Yesterday I saw a four-year-old boy with school sores.
The day before my colleague saw a 16-year-old girl with a fever and knee pain.
Last week our visiting paediatric cardiologist saw an eight-year-old girl with a new cardiac murmur.
Last month our clinic health worker saw a 25-year-old male receiving his four-weekly injection for Rheumatic Heart Disease.
For those of us that work in remote Indigenous areas such as the Torres Strait Islands, diagnoses of Acute Rheumatic Fever (ARF) and Rheumatic Heart Disease (RHD) are woven into the fabric of our daily practice. Indigenous children and young people with school sores or sore throats are reflexively given an intramuscular LA-Bicillin injection to prevent ARF. We follow the dogma that fever and joint pain in an Indigenous child or young person is ARF until proven otherwise. Weekly RHD clinics here in the Torres are the norm.
The health inequalities between Indigenous and non-Indigenous Australians are well reported: 98% of ARF and 90% of RHD cases throughout Australia identify as an Aboriginal or Torres Strait Islander person. Young Indigenous Australians are up to 122 times more likely to have RHD and 19 times more likely to die from RHD than their non-Indigenous counterparts.
The main drivers of ARF and RHD are socioeconomic disadvantage including household overcrowding and limited access to infrastructure to maintain hygiene. Research groups such as Menzies School of Health Research are tirelessly researching ARF and RHD in an endeavour to optimise primary and secondary prevention and evidence based models of health care. Addressing these social determinants of health through public education, community engagement and sustainable governmental policy is vital in eliminating this disease from Australia. Key stakeholders and community members met in Darwin last year and agreed that ending RHD requires a collaborative and community-based approach with robust and respectful community relationships.
Here in the Torres, our stellar nursing and health worker staff run weekly RHD clinics to follow up patients and ensure their healthcare and LA-Bicilin injections are up to date. We are also fortunate to have Dr Ben Reeves, a Cairns-based paediatric cardiologist who regularly visits our region to screen our community, confirm new suspected diagnoses and follow up on our cohort of RHD patients. For most clinicians working in northern Australia including here in the Torres, our careers will be veiled by ARF and RHD. It is my hope that as the decades elapse, rates will continue to decrease, until one day we can celebrate the eradication of RHD.
Organisations such as RHD Australia and END RHD are fantastic Australian resources to learn more about this disease. You can download the Australian guidelines for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease (2nd edition) here. Diagnosis can be challenging and complex. Here in the Torres we carry around this free diagnosis calculator app developed by RHD Australia – a fantastic resource to have on your phone!