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Australian open-heart surgery volunteers in Tonga

Nuku'alofa, Tonga

OHI Team Leader, Julie Hulston, Chief Surgeon Dr Bruce French, and Dr Toakase Fakavikaetau, Vaiola Hospital. 12 September 2019.

A team of 35 medical professionals from Open Heart International (OHI) in Australia are currently in Tonga performing open heart surgery on locals with rheumatic heart disease.

At Vaiola Hospital, OHI Chief surgeon volunteer, Dr Bruce French, said since his first visit to Tonga in 2011 to date, the number of open-heart surgeries performed in Tonga is still the same.

But he attributed this to a screening program run in schools, which detects early rheumatic heart disease. The screening “doesn’t happen anywhere else in the world”.

“There is no reduction in the amount of operations. I think it’s being detected more commonly now than in the past,” he said. “As a result of that program, not only are children with early rheumatic heart disease being detected but also Tongan children with congenital heart disease, yet to cause symptoms, are being picked up.”

“And this is, I would have to say, something worth celebrating in Tonga,” he said.

Dr French, who has been volunteering his services in Tonga since 2011, will be retiring soon and chose Tonga as his last volunteer stint.

Acute Rheumatic Fever

People in Tonga and many other countries in the South Pacific suffer from acute rheumatic fever, which is an immunological response to an infection caused by a bacteria.

“Generally a sore throat, or tonsillitis or laryngitis, and it frequently occurs in children,” said Dr French.

“One of the problems with having repeated attacks of acute rheumatic fever is heart valve disease. And this is what we’ve been treating in Tonga.”

Repeat attacks of acute rheumatic fever affect three of the four valves inside the heart, particularly the mitral valve also the aortic valve and occasionally the tricuspid valve.

“When the valves, either do not open properly or do not close properly, then the blood doesn’t flow normally through the heart and that places a huge strain on the heart.”

He said in young people, they cope with it for a considerable period of time but eventually it gets to the point where irreversible damage is likely and the only solution is to replace the valves or very occasionally to try and repair the valves using the damaged valves and making them function normally.

Operations can take anywhere from three to four hours or half a day depending on the severity of the disease.


Dr French said the most important message he would like to advise Tongans is to try and prevent acute rheumatic fever.

“The disease usually occurs from having tonsillitis. So, tonsillitis should not be allowed to go untreated. It should be treated with antibiotics. That’s not going to entirely prevent rheumatic fever occurring, it however will probably do something to reduce the incidence of it.”

OHI Teamleader, Julie Hulston stressed how important it is for people who suffer from the disease to continue meeting their appointments and maintaining antibiotics treatments.

“If you maintain your treatment for period given it would reduce the likelihood to have further valvular disease or structural heart disease.”

The OHI volunteers usually perform open heart surgeries every two years but are now hoping to return to Tonga every year.

“From this visit, we are hoping to now come back every year because we can still see that there is a great need,” said Julie.

She added even if it’s not for further surgery, they can help local doctors with assessing and monitoring patients.

According to local paediatrician, Dr Toakase Fakavikaetau, the OHI team performs on average, 30 operations in 10 days during each visit.

She said the average cost to bring the team here is the same as sending three patients to have the same surgery overseas.

The OHI team will return to Australia at the end of the week.