Poverty, ignorance breed RHD
FIFTEEN year old Amira suffers from severe pain in the joints which have crippled her. She is the youngest among six patients awaiting a valve replacement operation at the female ward of Cardiac Surgery Department, Civil Hospital Karachi (CHK). Unlike others at the ward, she is awaiting surgery for many months and this is the fifth time that she has reported to the hospital.
“We are taking time because her blood tests show an increased level of infection in her body and this happens every time she comes for a visit. She was given medicine and it is only recently the infection has reduced to an extent that we can now operate,” said a nurse at the ward.
It wasn’t easy for Amira’s family to send their daughter five times all the way from Sukkur to Karachi. It has exhausted their resources and this time her father didn’t have enough money to accompany Amira to CHK and even she would not have made it if one of her uncles had not brought her to the city at his expense.
Amira is puzzled why she needs a operation on her heart for joint pains. “The doctors say that my heart is damaged. Though I can’t relate the two, I am ready to undergo anything which will free me of this pain which has kept me away from school and all the joys of life.”
She shares a bed in CHK with Zubaida who is from Dadu. At 33, Zubaida would have been a mother of 12 children if six of them had not died. Unlike Amira, she feels she has a clue why she is in this predicament. “My longing for my husband gave me this heart problem. I used to cry a lot for him while he was in a Dubai jail,” she believes.
There are eight more patients admitted for the replacement of valves while four are recovering in the intensive care unit after undergoing operations. Almost all have a case history of rheumatic heart disease (RHD) and similar complaints of severe joint pains, shortness of breath and chest pain. Their low social and educational status makes it difficult for doctors to make them understand that surgery is not a magic wand that will solve their health concerns for good. They have to undergo regular blood tests and maintain contact with their doctor, or they can develop severe complications.
“Ignorance and negligence have brought these patients to a stage where they have no alternative except replacement of damaged valve/s. The surgery won’t help until they follow a strict regime of blood thinner and regular blood tests,” points out Dr Abdul Bari Khan, head of the Cardiac Surgery Department at CHK. Of the 260 surgeries conducted last year, 130 were for valve replacement, almost all were because of rheumatic heart disease.
RHD is common among the young in our society who are poorly nourished and live in unhygienic conditions. Dr Khan has operated on children as young as seven suffering from RHD. He feels extremely sorry for them as many of them have to undergo heart surgery twice in their lifetime because as they grow up the mechanical valve fitted to their young hearts needs to be replaced.
The treatment at CHK cardiac surgery department, but in a private hospital, the operation, including the cost of the valve, would cost up around Rs300,000. The cost of a valve which is usually imported from the US runs into thousands depending upon its type. At the National Institute of Cardiovascular Disease (NICVD) Karachi, around 400 valve replacement operations are done every year.
Though in the early stage valve damage can be treated with valvuloplasty, a procedure used to open a fused heart valve, a majority of the victims of RHD in the country end up losing their own valve and live on blood thinners for the rest of their life.
The agony of the patients and the burden on the exchequer can be easily avoided if the public learns that this heart disease develops from a sore throat infection which is easily treated with common antibiotics. Timely treatment has nearly eradicated RHD in the developed world but still plagues Third World countries especially in the congested under-privileged areas with poor sanitation.
Explaining how this type of throat infection is different, Dr Shahid Sami, of AKUH Cardiac Surgery Department said it is caused by bacteria and while the body fights against it, some antibodies are produced that start attacking other human organs.
It starts as a sore throat with high fever for two to three days. The tonsils swell and pus forms in the throat. If left untreated it leads to rheumatic fever. Any further neglect leaves the heart and lungs damaged. Thus it is called the disease which licks the joints but bites the heart. The severe keep shifting from one part of the body to another which is why it is also called fleeting arthritis.
Dr Arif-ur-Rehman of NICVD says not all people who contract rheumatic fever have to undergo surgery, however, the anti-bodies once developed always remain and can damage a valve anytime. To mitigate their affect, the patient is given antibiotics for long term prevention.
The message to the public is don’t take a sore throat lightly.