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Untrendy, 19th Century disease stalks wealthy, 21st Century country

 

Most of the time, when medical articles cross my desk, I quickly read and file them. But this one threw me into an instant rage.

Tackling rheumatic heart disease in remote Indigenous communities ‘key to Closing the Gap’
ABC March 2016

When you are doing the morning meds as a nurse, you can instantly pick patients who suffered rheumatic heart disease as a child.

  • The patients have at least one full drug chart, of cardiac drugs
  • The cardiac drugs they are on are high doses of the heaviest hitting drugs on the market
  • Despite taking these medications every day, they suffer reduced mobility and live restricted lives, dominated by chronic illness and repeat hospital visits.

Patients with rheumatic heart disease stand out in any ward.

Rheumatic heart disease is not trendy; it does not attract coloured ribbons and aggressive advertising campaigns. Inner city billboards do not discuss the risks of rheumatic heart disease, or how easily it is avoided.

Rheumatic heart disease charities do not take up entire floors of buildings in the most exclusive parts of inner city suburbs. Millionaire pop stars, wannabe models and international crickets do not cry in front of mainstream media about rheumatic heart disease.

Why not?

Rheumatic heart disease is caused by an untreated throat infection of group A Streptococcus. One or several bouts of rheumatic fever will cause serious damage to the heart, particularly the heart valves.

Rheumatic heart disease has been wiped out in most parts of the developed world. Doctors say that rheumatic heart disease should not exist in Australia. However, the disease is prevalent in the Australian Indigenous community. Currently, 3,000 people in the Northern Territory alone are being treated for the disease. According to Dr Remanyi, a paediatric cardiologist at Royal Darwin Hospital, treating the late stage disease with expensive, high-tech surgery is not the answer.

Starting from preschool, we should be educating children about hygiene,  germ theories and how infections are spread.

Dr Remanyi also said it is essential to address overcrowded housing.

It doesn’t matter how educated you are if you have 20 people in a two-bedroom house, then it’s hard to prevent any infection spreading.

These comments echo 19th-century Sanitation movement literature. Florence Nightingale, Edwin Chadwick and Charles Dickins all raised the same issues. Childhood disease spread easily, and unchecked will cause death or chronic ill health. The rate at which infectious diseases spread is directly linked to the numbers of people living in one house and the proximity of houses to each other. Access to clean food and water and basic medical care are the cornerstones of health care. And finally, prevention is better than care.

 

19th Century London from Wikipedia

19th Century London from Wikipedia

 

Why are we having a 19th-century discussion in the 21st century? Because not everybody in our society has the same basic living standards. The result is unnecessary and million dollar bills for hospital treatments of dubious success rates. And low income people crippled for life, by a disease that is very easily preventable.

My suggestions?

Refuse to admit people to Emergency Departments unless they have a doctor’s referral stating that they can’t be treated by a GP. Slash the Medicare rebate list, banning every unnecessary test and treatment (an estimated one-third of the 150 billion a year health budget). Re-allocate minor medical tasks like rewriting scripts and performing minor tests to practice nurses. Make community health clinics the mainstay of healthcare and hospitals the place of last resort. Sack the Pharmacy Benefits Board (including the industry lobbyists), and only pay what the UK, NZ and Europe spend on pharmacy drugs. Allow doctors the legal right to refuse medical treatment that offers little benefit (the majority of the health budget is spent on people in the last year of their life).

Community prevention is where the majority of the health dollar should be spent, along with high tech startups and home based care. Trendy inner-city charities, Big Pharma, Big medical device, Big hospitals, Big private specialist, Big pathology and Big pharmacy simply don’t deliver value for money.

And people with should not be living with chronic diseases that are 100% preventable.

References

19th Century Sanitation Reform essay – e-notes

© Wikihospitals March 2016

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