Nate Hendley

Ancient Killer Still With Us

(originally published February 14/2003 in the National Post)

Manu misses her kids. She has two of them, both under five years old. She hasn't seen them since late January, because preteens aren't allowed inside her current residence.

Manu, who hails from Brampton, is one of 18 people who live in Ontario's only inpatient unit for treating tuberculosis. The unit is located at the West Park Healthcare Centre, an expansive medical facility situated near Jane St. and Eglinton Avenue. West Park has a century-old tradition of treating TB, a chronic, infectious disease that primarily affects the lungs. Left unchecked, tuberculosis can bore huge cavities in any organ it infects, causing disability or death.

Once called "consumption", TB was responsible for seven percent of all deaths in Canada in 1926. While medical advances have cut TB's prevalence, 350 - 400 people - a quarter of the country's total - still contract it each year in Toronto. Immigrants from countries where the disease runs rampant and people living in poverty are especially vulnerable.

Manu - who is not using her full name for reasons of privacy - first noticed she was sick last fall.

"I had a cough," she says. "I went to the family doctor. He said it was bronchitis that I had. He game me some medicine ... [later] I went to a walk-in clinic. They said they same thing, I had bronchitis. It was like that two or three times."

In December 2002, she went on a family trip to her homeland of India. There, her health rapidly deteriorated. Upon returning to Canada, she revisited her doctor. He gave her X-rays then referred her to Dr. Monica Avendano, a respirologist who runs West Park's TB unit. Shortly after seeing Dr. Avendano, Manu moved into West Park's TB ward. She might have to stay until the spring; the average length of treatment in the unit is four months.

Manu, who is an accountant, lost her job after she became ill. Then her babysitter quit, citing possible risks to her own health. Manu's husband, a mechanical engineer, has been running the household by himself, ever since she entered West Park.

Manu's current residence resembles a university dorm, albeit, a dorm with double, locked steel doors and its own air filtration system. The 14,000 square foot unit is brightly lit and has two lounges, each of which are equipped with a TV, VCR and computer. Board games and books abound, in an attempt to keep the 14 men and four women who live in the unit occupied. Many of these residents live in individual rooms, set along a main corridor. An air filtration system keeps potential germs from wafting into other parts of the hospital.

Patients have to wear surgical masks when seeing visitors and no one under 13 is allowed inside the unit. While patients can stroll around an outdoor patio area, they can't leave the hospital grounds.

Dr. Avendano stresses that most TB cases can be treated outside of hospitals. Toronto's public health department, for example, runs a program called DOT (Directly Observed Therapy) under which nurses supply patients with medication right in their homes.

Not everyone is suitable for DOT, however; people with severe TB or patients who live with young children, elderly parents or room-mates are encouraged to seek treatment in a hermetic setting such as West Park.

Should you refuse treatment, you might wind up at West Park anyway. TB is one of the few diseases for which you can be hospitalized against your will in Ontario. Tubercular patients who won't take their meds can be involuntarily detained at West Park by court order. Which makes sense, as TB retains the power to kill; over a million people still die from the disease each year, primarily in the Third World.

The TB unit sees "three or four" court-ordered cases a year, says Dr. Avendano. "You have to take these patients and isolate them, because of the infectiousness."

Isolation - for voluntary and involuntary patients alike - creates its own set of problems.

"We have a lot of psycho-social issues related to this population," says Leslie LeGresley, manager of services for the TB unit. "These issues are related to their confinement for extended periods of time."

To deal with these issues, the two-dozen full and part-time hospital staff that work in the TB unit include a psychologist, social worker and recreational therapist. The recreation assistant has brought in Tai Chi instructors, organized movie nights and encouraged discussions about cultural or religious traditions to keep spirits up.

Despite the best efforts of staff, feelings of boredom are common among patients.

"It's a long day," states Paul, a tall, gaunt patient who has been in unit since October, 2002.

Paul, who was born in Ireland and is 58 years-old, isn't complaining, however. He says his treatment is excellent and he appreciates the care and concern of the staff. As with other patients who are Ontario residents, Paul's stay is covered by OHIP. The Ontario Ministry of Health, meanwhile, picks up the TB unit’s $1.5 million operating budget.

"If you're going to be sick, this is one of the best places to be," notes Paul, echoing a common sentiment.

Sir William Gage and a group of philanthropic businessmen founded West Park in 1904. Originally called the Toronto Free Hospital for the Consumptive Poor, the facility offered high-end care for low-income patients. Some of the original housing units consisted of decommissioned horse-drawn carriages donated by transit authorities.

At the time, the main treatment for TB was rest, fresh-air and sunlight (ultraviolet light helped affect a cure in some people). While West Park offered excellent care, TB remained a fatal illness. Almost half of the 6,695 patients treated at West Park in its first 25 years of operation died of the disease.

The discovery of anti-biotic drugs in the late 1940s dramatically reduced TB's mortality rate in Western nations. West Park's TB unit hasn't lost a patient to the disease since the late 1990s.

That said, tuberculosis remains shrouded in fear and ignorance, even in Canada.

Manu, for one, hasn't told the rest of her family or even close friends about her illness.

Asked why, she says, "Your best friends [they can] turn on you."

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