Assembly of First Nations
Ottawa, Ontario, Canada

First Nations' Public Health

Tuberculosis :: Photo Essay: Cross Lake First Nation

We would like to thank Cross Lake First Nation for allowing us into their community to capture one aspect of their lives. Our goal of raising awareness about TB and its impact on First Nations is greatly helped with their contribution.

Photos were taken by Karyn Pugliese, AFN Communications Officer.

1. Cross Lake is a remote community in Northern Manitoba (see map).

2. Many of Cross Lake’s homes are overcrowded which can contribute to the spread of TB. Cross Lake’s on-reserve population is 4,445, but it has only 808 Housing units.

A mother tends to her four children who share this room.

Children sleep in overcrowded conditions.

3. Overcrowding has caused mould to grow in many of the homes, as evidenced on the wall beside the children’s bed in the picture below, and surrounding bedroom window. Prolonged exposure to black mould can damage the lungs, cause asthma and reduce the body’s immune system and ability to resist TB. Currently more than 200 housing units at Cross Lake are in need of repair.

4. Children peer out the window of their home at Cross Lake.

5. More over-crowding in Cross Lake. In all, five children live in this small two-room cabin. The front room is a living area, the back room is the family bedroom. Over-crowding contributes to the spread of TB.

6. The cabin has no running water. The basin is used as a sink and to wash, a bucket is used as a toilet.

7. A home with plastic covering on the window. Plastic on the window impede air circulation which can contribute to the spread of TB. In the winter many families in the northern communities wrap their entire homes in plastic to protect against the cold because the homes lack proper insulation.

8. On average housing costs more than 30% of First Nations before-tax household income. The Assembly of First Nations data projects that 87,000 new housing units are needed to meet demands in First Nations communities across Canada. Currently only 2300 new units per year are funded through federal government initiatives and 500 units Rural Renovation Application Program or RRAP units.

The new First Nation Market Housing Fund separate from CMHC and INAC as a new approach to financing or backstopping loans for housing has a ten year target of meeting 25,000 new units with a projection of building 3800 unit in the first three years starting this current fiscal year. However, projections tell us that this commitment will not meet the need, especially considering that the First Nations have a young and rapidly growing population with more than 50 % of the population under 30 years of age.

9. Grocery Store at Cross Lake. Due to shipping costs, northern communities can find the cost of healthy food can be one and a half times to triple the price of the same food in the south. Cross Lake also has a high unemployment rate making it difficult to afford a healthy diet.

10. Cross Lake has a nursing station with 2 DOTS Therapy workers. A dedicated TB RN was appointed by Health Canada in March 2008, following a TB outbreak. Patients suspected of TB are flown to a hospital and begin treatment immediately. When necessary, Health Canada tests family members and co-workers who may be at risk through exposure to the patient.

11. As explained in the poster on the wall of the nursing station only 38% of people with latent TB finish their medications.

As an incentive Health Canada offers patients food for their families as an incentive when they take their medication. The reasons people may pre-maturely stop taking medication include: a stigma surrounding TB, a lack of understanding that they must complete medication even though they may feel better, and competing priorities.

12. To some extent TB is also a legacy of residential schools. From – to – FN children were removed from their homes and communities to live in schools run by churches and the state. Over-crowded conditions, poor ventilation and improper nutrition led one-third of the children to die from TB, and an unknown number to become infected with latent TB. As the population ages and their immune system weakens, latent TB can become active and contagious.