A doctor with heart targets Rheumatic Heart Disease
A project focusing on rheumatic heart disease— referred to as RHD in the medical community— has taken off in the territory, and, as is the case with many such projects, it was begun because of one doctor’s deep commitment and concern for her patients.
In this case, the patients were the children of American Samoa, and the doctor was Beth Parker, MD, a pediatrician at LBJ Medical Center here on contract from Cleveland, Ohio.
According to Dr. Parker, RHD was a global problem for centuries. Before the advent of antibiotics—specifically penicillin— RHD was a serious, potentially fatal form of heart disease which targeted youth and adolescents.
(According to the Mayo Clinic, the most commonly affected are children, age 5 to 15 years, although infants and adults can also come down with it.)
Before the discovery of antibiotics in 1928 and its widespread use (which occurred during WW2) anyone who came down with ‘strep throat’ —a severe sore throat caused by the streptococcal bacteria— faced the strong possibility of developing rheumatic fever, an autoimmune disease which damages the valves of the heart.
The streptococcal bacteria, which is present everywhere, can also be found in skin wounds; here again, antibiotics have come to the rescue to eliminate the virulent bacteria, and early treatment with antibiotics for skin wounds also helps to eliminate the possibility of developing rheumatic fever and heart problems associated with the once common condition.
According to Dr. Parker, it wasn’t just the advent of antibiotics, it was also the push to inform the public through U.S. Public Health initiatives, along with the prevalence of antibacterial soaps, cleansers, and antibiotics in the United States that have relegated the problems of RHD into a distant memory there. A general and widespread understanding of the role of hygiene and cleanliness have also helped eliminate problems associated with strep infections, she noted.
In fact, the problems related to rheumatic fever and RHD have all but disappeared in the mainland United States, Hawaii, and most of the developed nations of the world, but according to the LBJ pediatrician, it continues to plague the population of many island nations in the Pacific, including the territory of American Samoa.
When Dr. Parker arrived in 2010, she was struck by the high number of children with RHD. She spoke with her colleagues, including pediatricians Dr. Mike Favazza, Dr. Maria Gayapa and head of Pediatrics Dr. Jim Marrone, and they agreed that it was a problem which needed to be addressed with an aggressive combination of strategies.
Focusing on patient/parent compliance to drug treatment, surveys to determine how widespread the problem, and parent and public education, they enlisted the aid of colleagues in an Oregon medical school to tackle the problem. They have also had researchers from the CDC (Centers for Disease Control) come out to study if outbreaks of scabies (a highly contagious skin disease) have had an impact on Rheumatic Fever infections. They have also opened communication with the World Heart Federation.
SURVEYING THE FIELD WITH THE HELP OF COMMUNITY PARTNERS
Recently, Pediatric Cardiologists from Oregon’s Health and Science University in Portland (OHSU) visited the territory to conduct preliminary research on the prevalence of RHD among school children. Beginning with the high schools, they performed screening echocardiograms on approximately 200 high school students.
Among this population they found 30 children with abnormal heart valves, 27 of which appear to be previously undiagnosed cases of RHD. Those children have now been linked up with LBJ Pediatrics for treatment which should halt the progression of heart disease. The OHSU team plans to make two more visits to American Samoa over the next six months to screen another 400-600 children.
Additionally the local pediatrics team has increased their focus on children with acute rheumatic fever to ensure that they come in on time for their antibiotic shots. This entails antibiotic injections every three weeks, which help prevent the progression to heart disease. This effort, led by Nurse Practitioner Amber Rogers, has increased the overall compliance rate from 79.6% to 90.9% over the past nine months.
The OHSU project was funded primarily by StarKist Samoa, who have begun a community partnership with LBJ’s pediatric department, and taken up the cause which Dr. Parker and her colleagues have championed.
“We have fixable, preventable heart disease here” said Dr. Parker, who welcomed the opportunity for collaboration with community partners. She said the Department of Health is also part of the community effort, and have supplied additional funding. They sponsored the research arm of the latest trip by OHSU staff, while LBJ and Starkist helped more with the clinic part of the trip.
Over the past few years, Starkist has been donating money to the pediatrics department and most recently, through their "Heart to Heart" campaign, a combination of donations were solicited from Starkist employees as well as the head office. A total of $15,000 was given to LBJ pediatrics department to help pay the expense of bringing the OHSU team to the territory.
The ongoing research project seeks to characterize the incidence of rheumatic heart disease on island, while the OHSU team additionally provides a cardiology clinic for those children identified as having rheumatic and other heart diseases.
StarKist’s donation made possible this last visit and they are committed to support future visits by the team, paying for airfares, hotel rooms and other supplies. “Without their support, this project would not be possible,” said Dr. Parker’s colleague, Dr. Favazza, who is working— along with the entire pediatrics department— to help eradicate RHD in the territory.
Dr. Favazza added, “We’re working as a team, but it was Dr. Beth Parker who put RHD on the radar, and eradicating RHD is now included as part of the five year Non Communicable Disease plan for the territory.”
"With the American Samoa Department of Health supporting screening measures and LBJ supporting treatment measures, we are seeing our local healthcare system function in an efficient and effective manor to address this critical but preventable non-communicable disease,” Dr. Favazza told Samoa News.
Left untreated, strep throat —which is an extremely painful sore throat accompanied by a fever— too often becomes RHD.
“Often, parents wait till the child is extremely sick before bringing them in to see the doctor, which means Rheumatic fever may have already done its damage” Dr. Parker explained.
She said that anytime a child has the identifying symptoms— a fever with a sore throat —they should bring the child for a “culture” which is a simple swab of the mouth with cotton that can verify the presence or absence of strep.
"If a basic strep infection isn't treated within nine days, children in American Samoa run the risk of developing rheumatic fever, usually heralded by debilitating migratory joint pain. Of those children, about two-thirds will progress to life-threatening rheumatic heart disease," she noted.
Treatments for RHD, taken in time, can reduce tissue damage from inflammation, lessen pain and other symptoms, and prevent the recurrence of rheumatic fever.
“It’s been done elsewhere,” Dr. Parker told Samoa News. “And it’s possible to eradicate RHD here.” Knowing Dr. Parker, it will happen.