This Opinion piece is by Dr. Ibrahim Khan, the medical health officer for Indigenous Services Canada.
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Prior to the pandemic, there had not been a baby born in Saskatchewan to a mother with syphilis since 2014. In the past year, we have once again seen cases.
We’ve been talking non-stop about COVID-19 and the associated mental health crisis, sometimes called the parallel pandemic.
We are about to see a third pandemic. Few are thinking about it, but it’s keeping me up at night. This is a monster with three heads: HIV, syphilis and hepatitis C.
While Saskatchewan has long been home to the highest numbers of HIV in Canada, the novel coronavirus is going to set us back years, if not decades, and it’s likely to put further strains on our health-care system.
As the medical health officer for Indigenous Services Canada, I and my team serve First Nations in south and central Saskatchewan. We’ve been leading the COVID front for those communities, while still keeping a sharp eye on other infectious diseases.
HIV is an opponent we’ve been working hard to defeat.
Over the past few years, we’ve worked with communities and their leaders to get 44 harm reduction sites in communities across Saskatchewan. We’ve implemented mobile testing for HIV and other infectious diseases. We’ve embarked on a massive education program and done our best to help improve the lives of our indigenous population.
That work was paying off. Case numbers were coming down. Then COVID hit.
For months we’ve been unable to test, meaning people who unknowingly had HIV or another sexually transmitted disease were unable to find out if they were carriers. Lockdowns in some communities meant there was little to no access to medical care, other than emergency care.
Isolation, fear and uncertainty helped drive increased drug use and unprotected sex. HIV and syphilis often show up together.
An old disease
If you aren’t familiar, syphilis is an old disease. It was first recorded in 1494. It’s transmitted through sex.
It begins with symptoms such as painless sores/lesions, rashes, wart-like growths, hair loss and swollen lymph nodes. If left untreated, it can cause blindness, heart problems, dementia and many other issues. The damage it can cause to the body cannot be undone.
It is curable through antibiotics, but will not go away on its own.
We know the syphilis numbers aren’t good. Testing has only started to come back in some communities. Preliminary rates from 2020 show the syphilis diagnosis rate for the communities we serve was 308 cases per 100,000 people. This is a 110 per cent increase compared to the previous year, and those numbers are preliminary.
We’re also seeing something that hasn’t happened in years: syphilis in childbirth.
When a mother passes syphilis in utero to her child, it can lead to two outcomes. One is a stillbirth. The other is congenital syphilis.
A child with congenital syphilis can come into the world with a range of issues. Sometimes it takes months or years for the issues to appear. They can range from an inability to thrive to birth defects, meningitis, intellectual disability and — if they survive — a lifelong need for support from our health-care and social welfare system. All of these possibilities are heartbreaking.
When there is a single case of a woman passing syphilis to their baby, it sets off alarm bells in the medical community. It means an entire medical system failed, because the woman didn’t receive any prenatal care.
In many cases, these women are young, frightened, have addiction-induced critical issues, and lack a stable home life or family. Sometimes they are hard to reach and harder to help. COVID has made that even more difficult.
At the risk of repeating myself, we haven’t seen a case of this in many years. This is serious. I’d call it a public health emergency.
We are all affected
COVID has erased the strides we’ve made in the past decade, and it may have pushed us back to where we were 20 years ago. When it comes to HIV, syphilis and hep C, what happens in Indigenous communities is mirrored in the rest of the population.
Even if you don’t consider yourself at risk, consider the human and financial cost to treat these infections. Think of the toll on families and communities, and how this put additional pressure on our health-care system.
So how can we change these numbers?
Condoms would be the first line of defence to stem the spread of syphilis and HIV. We must educate people on the early signs of syphilis. Better yet, we could encourage people to get a routine blood test that looks for all of these conditions.
If you are pregnant, talk to your community health nurse or a family doctor to arrange for regular checkups, as all these conditions are 100 per cent preventable and the care is freely available to any First Nations person on- or off-reserve in Saskatchewan.
As we emerge from one pandemic and begin the battle against this deepening health crisis, we also need to improve access to these hard-to-reach populations and build partnerships for more community-based and culturally-grounded services. We need to ensure seamless access to addiction and mental health programs, and syringe distribution programs, are available everywhere they are needed. We must provide free condoms.
We need to support the people around us to help them make choices that will reduce these risks and improve their health.
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