Rarely seen in urban populations, Rheumatic Heart Disease is quietly killing Australian Aboriginals
Rheumatic health disease was common until the 1960’s when penicillin become widely available. It is now virtually unknown about urban populations.
It’s causes include overcrowded housing, poor sanitation and lack of regular medical treatments.
The disease is still common in Aboriginal and Torres Strait Islander communities across Australia.
What is rheumatic heart disease?
The Group A Streptococcus bacterium first manifests itself as a sore (strep) throat, or skin sores. Most people recover with timely medical treatment and antibiotics. However around 3% to 6% of people go on to develop an abnormal response to the bacteria. The result is the body’s immune system attacks its own tissues. Symptoms for people include sore joints, fevers and inflammation of heart valves. If left untreated, this can lead to severe heart damage and potentially, early death.
The treatment is a long course of penicillin injections and ongoing medical reviews. Children typically need a monthly injection of penicillin for a ten year period.
Today, rheumatic heart disease affects more than 32 million people worldwide and kills more than 275,000 people every year. It is associated with low income countries like Africa and some parts of Asia.
98% of the cases of the disease diagnosed between 2005 and 2010 in Australia were for Aboriginal and Torres Strait Islander peoples.
Children in the Northern Territory, between the ages of 5 to 14 years are the most likely to be first identified with the disease.
One of the few urban living non indigenous people in Australia who contracted rheumatic heart disease was Kevin Rudd the former Prime Minister. He contracted the disease while living in rural communities as a child.
Australian Aboriginals suffer from this preventable disease at an unacceptably high rate
An Indigenous person living in the Northern Territory is 54.8 times as likely to die from the complications of rheumatic heart disease than a non-Indigenous person. Rheumatic heart disease Australia.
Due to lack of coordination between different Australian state health departments, the actual number of people who have been diagnosed with rheumatic heart disease in Australia is unclear.
Between 2007 and 2009, 897 deaths were attributed to rheumatic heart disease. Rheumatic heart disease Australia.
Dr Bo Remenyi is a Paediatric cardiologist who works at the Royal Darwin Hospital and services many remote indigenous communities
These are her main points –
- Rheumatic heart disease is really a disease of indigenous people in Australia.
- Rheumatic heart disease is the leading cause of cardiovascular health inequality between indigenous and non indigenous Australians.
- 41 is the average age of death for people with RHD in Australia.
- Aboriginal people are 122 times more likely to have RHD than non Aboriginal Australians.
- Rheumatic heart disease rates had began to drop in urban western populations for the introduction of Penicillin.
- The biggest marker of social disadvantage today, is the disease rheumatic heart disease.
- Skin sores and sore throats are normalized in indigenous communities. In some communities 50% of all indigenous children will have these diseases. In one community 10% of children are receiving monthly penicillin injections.
- The burden of rheumatic heart disease in Australian indigenous communities is higher than anywhere else in the world.
- Even if people with rheumatic heart disease are treated with penicillin, they are likely to return to overcrowded and unhygienic houses where they will be constantly re infected.
- Treatment for rheumatic heart disease needs to be based at the community level, not the individual patient level. Current methods are costing taxpayers a lot of money and patients their lives
- As with eye, ear, kidney and lung problems in indigenous communities we are applying ‘surgical’ solutions that are not effective in reducing rates of disease or preventing recurrence.
- Despite the fact that there are now 20,000 injections of penicillin being given to indigenous people with rheumatic heart diseases, the incidence of the disease are actually rising. This requires a massive nurse workforce.
- The only way to deal with rheumatic heart disease is changing from a medical to a community approach – increasing living standards, community hygiene and education about how disease spreads.
Patients with rheumatic heart disease stand out in any hospital ward
When you are doing the morning meds as a nurse, you can easily identify people who suffered rheumatic heart disease as a child.
- They are taking a large amount of cardiac drugs every day.
- They suffer reduced mobility and live restricted lives, dominated by chronic illness and repeat hospital visits.
Despite it’s terrible toll, rheumatic heart disease does not attract coloured ribbons, sexy pop stars and million dollar concerts.
Despite being the biggest killer of Indigenous Australians, it is not a emoji, gif, uTube or Twitter channel. Community information about rheumatic heart disease does not have its own podcast, Facebook page or app.
Rheumatic heart disease charities do not have sponsorship deals with private hospitals, chains of bread shops, football clubs or real estate chains.
How the sanitation movement doubled the average European life expectancy
The Sanitation movement in 19th Century England and Europe helped wipe out childhood killers like tuberculosis, pleurisy, typhus, tonsillitis, cholera and dysentery. Within 200 years the average life expectancy has risen from approximately 35 to 85.
The campaign fought for –
Widespread access to nutritious food and clean drinking water
Building regulations that restricted numbers of people able to live under one roof and set standards required for houses to maintain.
Building a network of underground sewers that removed waste from cities and disposed of it far away from human populations.
Brought in widespread public education about the connection between dirt, disease and sickness.
Lobbied for compulsory hand washing and sterilization of medical equipment
Brought in public vaccination programs to give ‘herd immunity’ to the majority of populations.
We need to introduce a sanitation movement style reform in Indigenous Australia
The same methods that worked for 19th Century Europe would work for 21st Century indigenous Australia.
Here are some suggestions
Pull down slums, force public housing to comply with regulations and limit the number of people able to live together.
Force the removal of rubbish from living areas and it’s safe disposal.
Insist people maintain higher rates of hygiene, from hand washing to general cleanliness.
Educate people about how germs actually breed, infect and kill people.
Using Indian and African style rural health programs to bring good health care to remote communities. Train up locals to do health checks, use texts, smart devices and teleconferencing to bring medical specialists to remote populations.
For a fraction of the billions Australia currently wastes on bureaucratic red tape and city based hospitals, indigenous Australians could be moved into the 21 Century, and take their rightful place among Australia’s future leaders.
Why are Aboriginal children still dying from rheumatic heart disease? The Conversation 2016.
Burden of disease. RHD Australia
© Wikihospitals March 2016