An entirely preventable condition called rheumatic heart disease is leaving Indigenous children with severe and irreversible heart damage
No child should bear the scars of open-heart surgery. It is a procedure most often associated with old age, to treat conditions such as coronary heart disease or abnormal heart rhythms.
But in rural and remote Indigenous communities throughout Australia, and particularly in the Northern Territory, it is not uncommon to see children as young as seven carrying the long scars of open-heart surgery running vertically down their chest. Some of these children and teenagers have endured the surgeries up to four times in their short lifetimes.
These scars are an indication that the health system has failed, Dr Bo Remenyi, a paediatric cardiologist based in Darwin, tells Guardian Australia.
But they are just physical scars and, while they reflect the physical cost to the children, they do not do justice to the emotional cost of this disease.
Remenyi is talking about an entirely preventable condition called rheumatic heart disease (RHD), which is only found in the most disadvantaged areas of developing countries such as Africa, the Middle East and central and south Asia. But it is also found in Australia, in remote Indigenous communities plagued by social disadvantage. And, in those communities, it overwhelmingly affects children.
RHD is caused by infection with the highly contagious group A streptococcus bacterium, which leads to a condition known commonly as strep throat. Most Australian children acquire strep throat at some point but are usually only exposed to the infection once or twice and, when they are, receive fast treatment with antibiotics.
But, in disadvantaged communities, where overcrowding and substandard housing is common, children are exposed to group A streptococcus bacterium constantly and often suffer from recurrent bouts of disease. Treatment with antibiotics is often delayed or non-existent due to woeful access to health services. This repeated and prolonged infection and exposure to strep can lead to a condition called acute rheumatic fever, an inflammatory disease that can involve the heart.
As the immune system attempts to destroy the streptococcus bacterium, it can also destroy the heart, which contains similar looking proteins to those of the strep bacterium. These attacks can damage the hearts aortic and mitral valves.
Without antibiotic treatment to stop the bouts of acute rheumatic fever, the heart can be left permanently damaged and it is this severe and irreversible heart damage that is known as RHD. Without open-heart surgery to repair or replace the damaged heart valves, proper flow of blood through the heart is diminished, the heart becomes enlarged, clots can form and children are at risk of dropping dead from stroke at any time.