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Tuesday, 21 May 2019 06:37 pm

Heart fever rates fail to fall among Maori and Pacific Island people

Feb 27th, 2009 | By | Category: Features, Student Features

ebmainIt began as a sore throat, but within weeks it was scarlet fever.

JESSICA DIXON suffered a rare illness developing from a streptococcal infection that left her in bed for weeks. If she was Maori or Pacific Island, this could have affected her for the rest of her life.

She investigates  why rheumatic heart disease affects Maori and Pacific people more than those of other ethnicities:

TEN-YEAR-OLD Ebony Davey-Turner (right) woke in the middle of a July night last year to find she couldn’t move and had a sore stomach.

She yelled for her mum who realised her daughters’ glands were swollen and she was freezing cold.

Ebony’s mum, Raeleen Davey (pictured with her daughter), took her to the hospital’s Accident and Emergency department. They said nothing was seriously wrong and sent her home with paracetemol. 

Throughout the next week Ebony started to deteriorate, Raeleen could find no way to warm up her shivering daughter despite hot baths and wrapping her in extra blankets. The pair returned to the hospital and this time the doctors got it right – diagnosing Ebony with acute rheumatic fever.

The infection spread rapidly and right from the start Ebony showed symptoms that she was suffering from chronic rheumatic heart disease, a heart condition caused by the illness.

Ebony spent 31 days in hospital before she was sent home on a course of penicillin and aspirin. She spent another three weeks off school. 
The young girl was previously healthy, had never really been sick before, was physically active and enjoyed playing all kinds of sport.

Now she is down to monthly injections of penicillin and preparing for a heart operation in March. She says she is not nervous about the operation, but she struggles with some of the treatment: “I hate the injections.”

Rheumatic heart disease results in an average of 150 deaths a year, making it probably New Zealand’s most infectious disease in terms of life lost through premature death. 

Maori and Pacific people in New Zealand have one of the highest rates in the industrialised world. Ebony is one of many Maori children affected by the disease, which is now most commonly found in third world countries.

Acute rheumatic fever begins with a streptococcal infection; this can simply be a sore throat similar to something everyone would and will have experienced many times in their lives. If treated soon with antibiotics the infection stops here, but without proper diagnosis a sore throat can lead to the development of Rheumatic Heart Disease in just three weeks.

The fever affects the heart, joints, skin and brain. The heart is the only organ that suffers long term damage and premature death is the ultimate consequence of the disease.

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Despite the dangers of ARF it is often misdiagnosed or not taken seriously. Rheumatic fever mostly affects those in the under 20 age group.

For more information on diagnosing and treating rheumatic fever, refer to the New Zealand Guidelines for rheumatic fever, available from: www.nhf.org.nz

Dr Anthony Ruakere says the trouble with a 10-year-old is they have a sore throat and don’t say anything about it. They think it is just a sore throat. And they don’t say anything because they think their parents will say it’s just a sore throat and it will go away.

“The problem is, it does go away but then all of a sudden they get really sick for what seems like no reason.”

Children sometimes can get rheumatic fever when they are young, but it’s not noticed or treated incorrectly, and later in life they may develop heart disease. 
Rheumatic fever has had a significant impact on Maori and Pacific peoples in New Zealand. 

Hospitalisations, particularly of Maori and Pacific people, have failed to decrease in New Zealand over the past decade and are amongst the highest seen in a developed country. 

Sore throats are a common medical condition. They are usually viral and benign. Sometimes a sore throat can be a group A streptococcus sore throat, and this is the infection that can lead to rheumatic fever. There are currently no vaccines for group A strep in New Zealand. 

However, in New Zealand not all groups are at equal risk of developing ARF as a consequence of having a sore throat. 

Well known for his research into Maori health issues, Professor Mason Durie talks of how over 100 years ago Pakeha expected Maori to die out and be replaced by the white man. One of the main reasons for this was that disease would kill them off – diseases like rheumatic fever, which was introduced by Pakeha. 

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After the Treaty of Waitangi was signed in 1840, the decline of the Maori population continued. In 1846, Dr Isaac Featherston, a surgeon who was to become part of the House of Representatives, declared: “A barbarous and coloured race must inevitably die out by mere contact with the civilized white…and all we can do is to smooth the pillow of the dying Maori race.” 

Europeans had already spent hundreds of years building up a resistance to such diseases. Medical professionals don’t know why Maori have not developed a genetic resistance. 

Dr Lance O’Sullivan, chairman of Te Hotu Manawa Maori (Rheumatic Fever Guidelines Writing Group), says though the disease is now rare in industrialised countries and in New Zealanders of European decent, it remains a significant problem for Maori and Pacific children in NZ.

There is no evidence of a genetic susceptibility of Maori to rheumatic fever, yet unlike New Zealand Europeans infection numbers have failed to decline. Today, Pacific rheumatic fever rates are similar to those of European New Zealanders in the 1920s. In 2006, Maori accounted for 62% of rheumatic heart cases, with 89% of those affecting people under the age of 20. 

“It is unacceptable that the Maori and Pacific youth of NZ carry a third world burden of this preventable disease,” says Dr O’Sullivan.

There are many factors contributing to these high rates; they are outlined in the recently developed NZ guidelines. They include overcrowded living conditions, socio-economic deprivation and decreased access to appropriate and effective healthcare.

There is also clear evidence that people on low incomes are more at risk, especially if living in over-crowded environments. Maori are more likely to be represented in this demographic. 

Dr Ruakere says children and families sleeping in the same beds can also be at risk. This can be due to over-crowding, lack of education and sometimes cultural appropriateness. Maori and Pacific people are familiar with sleeping in close proximity to one another for many reasons. Sometimes children share the same bed for warmth or due to lack of space. 

Problems can occur when a child surrounded by others suffers a sore throat, proper care is not taken and it is shrugged off as a viral infection. The fever can then spread to inffect others. 

Dr Ruakere says the biggest problem is when parents and people think it is just a sore throat and they don’t go to the doctor. This is far more likely to happen within the low income Maori and Pacific population. Especially, Pacific island people don’t go to the doctor much anyway. Then it gets put off because of the cost and the need of money for other things, “you can’t treat people who don’t go to the doctor.”

The problems do not go away for patients after they have been treated for rheumatic fever. There are a number of complications that follow treatment and these can seriously compromise quality of life for many patients.

Paediatric nurse Karen Georgeson has seen and worked with many children suffering from rheumatic fever and talks of Ebony as being the most memorable. She says the infection was so full blown and her systems shut down very quickly. “Her only warning was a sore throat a couple of days earlier.”

Mrs Georgeson says recovery for a child with the disease is a life-long process. They need monthly injections of antibiotics until they are 21, sometimes even for the rest of their lives. “The injections are really painful, too.” If patients don’t have them, they are at risk of getting more streptococcal infections, which could do more damage to the heart. 

If they ever need surgery or dental work done, they need extra prophylactic antibiotics as well, because of the risks caused by leaky or deformed heart valves. 

Nurses often have to track down these kids for their monthly injection. Young people can sometimes go through a phase of rebellion during adolescence and this can cause complications later on.

A 30-year-old woman says she has suffered the effects of rheumatic fever since she was a child. “I remember having a sore throat when I was 9 and thinking it would just go away.”

The sore throat did leave, but rheumatic heart disease set in and since that time it has affected her ability to play sport or join in with physical activities. She says she wishes it had never happened to her because of how much it has controlled her life. “I lost the ability to do things that other people can do.”

The disease is preventable, and that’s what makes it so hard from a nurse’s perspective. “Warning signs should never be ignored. Never ignore sore throats.”

Treatment of rheumatic fever is expensive. In 1991, it was estimated that the total cost to the Auckland health service alone was $3.6 million. Chronic rheumatic fever accounted for 71% of the costs. There are a number of indirect costs, which are often difficult to measure. These include not only the loss of quantity of life (it has been estimated that five to ten young people die each year as a direct result of ARF or RHD), but also the loss of quality. 

New Zealand guidelines suggest that in the future a cost-effective vaccine for strep throat may be the ideal solution for preventing rheumatic fever. Scientific problems have so far prevented the development of such a vaccine. Currently, preventing the development of rheumatic fever requires prompt and accurate diagnosis with antibiotic treatment.

Magazine Best Practice New Zealand says it is important for GPs to be suspicious of rheumatic fever within high risk groups. The GP’s main task is to suspect the condition and refer the patient to secondary care for confirmation of the diagnosis and then treatment.   

University of Otago researchers Dr Richard Janie and Associate Professor Michael Baker say the high rate among Maori and Pacific people is evidence that primary prevention is inadequate. They argue it is a public health priority to improve service to these people.

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Ebony and Raeleen are preparing for the trip to Starship Hospital in Auckland where Ebony will have a heart valve replacement operation.

Raeleen says she hasn’t had a good night’s sleep since her daughter was first diagnosed. “I keep worrying. Is that normal?” She has since become interested in any conditions that affect the heart and why this condition affects Maori more than other ethnicities. 

“I think the more that people know about it the better. “If I knew my child was at risk because she was Maori, I would have been more aware.”

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is a Whitireia Journalism student.
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  1. Very interesting reminds me of nursing 50 yrs ago We saw a lot of this then. Sorry it hasn’t changed.

  2. I found this a very interesting article, it reminds me of nursing 50 yrs ago. We saw a lot of this then. Sorry it hasn’t changed.

  3. A very informative educational article, interesting to read and gives good feeling about the disease and its long term impact for the patient and their family. It is such a shame that health professionals are not more aware and alert to the dangers of assuming our children have “just a sore throat”.

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