BEN HARVEY: Rheumatic heart disease a stain on Australia’s soul

Of all the depressing statistics about the health of Aboriginal people one has always stood out — First Australians are able to access the aged care system 15 years earlier than everyone else.

If you are Aboriginal, you are considered “old” at 50 years of age. The reasons for a reduced life span are legion and most seem insurmountable. There’s one that’s not — rheumatic heart disease.

The lethal condition starts with a sore throat or an infected skin sore caused by Strep A bacteria. Within two to three weeks, rheumatic fever sets in and the immune system attacks the heart’s valves.

Repeated episodes permanently damage the valves and a few years after the person had a scratchy throat, they have rheumatic heart disease and are at significantly higher risk of heart attack and stroke.

It is entirely preventable. That was the message delivered with refreshing bluntness in Perth on Wednesday night by Jagat Narula, president of the World Heart Federation, as he opened the Second World Congress on Rheumatic Heart Disease.

“This is not a disease of poor countries,” he told delegates. “It is a disease of poor conditions, and poor conditions can persist inside a rich country for as long as a society is willing to tolerate them.”

In Australia, 81 per cent of the people on the disease registers are Aboriginal or Torres Strait Islander.

They live in a country whose health system is, in Professor Narula’s words, “universal, well-funded and world class”.

The Maldives has 765 people per 100,000 living with RHD. Timor-Leste has 787. Myanmar, 862. The Northern Territory? More than 1000.

Here’s the bit that should make every health bureaucrat squirm. The treatment — a benzathine penicillin injection every 28 days — has been around for 80 years.

It is incredibly effective, with Professor Narula observing that in eight decades Strep A had “never developed clinically significant resistance to it. Not once”.

Despite that, less than a third of First Nations patients prescribed the jab received enough doses to be protected. In 2019, adequate coverage was 40 per cent.

We are going backwards.

“Every one of those people has already been found. Diagnosed. Named on a register, with an address and a schedule,” Professor Narula said.

“This is not a failure to solve a hard scientific problem. It is a failure to deliver an 80-year-old antibiotic to a list of people we have already identified.”

He didn’t miss.

The maddening part is Australia knows how to fix this. Much of what the world knows about the disease was discovered here.

In 2020 Australia became the first country to write and cost a blueprint for eliminating RHD. The disease-specific package was priced at $689 million over a decade.

Canberra has so far committed about $31 million.

We clearly don’t have our shoulders to the wheel on this one.

“That is roughly 4 per cent,” Professor Narula said. “Australia has not rejected its own plan. It has funded a fraction of it.”

He wants Australia to keep its 2031 elimination goal rather than settle for the 2040 deadline in the Perth Declaration, which will be unveiled when the congress wraps up on Saturday.

“For a country with this science, this plan and this wealth, 2040 is not a target. It is an alibi,” he said.

The disease survives, he argued, because no one owns it.

“It begins in a house, spreads in a school, is missed in a clinic, and is treated in a hospital in a distant city.”

It often begins in one room in the house — the laundry.

Washing clothes in remote communities is no simple thing. Getting a washing machine to the middle of nowhere is hellishly expensive; getting a plumber out to fix it when it breaks? Good luck.

An Indigenous-owned community development organisation, Aboriginal Investment Group, understands the problem.

With the backing of the Heart Foundation, it is installing shipping containers loaded with commercial washers and dryers in remote communities.

Chief executive Elizabeth Morgan-Brett said scabies presentations at the Barunga clinic in the Northern Territory fell 60 per cent within two years of its first laundry opening, and there has not been a new case of RHD there since.

Researchers say more rigorous evaluation is needed, but the logic is hard to fault.

The Federal Government is funding 12 new and upgraded laundries, including at Mulan and Fitzroy Crossing in the Kimberley.

It’s not glamorous. Nobody cuts a ribbon on a washing machine and makes the six o’clock news.

But clean clothes and sheets mean fewer scabies, fewer sores, fewer Strep A infections and, ultimately, fewer broken hearts.

Here’s hoping that the simple act of putting on a load of washing brings about the day when Aboriginals and Torres Strait Islanders are considered seniors when they’re in their mid-60s, like everyone else.