Rheumatic Heart Disease

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Medicine in Ethiopia is often difficult. None more difficult than watching many children and young adults suffer and die because of preventable causes. As a physician, it is easy to spend my time working hard to save the lives of the critically ill and hospitalized. As a family physician, there is the constant question, “what can I do to impact and prevent illness?” Ethiopia already has a structure in place for vaccinations and other public health projects, so figuring out my part in the greater pictures has been slow going. When we moved to Ethiopia three years ago, we had this vision of starting a community health program with Kavi and Taylor, but the demands of the hospital have not given us the full opportunity to figure out how and where to do such a project.

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Our RHD screening team in action
Two years ago at the CMDE conference, a cardiologist, Ron Johannsen, cast a vision during his talks on Rheumatic heart disease (heart disease caused by recurrent strep throat infections). He said, we can treat valvular heart disease with surgery (which until a few months ago wasn’t available anywhere in the country), or we can prevent it. Previously in Ethiopia, valvular heart disease has been diagnosed with signs of acute rheumatic fever, or maybe a murmur on exam when the changes are already very significant. The patient is then placed on prophylactic antibiotics (a penicillin injection) to prevent further strep infections and prevent worse scarring of their heart valve. His vision is to create a stable screening program based on Echocardiography (heart Ultrasound) for children age 8-18 years old at schools throughout Africa and to eradicate severe rheumatic heart disease in the developing world. The prevalence of mild rheumatic heart disease in Ethiopia is about 8% in our area, and is higher in girls than boys. Rheumatic heart disease often causes severe disease and death in young adulthood, especially after the stress of delivery.

This year, we caught his vision. With the generous gifts of our supporters, we purchased an ultrasound machine for the specific purpose of using it for this screening process and invited this expert to come and train a rheumatic heart disease screening team. It has been a slow, but steady start. We had 1 week of training with the experts and they have continued to provide long distance support for our program. We have screened 300 students to date.

During our training week, there was extra confirmation about the importance of the program. We had a 21 year old female 4 days post-partum, present in heart failure. She had severe disease on two valves, and despite our best effort she died. It is these moments that are both so tragic and such a motivation for change. For every child we identify with early signs of rheumatic heart disease and successfully treat with penicillin, we are saving a life. At the end of the day, when death and illness overwhelm me at the hospital, it is this preventive care that gives me hope for change in the health settings in Ethiopia.


video of our Echocardiogram screening


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