Shaping Healthier Futures Through Storybooks

Our health care workers feel very sad when they see a child or a young adult with Rheumatic heart disease, which is by far the commonest cause of death and disability from heart disease in young Ethiopians. Of course there are other significant conditions which affect the heart and circulation in Africa, for example hypertension and cardiomyopathy, but these affect adults. An infection in the throat with a streptococcal bacterium is followed, in some people, by rheumatic fever and it is the body’s reaction to the organism which initially damages the heart. Thus the heart will be further damaged if there is another infection.

The teams of nurses and health officers at health centres know that there is little that can be done for some of their young patients because the rheumatic process has damaged the valves of their heart beyond repair; they need very advanced cardiac surgery and it is not yet available in Ethiopia. But they also know, as a result of the targeted training that we give them, that it is possible to prevent recurrences of rheumatic fever if penicillin is given every 3 or 4 weeks to children and young adults who have established rheumatic heart disease.

As care of rheumatic heart disease has now been decentralised to health centres through our programme, our nurses are wonderfully positioned to do basic prevention of infection through regular penicillin. It is they who will keep giving    the monthly injection. Here a young girl has become unable to go to school and is bed ridden because of severe rheumatic heart disease. She lives almost as if she has a ‘death sentence’ over her head.

The community can be protected from this fatal and disabling disease through decentralization of care to frontline health providers who detect and treat streptococcal sore throat. Decentralization also helps nurses to detect and refer cases who must first be fully assessed before the year on year of penicillin prevention is begun.