The effect of tuberculosis on the Indians of Saskatchewan : 1926-1965
KeywordsTuberculosis mortality - Saskatchewan
Indigenous peoples - Epidemics - Tuberculosis
Tuberculosis - Epidemiology - Saskatchewan
Tuberculosis - Saskatchewan Indian population
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AbstractThis research explored several adaptations to tuberculosis among the Indian population of Saskatchewan from 1926 to 1965 in order to demonstrate that this was an era in which disease played an significant role in the lives of the Indians. A broad ecological model' allowed for a variety of interactions to be explored. Within this framework, the study examined: the epidemiology and ecology of tuberculosis in the Saskatchewan Indian population; the development of health services to the Indians and the role of health services in the ecology of disease in this population; and the individual Indians' hospitalization and tuberculosis experience. The epidemic of tuberculosis among the Indians of Saskatchewan began in the early 1880s. Rapidly assuming epidemic proportions, the death rate from tuberculosis among the Qu'Appelle Indians peaked in 1886 at a rate of 9,000 per 100,000. The death rate declined gradually after 1890 through the acquisition of population resistance and the elimination of the non-resistant families. The acute phase of the tuberculosis epidemic, characterized by extra-pulmonary disease in which the majority of cases terminated in a few months, lasted about two decades. Between 1907 and 1926, with gradually improving living conditions, continued acquisition of population resistance, but without application of any specific anti-tuberculosis measures, the death rate fell to 800 per 100,000. Tuberculosis was endemic in the Saskatchewan Indian population by the beginning of the 1930s. Once endemic, the decline of the tuberculosis death rate continued to the end of the 1940s, without application of any specific anti-tuberculosis measures. By the time that specific measures were introduced, the death rate had declined to 417 per 100,000 in 1949. With the introduction of BCG vaccination and antimicrobial drug treatment, by 1959 the death rate declined to 39 per 100,000. By the early 1960s tuberculosis mortality was successfully controlled in Saskatchewan, although death rates remained 15 times higher among the Indians. Tuberculosis morbidity continued to be a problem into the 1980s. In 1984, the incidence of tuberculosis was 21 times greater among the Indians than the corresponding rate in the non-Indian population. Various environmental and cultural factors contributed to the Indian population's experiences with tuberculosis. The most important factor was the absence of population immunity. In addition, concentration of the population on reserves, the occurrence of intercurrent epidemics, sudden and dramatic dietary change, and lifestyle factors such as housing, sanitation and personal hygiene all contributed to incredibly high tuberculosis mortality in this population. The effect of medical care on the epidemiology of tuberculosis in the Saskatchewan Indians was not even considered in the preliminary analysis of the epidemic, because throughout the first several decades of the epidemic, no organized health services existed for the Indians. In Saskatchewan, before World War II, medical services to the Indians were characterized by occasional surveys, the employment of part-time physicians, and health education through the distribution of circulars to Indian agents on health-related issues. Organized anti-tuberculosis programs which were developed in the years following the Second World War, in a large part, account for the dramatic decrease in the tuberculosis death rate in the province through the decade of the 1950s. In the late 1940s, and throughout the 1950s and 1960s, most active Indian tuberculosis cases diagnosed in Saskatchewan were hospitalized for treatment. At least 10% of the Indian population of Saskatchewan received Indian hospital or sanatorium treatment throughout the first decade that those services were available to them. Interviews conducted with fourteen Indian individuals who had been hospitalized for tuberculosis treatment provided two dichotomous perspectives on tuberculosis. Several individuals feared tuberculosis because of their familiarity with it in their families and on their reserves, however, most said that they knew tuberculosis, but they did not fear it. In terms of their knowledge about tuberculosis from a biomedical perspective, most had some idea of its symptomology although its specific etiology was not known. Most of the people interviewed appeared to understand the infectious nature of tuberculosis, however, their concern for their families may have stemmed from observations that tuberculosis was "in" particular families, not necessarily because they thought they could "give" tuberculosis to them. In terms of a perspective on the treatment of tuberculosis, most of the individuals interviewed were aware that hospital treatment was necessary. Archival sources and government annual reports, indicated that many Indians took a very active role in attending to their health needs. None of the individuals who were interviewed refused to go to the sanatorium, except for one woman who ran away several times. Most, however, planned their escape time after time. This suggests that their stay in the sanatorium and hospital may not have been of their own volition. The most common and recurring theme that emerged from the interviews about life in the sanatoria or Indian hospital revolved around the structured, regimented nature of the treatment. Several individuals remembered quite vividly seeing other patients confined in strait jackets and body casts and distinctly remembered how strict the staff was with children. While they were hospitalized, all of the individuals who were interviewed knew several other people who were being treated at the same time who were also their contemporaries from their own or surrounding reserves. All of the individuals also made several lasting friendships with people that they met while in the sanatorium. In addition, all, except for one young boy, were visited frequently by their families and friends. This indicates that the Indian people interviewed were not "isolated" from their families and friends for the duration of their treatment. Hospitalization, for those interviewed, was not a traumatic event because they had an extensive social network which enabled them to cope with the experience. In addition, because of the poor living conditions on many Indian reserves, a trip to the sanatorium or Indian hospital was a relief for some. Indian children in the sanatorium and hospital were given new clothes, toys, and books, and in some cases an education; things they did not get at home. One woman chose to remain in the sanatorium after her treatment regimen ended so that she could complete her education, something she could not do back at home in the north. Only one individual suggested that the experience was instrumental in determining the direction his future took. In demonstrating that this was an era in which disease played a major role in the lives of the Indians, the epidemiology of tuberculosis in this population illustrated the pervasive influence that tuberculosis had on demographic and biological aspects of the population. The history of health services illustrated the role of medical intervention in the ecology of tuberculosis in this population. As a probe for behaviourial adaptations to disease on the individual level, the interviews contributed a human dimension to the study. To complete the picture of the role of disease in the lives of the Indians, the examination of the final component in adaptation, behaviourial adaptation to disease at the cultural level, is recommended.
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