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Greenland Housing conditions and tuberculosisThe critical factors for the development of tuberculosis is how close together people live, the hygiene. But Tb cannot be, it cannot be eradicated. At the end of the Second World War, tuberculosis was a gigantic problem. At that time, the disease accounted for one third of all deaths in Greenland. Around 1950 it was therefore decided that a massive operation was needed. The action taken included the construction of a sanatorium, Dr. Ingrid's Sanatorium, in Nuuk in 1954 and use of a special shipvessel, "Misigssut" to trace new cases of TB. The operation succeeded - fewer patients died! In 1955, the incidence of tuberculosis was 23 per 1,000 inhabitants. By 1965, it was down at 2.9. The big fall was due to a combination of vaccination and early tracing of new cases. In the same period, more effective treatment became available in the form of antibiotics, including streptomycin. In just 10 years the disease was brought down to approximately the same level as in Europe. The figures fluctuate due to microepidemics. The first epidemic occurred in the district of Nanortalik in 1990-91, the next in Upernavik in 1994-98 and the most recent one in South Greenland, concentrated mainly in Nanortalik. More and better homesIn the last few years, however, there have been outbreaks of tuberculosis in Kullorsuaq in Upernavik district, in Uummannaq district, and in Nanortalik, Narsaq and Qagortoq. I asked Gunnar Pallisgaard, a specialist in pulmonary diseases in Nuuk, whether it was impossible to eradicate tuberculosis. Gunnar Pallisgaard replied, "The TB epidemic in Kullorsuaq appeared in 1994 - 20 cases among 300 people. With an incidence like that, there is every likelihood of the epidemic spreading - mainly perhaps because of the number of people living in each houses. There could be 18 people crowded together in a house no bigger than 70 m2. We pulled out all the stops to educate people and held meetings on hygiene. Ove Rosing Olsen carried out a project that included improving the general standard of hygiene, repairing the local dump, building more houses and, first and foremost, building a service centre, which was called "Prins Henrik". In 2001, there were four new cases of TB, so the disease is clearly still smouldering." In both Denmark and Greenland, the fall in TB came with better housing conditions, better institutions and better social conditions. Cases of TB fell still further with the advent of effective medicine against the disease around the time of the Second World War. All these factors helped to improve the population's general resistance to tuberculosis. In the last few years, the incidence of TB in both Greenland and Denmark has been rising - in Greenland because of microepidemics and in Denmark because of athe relatively high incidence of TB among immigrants. A healthy immune system in a healthy bodyWhen a person is infected with the tuberculosis bacterium, the disease spreads to the whole of the body within six weeks. At that point, the person begins to form antibodies and can fight the disease. One can have an inactive form of the disease, which means that, although infected, there are no symptoms. If a person later becomes weakened for other reasons, the disease can break out as pulmonary tuberculosis or tuberculosis in other parts of the body. One can be counteracted by diseases by having as good an immune system as possible, i.e. by avoiding smoking and other strains onburdening of the immune system. The public health service in Greenland has not had the best of conditions in the past 10-15 years. Some health personnel have been employed on short-term contracts. They have not had sufficient reserves of energy to worry about TB. It is therefore very important for the Medical Officer of Health to be notified of all new cases of TB. A team that includes a specially trained TB nurse has been created and is ready to go out in the event of new epidemics. Gunnar Pallisgaard likens TB to a vicious cur, saying, "You have to keep a close eye on it. If you turn your back, it will bite you!" Tuberculosis will continueWhereas outbreaks of influenza and measles last for weeks, outbreaks of TB can go on for years. Looking at TB in the last hundred years, one can conclude that the fall in the disease in theat period was due to TB's own dynamic. There is some form of interaction between the TB bacterium and vaccine and antibiotics. The protection provided by vaccination varies greatly (from 0-80%). A very worrying development is the growing incidence of multidrug resistant tuberculosis. There is therefore a long way to go before the disease is eradicated. Looking at the next hundred years, TB, malaria, leprosy and measles will continue to dominate the global pathological picture. TB has not been eradicated and will only be eradicated when the disease has run its own course, but it can be reduced considerably with healthy housing and a healthy lifestyle
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