculosis among the Inuit, and then their action, though effective, was brutal: instead of establishing tuberculosis hospitals in the Arctic, they conducted mass chest X-ray surveys among the Inuit and forcibly sent Inuit patients with active tuberculosis to sanatoria thousands of miles to the south. Police took patients abruptly from their communities without telling them where they were to be sent; they separated children from parents. The patients usually did not speak English, and sanatorium staffs in southern Canada did not know the Inuit language, Inuktitut. The patients did not know where they were, nor what was to happen to them. Their despair can only be imagined.

Yet, in its rough way, the removal of tuberculosis patients from Eskimo communities did lower tuberculosis mortality and reduce the incidence of the disease very rapidly. The prompt removal of people who were sources of infection and their thorough treatment were undoubtedly essential to the decline. Unfortunately, in view of the suffering described by Grygier, as recently as 1986 tuberculosis continued to occur among Inuit at a rate twenty-four times higher than in the population of Canada as a whole. ¹ The reason appears to lie in the geographical separation of tuberculosis treatment from where the Inuit live. If the Northern Medical Service of Canada is to eradicate tuberculosis from the Inuit, it needs to have several hospitals distributed across the Arctic, where Inuit patients may be treated by staff who speak their language and understand the conditions of their life. Such hospitals might also serve as bases from which tuberculosis surveillance teams could travel to isolated communities to administer tuberculin tests and chest X rays. Positive...