MEET THE TEAM

Executive Team

  • Rachel Kiddell-Monroe

    Executive Director

    Rachel Kiddell-Monroe is a lawyer, a humanitarian practitioner and an advocate. She is a Board Director at Médecins Sans Frontières (MSF), a founding President of Universities Allied for Essential Medicines and a Professor of Practice at McGill University. Rachel believes putting people and their community first is key to creating a more humane, just, and fair society.

  • Samantha Poncabare

    Executive Assistant

    Samantha Poncabare holds a BA in International Development with a minor in International Relations and Environmental Sciences from McGill University. Previously, Samantha worked in the sales department of a startup, organized a course on Humanitarian Action at the McGill Summer Institute in Global Health and volunteered with SeeChange on fundraising and event planning.

  • Peter Saranchuk

    Medical Director

    Peter Saranchuk is a medical doctor with more than a dozen years of international experience with the humanitarian medical organization Médecins Sans Frontières (MSF). In addition to performing HIV-TB clinical work in resource-limited settings, he has worked as a TB-HIV Advisor in MSF’s Southern African Medical Unit. He currently works in a Community Health Centre in southern Ontario.

  • Sumeet Sodhi

    Monitoring & Evaluation Coordinator

    Sumeet is a family physician in the Toronto Western Hospital Family Health Team, an Associate Professor of Medicine at the University of Toronto, and the Academic Lead for the Indigenous Health Partners Program at the Department of Family and Community Medicine at the University of Toronto. Sumeet has led many global health initiatives, including indigenous health, diabetes, HIV, TB, primary care integration, community-based programming and chronic illness care.

  • Tanya Ayala

    Communications Officer

    A storyteller at heart, Tanya Ayala is a Communications Consultant and holds a BA in Political Science with a minor in Professional Writing from Concordia University. She also holds a Graduate Diploma in Paralegal Studies from Conestoga College and is pursuing a Graduate Diploma in Public Relations & Communications Management from McGill University. She previously worked in the private sector as a Sales Manager, Recruiter, and Internal Communications Specialist.

TB Initiative Team

  • Malcolm Ranta

    Local Director

    Malcolm Ranta is the Executive Director of the Ilisaqsivik Society. He also manages the Ittaq Heritage and Research Center and the social enterprise Tukumaaq Incorporated. Malcolm has years of experience working in Nunavut in government and non-profit sectors. He has worked in public health and community development with remote and urban Indigenous communities. Malcolm is also a wannabe weekend hunter.

  • Sheila Enook

    TB Project Coordinator

    Sheila Enook has a business degree from Queen’s School of Business. She worked for the Government of Nunavut as Manager of Finance with Arctic College and Director of Finance for the Department of Health. She is a member of Regional TB Committee. In her free time, Sheila makes traditional hunting equipment and goes out to her cabin or hunting.

COVID-19 Initiative Team

  • Jessica Farber

    Community Readiness Coordinator

    Jessica Farber works with community leaders to organize, prepare and respond to COVID-19 using the CommunityFirst COVID-19 Roadmap. She has experience in outreach, advocacy and project coordination with forced migrants and asylum seekers in Montreal and Mexico. Jessica holds a B.A. in International Development from McGill University.

  • Megan Corbett-Thompson

    Community Readiness Outreach Coordinator

    Megan Corbett-Thompson holds a BSc in Ecological Determinants of Health from McGill University. She has gained diverse experience in protection work, community mobilization and environmental health promotion alongside NGOs in Latin America. Megan is committed to community empowerment and upholding the dignity of all persons.

  • Violeta Chapela

    Medical Advisor for Community Health

    Violeta Chapela is a doctor with humanitarian experience in the areas of sexual violence, migration, sexual and reproductive health, mental health for victims of violence and primary healthcare in exclusion and war zones. Violeta also has an interest in strengthening community networks from a gender perspective.

Board of Directors

  • Denis Blanchette

    President and Treasurer

    Denis Blanchette has spent 30 years bringing community first. He worked with communities in Africa and Latin America. After working at the Supreme Court of Canada, he is now a partner at one of Canada’s leading law firms supporting Indigenous communities. Denis is recognized as a leading practitioner in Indigenous law in Best Lawyers in Canada 2020.

  • Madlen Nash

    Board Secretary

    Madlen Nash holds an Honours BSc in Microbiology and Immunology and an MSc in Epidemiology, both from McGill University. She has led several global health research studies in India and authored academic articles in leading scientific journals. Madlen is a founding member of SeeChange and currently works as a Research and Advocacy Associate at AIDS-Free World.

  • Jasper Monroe-Blanchette

    Member

    Jasper Monroe-Blanchette studies Forestry at Cégep de Chicoutimi. Through his studies, he is working towards getting involved with Indigenous communities in relation to forest management. Jasper loves wild places and finds his calling in mountains and forests. He is a yoga teacher and finds his peace in practicing traditional forms, which include qigong and kung fu as well as yoga.

  • Michelle Osry

    Member

    Over the past 25 years, Michelle Osry has worked across North America, Europe and Africa as an academic and investment banker She is now a partner at Deloitte Canada, where she leads the firm’s Family Enterprise Consulting practice. Michelle is Vice Chair of the Family Enterprise Xchange, a Canadian organization dedicated to empowering enterprising families and their advisors.

  • Carol Devine

    Member

    Carol Devine was a founding member of SeeChange and is a Humanitarian Affairs Advisor with Médecins Sans Frontières (MSF) Canada. Carol was a 2016 fellow of the Ecologic Institute’s Arctic Summer College. She is a member of the Scientific Committee on Antarctic Research Humanities Expert Group and a Community Fellow at the Dahdaleh Institute for Global Health Research.

Board of Advisors

  • Jennifer Furin

    Dr. Jennifer Furin is an infectious diseases clinician and medical anthropologist who has spent 25 years working to address TB and HIV in vulnerable populations. She is a lecturer at Harvard Medical School and serves as a consultant for a variety of organizations to support person-centered care. She specializes in the care of children with drug-resistant forms of TB.

  • Daniel Solomon

    Daniel Soloman is a businessman and trustee of the Heathside Charitable Trust which is a family charity based in London, United Kingdom. The charity funds projects both in the UK and overseas.

  • Grace Yang

    Grace Yang is the Chief Trouble Maker at TEDxMontrealWomen, curating and encouraging speakers to step outside of their comfort zones to deliver their most compelling talks. She leads a dynamic team of volunteers and fosters a creative culture where everyone can grow together. Previously, Grace worked in the investment industry on both the buy and sell sides of the Street.

  • Stephen Lewis

    Stephen Lewis is co-director of the international advocacy organization AIDS-Free World and co-chair of the board of the Stephen Lewis Foundation. He has previously served as the UN Special Envoy for HIV/AIDS in Africa, as Deputy Executive Director of UNICEF, and as Canada’s Ambassador to the United Nations.

  • Courtney Howard

    Dr. Courtney Howard is an Emergency Physician in Canada’s subarctic, and board President of the Canadian Association of Physicians for the Environment (CAPE). She was the first author on the 2017 and 2018 Lancet Countdown on Health and Climate Change Briefings for Canadian Policymakers, as well as being the 2018 International Policy Director for the Lancet Countdown.

  • Jerry Natanine

    Jerry Natanine was born and raised in Clyde River, Nunavut. He has been working with Ilisaqsivik for several years. He completed Ilisaqsivik’s Our Life’s Journey: Inuit Counsellor Training Program. Jerry has held many leadership roles in Clyde River, including Chair of the Hunters and Trappers Organization. Jerry is currently Mayor of Clyde River for a second time.

  • Igah Sanguya

    Igah Sanguya currently sits on the Board of the Ilisaqsivik Society and serves as the Community Health Representative of Clyde River, Nunavut. In the past, Igah has also served on the Board of Directors of Pauktuutit and the Canadian Aboriginal AIDS Network.

  • Georgia White

    Georgia White is a Strategy and Policy Associate at the international advocacy organization AIDS-Free World. Over the past decade, Georgia has worked in the United States, Cambodia and her home country of Australia as an advocate and policy expert on health and social justice issues.

Interns & Volunteers

  • Béatrice Petitclerc

    Volunteer

    Beatrice is a student in the Law-MBA co-op program at the Université de Sherbrooke, with an interest in humanitarian and environmental issues, as well as Indigenous law. Previously, Beatrice has travelled globally for humanitarian and scientific projects. She completed an internship in Iqaluit through College Sainte-Anne de Lachine, as well as a contract with the Government of Nunavut, focused on long-term health in the region.

  • Emanuelle Lyons

    Communications Intern

    Emanuelle is a recent graduate of McGill University, holding a Graduate Diploma in Public Relations & Communications Management. She also holds a BMus in Opera Performance from the University of British Columbia where her passion for communications and storytelling began. A recipient of the McGill Integrated Internship Award, Emanuelle is thrilled for the opportunity to work with SeeChange.

Partners

  • Ilisaqsivik Society

    Community initiated and community-based Inuit organization located in Clyde River, Nunavut. Ilisaqsivik Society is dedicated to promoting community wellness by providing space, resources, and programming that helps families and individuals find healing and develop their strengths. Ilisaqsivik Society is a Canadian registered charity and brings two decades of Inuit-based experience in training and community empowerment.

    Learn more about the Ilisaqsivik Society

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Feb 27, 2020

Three challenges related to the expansion of LTBI diagnosis and treatment in Nunavut

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Words byPeter Saranchuk
Photo bySeeChange Initiative

If we are to eliminate tuberculosis (TB) in Nunavut by 2030, we need to increase certain medical activities within affected communities on a proactive and regular basis over a number of years. One of these activities is the diagnosis and treatment of latent TB infection (LTBI, also known as ‘sleeping TB’) [1].

Expansion of LTBI diagnosis and treatment is supported by the World Health Organization (WHO), whose EndTB Strategy (2014) states that “ending the TB epidemic will require the elimination of this pool of [latent TB] infection”. More specifically, one of WHO’s EndTB Strategy documents states that “management of LTBI in people with a high risk of developing active TB could be an essential component of TB elimination, particularly in low TB-incidence countries.”

LTBI is most commonly diagnosed using Tuberculin skin testing (TST), which is a test that can be performed by a nurse in even the most remote community. Someone having a positive TST result is then considered for treatment that can help to prevent the development of active/infectious TB, which is important because active/infectious TB cases allow the TB germ to spread to other people. Preventing new cases of active/infectious TB helps to break the cycle of TB transmission. The WHO has communicated that such TB preventive treatment, when given to people at the highest risk of progressing from TB infection to disease, remains a critical intervention to benefit individuals and communities alike.

However, there are several challenges associated with the expansion of LTBI diagnosis and treatment. Firstly, although we know that certain groups of people with LTBI are more likely to go on to develop active/infectious TB disease, it is not possible to predict exactly which individuals will. Groups at highest risk of developing active TB include:

– those having recent contact with someone having active TB, especially young children with weakened immune systems
– recent converters, i.e. people who have recently gone from TST-negative to TST-positive miners exposed to silica dust
– those with nutritional deficiencies

But limiting LTBI diagnosis and treatment to individuals in the above ‘risk groups’ over the past few decades has not led to a reduction in TB rates in Nunavut. In fact, things have gotten worse within the territory, not better. Because of this, we should consider implementing more aggressive and innovative LTBI diagnostic strategies in those communities within Nunavut that continue to suffer from high rates of active TB.

Expanded diagnosis and treatment of LTBI has been performed in the past and with some success. Dehghani et al (2018) reported that population-based LTBI screening and treatment, i.e. offering TST to an entire population rather than just to individuals with certain risk factors, was associated with a significant decrease in TB rates in Indigenous populations in Canada, USA, and Greenland between 1960 and 1980.

A second challenge relates to the drugs used to treat LTBI, as these can sometimes result in severe side effects. Older individuals and those with pre-existing liver disease are some of those at higher risk of such side effects. Campbell et al (2019) argue that we face a choice between the current patient-centred approach that values shared decision-making (but will not achieve TB elimination) versus a utilitarian approach that tolerates individual net harm to advance public health goals. “TB elimination in low-incidence countries will require extensive screening and treatment of LTBI, including in people for whom the harms of LTBI treatment outweigh the likely benefits”.

When it comes to side effects from LTBI treatment, it might help to look at things from a different perspective: entire families and communities suffer from the detrimental effects of TB, not just individuals. For that reason, an important group to consider testing and treating for LTBI are those who, if they did develop active TB, would place vulnerable contacts at risk. Thus, anyone whose work brings them into regular contact with young children and the elderly, such as those employed to perform community programs, should be offered TST on a regular basis.

Normally before health care workers offer any medication to a person, a risk vs. benefit analysis is performed. Fortunately, a shorter medication regimen is now available for those with LTBI, which has fewer adverse effects and thereby improves the risk: benefit ratio in favour of the latter. This newer regimen involves taking 2 different medications (rifapentine and isoniazid) once weekly for 3 months (so commonly abbreviated as ‘3HP’) is now available in limited settings in Canada. A recent study by Alvarez et al (2020) supports the feasibility and safety profile of 3HP for the treatment of LTBI in Nunavut.

A third challenge related to the expansion of LTBI treatment is ensuring that people ultimately complete the medication regimen. Pease et al (2019) reported that older individuals and those identified via employment screening were at highest risk of not completing LTBI treatment. Thus, a number of people on LTBI treatment will require adherence support.

But how best to actually expand LTBI diagnosis and treatment within Nunavut? WHO’s EndTB Strategy mentioned above makes it clear that there should be plenty of community involvement: “The affected communities must also be a prominent part of proposed solutions. Community representatives and civil society must be enabled to engage more actively in programme planning and design, service delivery, and monitoring, as well as in information, education, support to patients and their families, research, and advocacy. To this end, a strong coalition that includes all stakeholders needs to be built.”

More on this in another blog…

Footnote

[1] The Nunavut TB Manual defines LTBI as “the presence of infection with TB bacteria, without evidence of clinically active TB. Clients with LTBI have no TB symptoms, no evidence of radiographic changes that suggest active TB, and negative TB smears and cultures. LTBI is not infectious.”