One nurse's quest to track down TB on the eastern edge of Greenland
The town of Tasiilaq, Greenland, sits perched on the shore of a natural harbor in a dramatic fjord. It is the most populous community on Greenland's east coast, with just slightly more than 2000 inhabitants. It is also home to a concerning number of tuberculosis (TB) cases, with a TB rate of 900 cases per 100 000 population. In comparison, the average rate among the 53 countries of the WHO European Region was 37 per 100 000 in 2014.
Margit Weismann came to Tasiilaq in 2005, after completing her nursing studies in Denmark. In 2007, she moved to the even more remote community of Kuummiut, where she served as the sole nurse practitioner for about 400 people. There was no doctor in the settlement to support her work.
Then, in 2009, the tiny community experienced a TB epidemic. The high number of TB cases made some people afraid to come to Kuummiut, further isolating Weismann and her fellow residents. Though she had little first-hand knowledge about TB, Margit became the health worker primarily responsible for dealing with the epidemic. This experience made her interested to learn more. When she left Kuummiut after three years, she came back to Tasiilaq to work specifically as a TB nurse.
Margit's daily tasks in this role included checkups with her TB patients and examinations of their family and friends, to see whether they had also been infected with the disease.
"It was very interesting work, but it was also difficult," she said. "It was difficult to reach all the people because some of them didn't want to get treatment. You really had to go out and grab patients."
As the first TB nurse ever in Tasiilaq, Margit pioneered new techniques for dealing with the disease. She created a map where she could track all of the TB cases in the area. This type of tracking helped her dispel certain false assumptions about TB, for example that most cases occurred among people living in old houses. In fact, she concluded that more cases occurred among people living in newer houses. These houses were more expensive and, therefore, tended to have more people living in them and sharing the cost. This meant the disease had more opportunities to spread and infect new people.
"The most important thing in my job was to find the TB," said Weismann. "You had to be 100% focused on TB, and nothing else. Then you find a lot of TB."
Though Margit no longer works exclusively as a TB nurse, she continues to view the disease as an important priority and one that deserves a prominent place on the country's political agenda. But she believes that, in order to effectively fight TB in Tasiilaq and across Greenland, you can't just go looking for the disease. It is vital to have a broader perspective. "To prevent TB, you need better houses, cheaper healthy foods, better family conditions, better schools," she said. "The social problems are much bigger than TB. But if you solve those, then you can also get rid of TB."
At the request of Greenland's Ministry of Health, a team of experts from WHO/Europe, the Danish Lung Association and Statens Serum Institut Denmark are visiting the island on 5–11 June 2016 to evaluate the country's efforts to address the increasing number of TB cases. The visit is a follow-up to an assessment mission by WHO/Europe and partners in April and May 2010. Tasiilaq was the first stop during the mission.