The patient has severe rheumatic mitral valve insufficiency. This could have been prevented with penicillin to treat his initial strep throat infection. Through a translator, Jean Baptiste tells you that he could not see a doctor when he had a sore throat.
The underlying cause was untreated strep pharyngitis. This could largely have been prevented by oral antibiotics (penicillin). This patient did not have access to antibiotics because of the lack of medical care in rural Haiti.
Globally, rheumatic heart disease is the leading cause of pediatric heart failure and cardiovascular death, and 80–85% of children worldwide live in areas where it is endemic.
However, the disease has essentially been eliminated in developed countries. It is now a disease of poverty. “Acute rheumatic fever and rheumatic heart disease can be regarded as physical manifestations of poverty and social inequality.”
You decide to learn more about Haiti and the town where Jean Baptiste lives, Bon Samaritain.
People living in rural Haiti are disadvantaged on multiple levels:
Typically there is no running water, electricity, toilets, paved roads, emergency services or basic health care for safe childbirth or treatment for malaria.
Many people in Bon Samaritan have no access to health care services.
Very few people can access the one existing health center because of its location along the coast. For those who can access the health center, not much can be said about quality of care they receive because no one is measuring or evaluating this.
Financing of health services is very challenging.
The population is extremely poor and the government salary support for the six nurses and one Haitian physician is unreliable due to governmental mismanagement. This, in turn, affects the health center’s ability to purchase supplies and medications. Public health efforts are absent in this area.
- Marijon E, Mirabel M, Celermajer DS, Jouven X. Rheumatic heart disease. Lancet. 2012;379(9819):953-964. doi:10.1016/S0140-6736(11)61171-9
- Rothenbühler M, O’Sullivan CJ, Stortecky S, et al. Active surveillance for rheumatic heart disease in endemic regions: a systematic review and meta-analysis of prevalence among children and adolescents. Lancet Glob Health. 2014;2(12):e717-e726. doi:10.1016/S2214-109X(14)70310-9
- WHO: Western Pacific.
- What is Health Policy and Systems Research (HPSR)? Alliance for Health Policy and Systems Research.
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