Fagatogo, American Samoa — To assist with American Samoa’s Rheumatic Heart Disease (RHD) relief efforts, David Adams from Duke University Medical Center, an Advanced Cardiac Sonographer, and his colleague Peg Knoll from the University of California Irvine Health, arrived on island to conduct a two-week didactic and hands-on (live scanning) training on echocardiography, a painless procedure that uses sound waves to take “pictures” of the heart.

Additionally, the Department of Public Health (DOH) acquired two new ultrasound machines (Philips CX50 CompactXtreme Ultrasound Systems). Seven medical professionals from DOH and LBJ hospital will be trained on the proper use of these new echo machines to perform limited screening exams, which will enhance operational efficiency and improve the quality of care locally.

To determine the prevalence of RHD in American Samoa, a team from Oregon Health and Science University (OSHU) conducted echocardiographic screening. The findings of their study, published in September 2017, raised a call to action:

“The prevalence of RHD in American Samoa (12.9%) is to date the highest reported in the world literature… while American Samoa has a small overall population at 55,519 people according to the 2010 US Census. This study demonstrates the significant burden of rheumatic disease, which rivals that of larger countries.

“Furthermore, we proved with this study that a robust screening protocol using portable echocardiography machines is feasible and also facilitates education. A calculated screening protocol focusing on older children should be undertaken in populations at high risk for this ultimately eradicable disease.”

Prior to this revealing study, a list from the LBJ Pediatrician showed that a total of only 284 patients had been diagnosed with Rheumatic Fever (RF) and RHD.

However, the OSHU study showed that the number of children living with RF and RHD in the territory is much higher than those listed in the LBJ and DOH shared data registry.

Based on the prevalence rate of 12.9%, and the number of school children attending public (13,823) and private (3,225) schools in American Samoa, it is estimated that 2,199 children are potentially suffering from RF/RHD.

These figures suggest that only 15% of children aged 5-17 years have been or are being treated for RHD, leaving 85% of American Samoa’s children vulnerable to this debilitating disease.

In light of this alarming data, DOH has set RHD as a public health priority, and has organized an RHD Advisory Committee and a local RHD team to develop a comprehensive RHD prevention and control program.

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