by Linny Folau

Tonga's only paediatrician Dr Toakase Fakakovikaetau - disturbed by the fact that too many sick children with heart problems were dying needlessly - set out to find them early with a screening program that has now received international recognition.

It is important because Tonga has the highest prevalence (confirmed by echocardiogram) of rheumatic heart disease in the world.

Dr Toakase in August was awarded the Louise Lown Heart Hero Award for Tonga's Rheumatic Heart Disease Prevention Program, which screens primary school children for rheumatic heart disease and provides early, effective treatment. The award is given annually by ProCor, a program of the Lown Cardiovascular Research Foundation in Brooklyn, USA, who chose Tonga as the winner from among 14 countries.

It was an accomplishment for Dr Toakase and the Ministry of Health who, despite the limited financial support and resources, managed in 2003-04 to screen 5,000 primary school children for rheumatic heart disease and provided early, effective treatment through penicillin injection to those who were identified with problems.

They confirmed their suspicions that Tonga has a very high level of heart disease.

Achievement

Delighted about the award from the US-based ProCor that recognises innovative, preventive approaches to cardiovascular health in developing countries, Dr Toakase remains humble about their achievement.

"I cried when I was informed Tonga was chosen as the recipient for the global health award and the award is very significant to me personally because it is an acknowledgement of our work not only nationally but internationally."

Dr Toakase also happily noted that another important aspect in winning such an award is that it will attract more international donors to assist in continuing the program, which she has restarted in July after it stopped in 2004.

"I took up this program because I was disturbed when many sick children were admitted to the hospital and most of them were beyond the surgery stage and we could not do anything about it, so we made the initiative to go out to try to find what is out there."

Since initiating the program in 2003 the determined paediatrician and her team using echocardiography screened children in 27 primary schools throughout Tonga, except Vava'u.

Highest prevalence

What they found was the highest prevalence ever confirmed by echocardiography in the world, with 33.2 per 1,000 schoolchildren in Tonga.

"This is because we are the only country that is out there looking for the rheumatic heart disease and confirming it whereas others are not," she said.

She said the good thing about this program is that the children found with the heart disease were put on a penicillin injection.

"Because of the early detection we are now constantly monitoring their status.

"Another vital aspect about winning this award is that it shows us this is the right way to go in regards to screening and preventing rheumatic heart disease in children and a lot of people have agreed with this method.

"People were blown away by the 5,000 children we screened, which was a third of the Government Primary schools in Tongatapu and 'Eua with more than half in Ha'apai, excepting Vava'u."

Early detection

She added that early detection and prevention through echocardiography is the best way because it picks up the disease and prevents it at an early stage thus saving the hefty funds for surgery when they patients are detected at a much later stage.

Rheumatic heart disease cases use up most of the funds available to send Tongans abroad for surgery and Dr Toakase believes that for the cost of sending one child to New Zealand for surgery they could screen all of the children in the country, and for the cost of sending a second one they could upgrade preventive services provided in Tonga's own primary care facilities

In July this year, Dr Toakase and her team have screened another 1,000 children in the main schools of Tongatapu, including Tonga Side School, Nuku'alofa Primary School, Fasi, Fanga and Ngele'ia. This resulted in 86 more cases found and put on medication.

"The program is well supported by the Ministry of Health and the public and we will go to Vava'u next week where we plan to screen and echo over half of the primary schools in the island," she said.

Open Heart team

Dr Toakase noted that the Open Heart program in Tonga was successfully completed last month and all the heart patient children who underwent surgery had been released from the hospital and are doing very well.

She said they invited the surgical team to come to Tonga through the assistance of the Sydney Adventist Hospital who advertised for the program. Thirty volunteer cardiologists, cardiac surgeons, anesthetists and specialist nurses were in Tonga from October 6-24 on the assistance mission.

Dr Toakase acknowledged the Sydney Adventist Hospital had some funds to initiate the program so through their help the team of surgeons and medical personnel came and were also supported by the Government of Tonga and others.

She said this is only the third time that such a team had visited Tonga, the last one was 21 years ago. "But we are planning to invite them again next year," she said.

RHD in the Pacific

Prevalence of RHD is extremely high in many areas of the Pacific Islands.

Rheumatic heart disease is a condition in which the heart valves are damaged by rheumatic fever.

Rheumatic fever begins with a strep throat from streptococcal infection.

The disease has been all but eliminated in wealthy countries, so almost all of these deaths occur in developing countries, primarily affecting children, adolescents, and young adults. Many cases are detected too late, when the disease has progressed to cardiac failure.

The best defense against rheumatic heart disease is to prevent rheumatic fever from ever occurring. By treating strep throat with penicillin or other antibiotics, doctors can usually stop acute rheumatic fever from developing.