DEVELOPING A REGIONAL APPROACH TO RHEUMATIC HEART DISEASE CONTROL IN THE PACIFIC

As part of its demonstration project on rheumatic heart disease control in the Pacific, the World Heart Federation organized the Second Rheumatic Heart Disease Prevention workshop in Nadi, Fiji, on 13-15 February 2008. Sponsored jointly with the World Health Organization, the workshop was a follow-up to the first regional workshop on rheumatic heart disease held in October 2006.

High burden of rheumatic heart disease in the Pacific

Although it can be controlled with cost-effective measures and has been all but eliminated in developed countries, rheumatic heart disease still affects 15–20 million people living in developing countries. Most of its victims are children and young adults, and few have access to the complicated and costly medical treatment needed to save their lives and reduce disability when the heart valve damage caused by acute rheumatic fever progresses.  

The Pacific Island Countries have the highest documented incidence of rheumatic heart disease in the world, and most do not have either the systematic control programmes that could prevent the heart damage it causes, or the advanced surgical facilities needed to repair it and limit its effects.  Many of the Pacific Island Countries have relatively small populations, have limited medical facilities and are isolated from other countries. Some country populations are spread over many small islands so that even internal travel and communication is a challenge.

Sharing data, experience, and challenges in disease control

Aiming to improve understanding of rheumatic heart disease and its control in the region, the Pacific rheumatic heart disease programme brought together senior public health officials and clinicians from Pacific Island Countries.  Fifteen of the 20 countries invited sent representatives to the workshop, where they joined rheumatic heart disease experts and other stakeholders from Australia and South Africa.

In presentations, group discussions and break-out sessions participants compared information on the disease burden in their respective countries, discussed experiences and challenges in management and control, and shared the World Heart Federation curriculum, educational materials and register databases developed and tested in project demonstration sites in Fiji and Samoa. In these sites the World Heart Federation programme is helping local health authorities develop best-practice register-based coordination of rheumatic heart disease control, the approach recommended by the World Health Organization to be the most cost-effective. Participants discussed local barriers to effective control and treatment, challenges of balancing rheumatic disease with other health priorities, means of systematically screening school children to ensure early identification of the disease, problems managing the crippling costs of sending patients abroad for heart valve surgery, and possibilities for obtaining funding to strengthen preventive programmes. Two satellite workshops gave practical introductions to echocardiogram use and management of register databases.

Breaking isolation, stimulating action

Sharing the serious barriers they face developing effective rheumatic heart disease control programmes alone, delegates at the workshop explored possibilities for developing a coordinated, collaborative approach for the entire region.  They endorsed the Call for Action drafted at the first regional workshop in 2006, and confirmed the mandate of the committee formed at the first regional meeting. Its members, who include Dr Toa Fakakovi of Tonga, Dr Hensley Garae of Vanuatu, Dr Joseph Kado of Fiji, Dr Satu Viali of Samoa and Dr Joseph Santos of the Commonwealth of Northern Mariana Islands, will work together to steer activities of the network to give rheumatic heart disease higher priority among health systems of the region and to help obtain funding for further development of rheumatic heart disease control. As the next step, a subcommittee was named to write a report on the status of rheumatic heart disease in the region.

Those attending the workshop reported that its content was useful and informative: Griffith Harrison of Vanuatu reported that it was "fulfilling to meet with others who share the same passion about our work." Since the workshop, delegates from Federated States of Micronesia have organized several workshops on rheumatic heart disease for their colleagues, and those from Tuvalu have organized screening for children which has identified many new cases of rheumatic fever.
 
To learn more about rheumatic heart disease, including RHDnet, the World Heart Federation’s global resource for its prevention and control, visit: www.worldheart.org/rhd.net