Screening to save lives in Micronesia

In 2016 Pohnpei saw the first ever screening of elementary school children for rheumatic heart disease (RHD). The results of that screening were incredible.  The two areas that were screened, Kolonia and Sokehs, had one of the highest rates of RHD in the world! This was only with 71 percent of the children screened.

Since then, there have been more screenings.  More cases have shown up.  The screenings have even gone on the road to nearby Chuuk.  The results in Chuuk were just as incredible as Pohnpei.

So what is RHD and how do you get it?  

Rheumatic heart disease is a condition in which permanent¬†damage¬†to¬†heart valves¬†is caused by¬†rheumatic fever. The heart valve is¬†damaged¬†by a disease process that generally begins with a¬†strep throat¬†caused by bacteria called Streptococcus, and may eventually cause¬†rheumatic fever.”

There it is.  Children who have strep throat and are not treated with antibiotics develop a disease process that eventually causes permanent damage to the heart valves.

So the next time you or you child (especially your child) has a sore throat, get that checked out by a professional.  So many times in Micronesia, children are not taken to the hospital for many reasons. It could literally be a life or death situation if strep throat goes untreated.  If the RHD is advanced and the heart valves are permanently damaged, the only way to fix this will be with open heart surgery.  If the RHD is not too advanced, to prevent any further damage to the heart valves, you would have to take bicillin shots every month for years.  Avoid all that and see a doctor.

To get an idea of the size of the problem in Pohnpei, RHD prevalence in most elementary school children is at .01%.  The screening results in Pohnpei show approximately 9 Р10 %.  That is pretty high.

Next steps

In the beginning of the screening process there was a single physician and a volunteer sonographer who came to help with the initial study in Pohnpei.  Dr Payne Perman had the single echocardiograph machine in FSM.  Thanks to the Rotary Club of Pohnpei, two portable hand held echo machines were recently donated to Pohnpei State Health services.

Additionally, more help arrived recently when a pediatric cardiologist and his team came from Tripler Army Medical Center in Hawaii.  They were able to help screen more elementary school children and also went to the high schools. At PICS high school, one of the local public high schools, they found almost 100 cases out of approximately 1000 students.

During the pediatric cardiologist team visit, a nurse was identified from Pohnpei State Public Health to assist Dr Perman.  Ms Wefonne Billen is now the other member of the RHD screening team in Pohnpei.  Trained by Dr Perman and the visiting team, she has been instrumental in the identification of many cases here in Pohnpei already.

The screenings will continue and more children will be identified.¬† It’s good to know that the Rotary Club of Pohnpei donated the scanners, and through¬†MAHI Internationl¬†help was provided by the pediatric cardiology team recently.

Most important part

The most important part of the fight to prevent RHD is to not have it at all.  One ounce of prevention is worth a pound of cure goes the old saying.  This is really the case here in Pohnpei and across the world in developing countries.  Awareness must be built into the minds of every parent who has a sick child with a sore throat.  That sore throat that does not go away or keeps on coming back needs to be treated.

Sadly, even taking a child to doctors for treatment will not prevent it if the doctors don’t treat the strep throat.¬† A case was related to me of a child who was taken in several times by careful parents, but still was identified as RHD because the doctors did not treat for strep throat.¬† What did they treat for?¬† I don’t know.

Education, awareness and education and awareness.  The most important next step is to prevent this from ever happening again.


Listen to my podcast on the RHD screening: The Micronesian Podcast on Anchor.

Author: patpedrus

I am here, you are there, we are one.

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