Strep has a specific, low level smell. Gambian pouch rats or dogs can be used to identify strep in a lab sample, similar to TB. Strep does not cause valve damage for weeks. Samples can be sent to a regional lab and then Penicillin given to just the people with the disease.
38
Thank you to the NYT for highlighting this important public health issue. My best to the clinicians who work to help these individuals. I hope the international community and the business sector partner to bring simple diagnostic tools and reduced cost medications to these nations in need.
In the 1930s before antibiotics, my mother and her sister contracted what we now know as strep. My aunt died an early death leaving behind two young children. My mother needed heart vale replacement surgery.
Thank you again.
33
It's not just strep throat that leads to heart valve damage.
About 52 years ago, I was diagnosed with a mitral valve murmur. About 25 years ago, this had progressed to a mitral valve prolapse, although during this period I was still able to run marathons. Because of my mitral valve problem, I took antibiotics before dental appointments.
Nevertheless, 14 years ago, I developed endocarditis, from the Streptococcus bacteria, following a series of dental appointments. Fortunately, it was early, and I had access to good care and insurance. My mitral valve was repaired, not replaced, and I am living a normal life for a 75-year old.
My heart (no pun intended) goes out to the people in the column without the resources that I had. But everyone should be aware of the danger of pre-existing heart conditions as well as the potential danger posed by "sore throats".
31
Stuff like this makes me sick. What's worse, medical science is dependent on the whims of rich right wingers who think poor people should just pay for everything. A fat lot of good that rosary does for that girl. The poor in the US don't get much better care than the ones in Africa who got anything at all. PItiful. Make america care again.
42
First: At the Davos Economic Council it was noted that the wage gap keeps increasing.
Eight multi-billionaires combined have the net worth of the bottom half of the 3.6 BILLION folks in the world.
Jeff Bezos gets richer every day--last count his net worth was up to $162 BILLION. He said that there isn’t a philanthropic issue here on earth worth his attention, so he’s one of three multi-billionaires looking to reach Mars.
I’ve been writing [email protected] every day to use his money to come up with a universal vaccine...one shot that would prevent ALL viral diseases from measles to HIV to the flu.
With this money he could open medical schools in Africa and train MDs THERE to be general practice doctors.
Strep throat requires more than penicillin--this was established in 2005. Cephalexin (Keflex) and other cephalosporins should be used.
Also I would encourage readers in First World countries to understand that only 9% of sore throats are strep. ALWAYS get a strep test--we have instant read now. IF you do have strep take the entire prescription to make sure you wipe out the strep.
If strep throat is left on its own, you will heal WITHOUT medication in 3 to 7 days...but you will be contagious for 3 weeks. Get tested. Don’t demand drugs--antibiotic resistance is real.
Strep only RARELY goes on to Rheumatic Fever, which then goes on to damage the mitral and aortic valves.
Work with your family practice doc or NP--get tested for strep. If positive, take the full course.
33
@Nuschler In my experience physicians are very reluctant to do cultures or even rapid strep tests, they tend to go with their clinical judgment about bacterial vs viral origins.
4
In the 1930s my father had strep that developed into rheumatic fever and heart damage. In the 1950s I had strep that developed into what at that time was called St. Vitus Dance (now Sydenhams Chorea). In 1997 my daughter had strep that developed into Sydenhams Chorea, and again in 1998 she had strep that developed into rheumatic heart disease.
Doctors treating strep need to calculate the dosage of amoxicillin taking into account what adheres and remains in the bottle and include an extra dosage so that when the medication is finished the full dosage has been taken. Parents need to be told a follow up visit is necessary.
Often doctors dismiss sore throats since strep tests aren’t always positive. The aversion to giving antibiotics as a rule should be carefully weighed after doctor and caregiver speak and not just dismissed because of routine guidelines.
Rheumatic heart disease eradicated in the U.S.? I humbly beg to differ. I have an adult daughter taking penicillin and a blood thinner for the rest of her life but thankfully her own damaged heart still beats. My heart breaks for the featured heart patients in this story. I know their parents anguish.
38
Where are all the oh-so-vocal celebrities and professional sports players who could afford to support this very important humanitarian situation?
20
I think readers are missing a key point in the article : that the parents and patients do not recall a sore throat. Thus, more education, docs, or antibiotics are not going to cut it. Rather, it seems more research is needed to understand what exactly is different about this Rwanda strain of strep.
15
@ms Please tell me about the sore throats you have had in the last 10 years and which ones you sought medical care for? Get my point?
7
Prevention with penicillin sounds like a common sense approach for this issue. Can we not set up training of rural health care workers with a steady supply of penicillin sent by mail and solve most of these cases rather than seeing the end result of years of a lack of a health care system? Isn’t the UN a part of an answer with a global response? Bless these medical professionals who give their time and professional knowledge to others to save the patients.
8
@Dr. P. H.And what do we do once the bugs become resistant to penicillin? Also, will people take penicillin continuously if they are feeling well?
4
@Dr. P. H.
My understanding is the strains of Strep A that cause RF in the US are considered eradicated
3
The motives and selflessness of the volunteers who do this type of work are indisputable. However, these efforts do have an element of imperialism. The idea westernized people who at one time colonized these regions and destroyed their governments and cultures can come in and show their benevolence and goodness to these peoples. I have no idea whether this effort is really what these people most need as simpler public health initiatives might yield greater benefits.
11
Untreated strep infections can cause rheumatic fever, scarlet fever or acute glomerulonephritis. Rheumatic fever is often accompanied by damage to the heart valves. This can be progressive, especially if there are subsequent infections, and can take years to manifest itself. For example, the death of Mealnie in "Gone With the Wind" is a text-book example of death in the second trimester of pregnancy in a woman with a narrowed mitral valve. (I saw many instances of this problem as a student in Kings County over half a century ago.)
10
How does one try to understand this semantic description, “neglected diseases of marginalized communities,” as well as the graphic photos, when considering the billions budgeted and spent for destroying and winning, in endless wars and what are euphemistically labeled as "conflicts?" Then. Now. Daily. Tomorrow? Activities and policies associated with the misuse of limited human and nonhuman resources which are critical for developing, and sustaining, types, levels and qualities of equitable wellbeing. This article uncovers a reality, globally, of additional "neglected diseases" and toxic conditions. Willful blindness about what exist which needn't be. Willful deafness to the pains, physical, psychological, social, spiritual, economic, etc.of the unhealthy, and even the muted pains of those exhausted, at times even traumatized, "volunteers," for whom the Good Samaritan is not just a Bible tale. Willful ignorance about available and accessible FACTS whose dimensions can and should be changed. When? When each of US "wills" it with our various efforts. The willful silence for which unending, targeted outrage, transmuted from sounds into effective actions. Willful empowerment of a culture of personal unaccountability. Engaged in by ranges of relevant individual and systemic stakeholders. Known and unknown ones. "Neglected diseases" of, and by, the heartless are not simply a medical problem or issue! Who enables? Locally. In neighborhoods. Regionally.Nationally. Globally.
8
These Rwanda caregivers are true humanitarians, and with so much wrong in the world, it is wonderful to see people get together to help others. Kudos to all involved!
Regarding RHD, I wonder how many Americans also suffer from this condition. . .
As long as access to health care for all Americans is not made a priority, there will be people who avoid going to the doctor and taking their children to the doctor. A former in-law of mine was always worried about medical bills. She did not bring her children to the doctor when they had sore throats, sore throats that turned out to be strep throats. At least one of her children developed rheumatic heart. Another, now suffers from a damaged heart and he is in his forties.
Please, let's all work together to make access to health care a priority. The United States has the money to do this. What is needed is a shift in thinking that health care is a privilege as opposed to a right.
The true measure of greatness in a country can be obtained by viewing how that country treats its underclass. The United States can, and should do a lot better in this regard.
42
If I was informed correctly (when I attended medical school 50 yrs ago) the united states just about wiped out rheumatic fever because GP's gave oral antibiotics to almost all children with sore throats to make the mothers happy even though they were taught not to do this because the overwhelming majority of these patients probably had viral diseases that wouldn't respond to antibiotics
So sometimes it pays to listen to your mother and not the professors of medicine
JRFMD
7
@DrF Strep A infections also have a socieconomic factor, so I think t attribute the elimination of rheumatic fever in western culture to injudicious use of penicillin may be overly simplistic.
4
And that's what leads to antibiotic resistance. Our physicians do not even test for causative organisms anymore.
Just antibiotics, antibiotics and more antibiotics.
9
I don't know what was more heartbreaking - seeing that a boy named Innocent - so young and wide-eyed that he sketched a wonderful giraffe with a beret - struggling after his surgery, or the closing photograph, with Gaudence reading surgery literature for a surgery she is too sick to have.
www.team heart.org - let's get 100% participation from New York Times readers, in any amount.
23
@common sense advocate Good idea! I just donated. Please note that the website is www.teamheart.org - no space between team and heart. Heartwrenching situation.
5
Thank you for fixing the broken link :)
1
We have quite a few African doctors here in the US over treating Americans. World incomes need to equalize and they will either through migration or massive wealth transfers to the third world. I see the first as more likely.
4
Thank you for this important article. As a preventable disease, RHD can be headed off with knowledge about strep throat and early medical treatment. WiRED International, a U.S. based non-profit, has been developing tools to train teachers, students, parents and medical workers in low-resource regions about RHD. These training modules are publicly available without charge:
http://www.wiredhealthresources.net/mod-rheumatic-heart-disease.html
This video offers a succinct description of the relationship between strep and RHD:
https://www.youtube.com/watch?v=NSJwthP7c9s
22
This story tells of A team visiting Rwanda. I wonder why we have not shined a similar light on the U.S. territory of American Samoa. American Samoa has the highest rate of RHD in the world. Note the link below to an NIH article
https://www.ncbi.nlm.nih.gov/pubmed/2893296
Can we treat our own house and citizens of the US territories.AS also has the highest per capital enlistment rate in the US military and as many know a number of pro football players. However, No Congressional delegation has visited this island nor seen the dilapidated hospital name LBJ, since he was president. .There are few nurses and fewer physicians on island
35
A stupid solution would be to flood poor countries with low or no cost antibiotics to just address this problem. The strep throat problem might be addressed as people take the drugs according to their self diagnosis or to prevent the infection from spreading to themselves. This would be bad because they would become an environment for the production of antibiotic resistant bacteria and cause widespread intestinal problems as the drugs destroy the normal balance of intestinal bacteria in great numbers of people. Cure one problem but cause others. There needs to be a well organized and supported medical intervention.
6
Gates or Zuckenberg could ameliorate this disaster as could the money it cost to build one air force bomber.Problem is that too many of those that can,dont.Same sad song for planet Earth
19
@gruis I don't think you are right about a simple solution. Strep A infections are a socioeconomic problem and defy simple solutions. The use of antibiotics in the treatment of pharyngitis is problematic in the US.
4
Let us remember this: 10 years ago there was an estimated $29 Trillion Bail-Out of Wall Street. Enough to probably fund an adequate amount of health clinics and to distribute penicillin across Rwanda and many other countries worldwide. We need to share the resources of the planet if we want to end preventable deaths and treat our brothers and sisters like they are members of the same human family.
Maitreya, the World Teacher who is emerging publicly to inspire humanity to change its ways and embrace sharing, has said years ago, "How can you be content with the modes within which you now live: when millions starve and die in squalor; when the rich parade their wealth before the poor; when each man is his neighbor's enemy; when no man trusts his brother? For how long must you live thus, my friends? For how long can you support this degradation?"
22
Regrettably, Rwanda is not the only "poor" country were children died because of almost non existent access to penicillin or other "cheap" antibiotics . In Argentina, due to the misguided economic and political decisions of the present Macri government, already six people have died from streptococcal bacteria because the drastic "cuts" in health care. This article on Rwanda is closely related to the NYT's article , "Manafort, A Ukrainian Hairdresser and a $30 Million Tax Bill" (both on the front page of the newspaper). While the rich send illegally their "dirty" profits to offshores paradises, and get richer--President Macri as all his cabinet have their money in these off-shore paradises-- while the poor don't have access to even such simple remedies as vaccines.
15
Thank you for this story. At the age of six, I was diagnosed with rheumatic fever. Fortunately, it was caught early and, after six years of penicillin medication, I had no long-term heart damage.
Over my lifetime, I became a runner and completed 24 marathons.
This article reminded me how lucky I've been and that I need to give back.
40
Same here, except for the marathons :)
9
It seems likely that the problem is due, in part, to low vitamin D status. Even though solar UVB doses are high in Africa, dark skin, staying indoors, and wearing clothes that cover the skin reduce the amount of vitamin D produced.
Searching pubmedlgov finds that vitamin D dose fight pneumcocci and reduce risk of rheumatic fever
Vitamin D Promotes Pneumococcal Killing and Modulates Inflammatory Responses in Primary Human Neutrophils.
pubmed/28241127
Evaluation of vitamin D levels in patients with acute rheumatic fever
ncbi.nlm.nih.gov/pmc/articles/PMC5512202/
Thus, vitamin D supplementation may greatly reduce the risk of these outcomes.
4
@wbgrant People blame almost all diseases on Vit D deficiencies. However, the valid assay for biologically active Vit D and a lack of complete understanding of its metabolism and biochemistry make it impossible to draw conclusions about.
5
@wayne griswald
Agreed. Upon further searching at pubmed.gov I found that strep throats are more common in Africa during the dry season when solar UVB doses are higher.
In addition, cathelicidin induced by vitamin D makes the body more susceptible to strep infection.
I retract my suggestion that vitamin D might be useful in this case.
1
@wbgrant Thanks, Vit D is a fascinating and very important hormone of which we don't know very much about.
1
Untreated and under-treated strep throat is having dire consequences here in the United States as well. The collection of symptoms known as PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) has led to thousands of children becoming critically ill. With PANDAS the strep inflames the brain. These children develop overnight personality changes, anxiety, restrictive eating, phobias, aggression, tics and psychosis. They cycle in and out of the mental health care world to no avail when what they really need is aggressive antibiotic treatment, along with other therapies.
34
Are you sure we don’t have trouble in the US - in poorer communities? My daughter’s old band room, think spit valves, was full of strep. Every year she would come down with it, once, prior to a trip to Hawaii. I begged our doctor for a standby antibiotic for the remainder of the family to no avail - nothing quite like a temp of 103 at 30,000 feet. They’ve since torn the school down. I have also wondered about strep tests, mouthwash and why ASO titers aren’t used, as my mom once failed the strep test but the ASO tiger indicated a strep infection? Could mouthwash foul a strep test?
6
@rebecca1048
Strep tests are not 100% accurate.
3
The U.S. is no stranger to rheumatic heart disease. In the 1940s and 50s it was still relatively common in children so survivors today, either with prior valve surgery or very mild valve disease are still to be seen. More common, immigrants from many countries have a significant incidence of prior rheumatic fever and/or established valvular disease, so the problem is not uncommon in public hospitals in some areas.
18
About 50 years ago, I had strep, off and on monthly, for the better part of a year; the bacteria hid in my tonsils and likely I was an early example of antibiotic resistance. Frequent penicillin spared my heart, although my joints have never been the same. A tonsillectomy finally solved the infection cycle.
Fifty years ago.
Surely we have the ability to get the most obvious of first world medicine spread globally. I can understand how we can't afford expensive equipment and treatment, but surely penicillin and vaccines are possible. Penicillin is mold based - surely we can afford to grow it and distribute it.
A simple solution, available for more than half a century, and we can't figure out how to get it to poor children globally.
12
@Cathy Treatment and diagnosis of streptococcal infections is more difficult and problematic that the article would lead you to think.
5
The most cost effective and high quality outcome for this is universal family planning- which means birth control and education to reduce the birth rate.
There will never be enough resources to get a handle on this and similar health problems with an exploding population in the underdeveloped economies of Africa and elsewhere. These people are doing wonderful charity work, but are essentially trying to keep a candle lit in hurricane winds.
15
Affluent countries have low birth rates while poor ones have high ones. Fewer children live to adulthood and live long enough to take care of aging parents in poor countries.
Populations aren’t “exploding.” This isn’t the 1960s. Some countries still have high population growth rates, but economic growth tends to bring that down as does educating girls.
3
@Jo Marin You are dead wrong. Africa today has a population of just over one billion and is on a trajectory to reach 4-6 billion by the end of the century. For reasons that are not clear, Africa is not experiencing the 'demographic transition', where economic growth and education of women leads to lower birth rates, as has happened in the rest of the world. Most Africans are already impoverished and poorly nourished. Just imagine how much worse it will get when there are four times more people than today. The implications of social breakdown and mass migration extend far beyond just Africa.
1
Antibiotics could change this very quickly but overuse of antibiotics has some very bad results, so there need to be a lot more qualified health care givers, doctors and nurse practitioners, who have access to good labs as well as ample antibiotics.
10
I have a comment indirectly related to the article. The Canadian-American medical team obviously is composed of caring professionals doing the best job they can. But the photo of the team during the decision making process show a sea of White faces, only a few non-White, working in an African country. One way to increase the numbers of the Team and its ability to perform this important work might be to increase the numbers of Black MDs, Nurses, and administrative help. Are there really so few Black meidcal professionals in the uS and Canada?
12
The race of medical relief workers is of no matter to people in Africa. There ought to be a lot more medical professionals and facilities established and staffed by Africans.
8
@Svirchev Are you seriously suggesting that the doctors providing this service should be screened by skin colour?
7
@Svirchev Africans are not as obsessed with race as Americans. They are grateful for any help - Kenya is currently in a happy tizzy about the arrival of Cuban doctors - and don't care about the color scheme. For some reason, political correctness seems less important when you are starving or dying.
16
Rwanda, an autocratic regime run by a military dictator who almost single-handedly makes all decisions on allocation of government resources. And almost the entire economy is public sector. This is the sad story of Rwanda and much of Sub-Saharan Africa. The prism that this story is told through is that of rheumatic heart disease and a cadre of brave, courageous and selfless medical staff who treat a few dozen patients a year. They are addressing the symptoms of a bankrupt political and economic system that saps the vitality of its citizens and relegates them to pauperhod and ravages of poor sanitation, health care, power generation, education and negligible social services. This story can be refracted through hundreds of similar prisms. This provides a meaningful experience of exotic foreign adventures to the donors and service providers, but leaves the Rwandans in the same bottomless pit they started from.
34
Other writers have made valid points regarding brain drain from 3rd world countries, prevention, and the ethical problems of focusing on tertiary care in this place. There are a wealth of other analyses that could be made about government inefficiency and corruption. I just want to say how proud I am of this team. In a day and age when we hear so much ill about modern medicine, what these people are doing is heroic in all the right ways. They are actively involved in a form of tikkun olam, the repair of the world.
34
Rheumatic heart disease is not the only potentially fatal complication of untreated strep infections. Nephritis, an infection of the kidneys, accompanied by elevated blood pressure, edema, and blood in the urine, is another.
How many Rwandans were diagnosed with nephritis and treated?
10
@Michael N. Alexander
Glomerulonephritis typically occurs in a somewhat older population. Rheumatic fever is more prevalent in young children.
2
This heartbreaking situation sounds like a perfect project for the Bill and Melinda Gates Foundation ---- supporting the intensive prevention measures needed, and then enabling more victims to be saved surgically. I know they have many demands on their money, but this is a win-win and would have incalculable ROI.
48
But in all honesty why are we looking to Bill and Melinda Gates foundation as our savior? Don’t get me wrong, I love the good they are doing but we can’t look to them to solve all of humanity’s medical problems. That’s not fair.
14
@Belinda
I suggested they address one very terrible waste of life, not "all of humanity's medical problems." I personally think this would be a meaningful, worthwhile use of their funds, quite in conjunction with the goals of their foundation. What's "not fair" is writing off these lives --- especially in the preventive aspect, which requires a relatively small amount of money compared to the surgery. Bill and Melinda have to make hard choices, of course. I suggest this choice.
Having worked in Southern Africa for several years , and observed the devastating heart disease caused by streptococcal infection, it is tragic that resources are not committed to preventing this infection. There are now well funded and functioning clinics focused on treating HIV and tuberculosis. The staff in these clinics, and teachers in schools and libraries can educate the populations they serve about the dangers of a sore throat . With private and public funding the affected children with sore throats can be treated with penicillin. Just the complaint of a sore throat warrants treatment ( if testing for the bacteria is available so much the better). This prevention approach is far more cost effective and beneficial to the affected population than selecting a few patients for expensive cardic surgery.
20
@Robert Jacobson
Typically 85% or more of sore throats are caused by a virus. You can't just prescribe penicillin indiscriminately.
6
With more funding and training in primary care for local health systems, these "heroic" measures by albeit well-intentioned outsiders that benefit only a few patients ( and perhaps not even over the long-term) while limiting their life choices (inadvisability of childbearing for women in cultures that place a strong emphasis on this) would not be necessary. The reliance on complicated surgery to treat a problem so easily prevented is tragically misguided. This is not a good solution for the developing world.
19
Is TAVR not an option for these cases?
2
@SteveW, TAVR is transcatheter aortic valve replacement, whereas rheumatic heart disease affects the mitral valve. There are some studies looking at transcatheter mitral valve replacement (TMVR), but only in very specific diseases (e.g. mitral annulus calcification, a completely different disease with different flow patterns & complications than rheumatic heart disease). There will undoubtedly be many innovations in the next several years / few decades, but right now it's unfortunately still very much in the future.
8
Minor correction - rheumatic heart disease can involve the aortic valve (20-25% of the time) but if it does the mitral valve is almost always affected too
Instead of funding more money into hi-tech drones to fund more American military bases in sub-Saharan Africa Command, we could build Rwanda surgical care with badly needed hospitals and provide trained African medical surgeons and staff. Importing American staff for short training stints to provide sample surgery can do no more than triage the patients to provide surgery for a few rheumatic heart treatments.
As Dr. Sundt points out, the program “is not sustainable,” indeed, almost useless for long-term care and widespread heart surgical needs. Only the American surgical teams really benefit from the treatment skills and knowledge that they gain in Rwanda— to serve Americans when the surgeons and staff return here.
Perhaps appeals to the Gates and Scholl foundations could offer needed funding for such an effort.
26
I agree. A friend who is a surgeon participated in medical missions for years, performing the surgery himself with a team in India. After a while, he realized he could do more good by training surgeons in India on the latest procedures rather than performing it himself.
7
Rather than plundering third world countries for the "best and brightest" to immigrate here, as is the latest trend on these pages, we should be helping them become better places to live and work. This article illustrates this. Bring their best and brightest here, train them with our money, and send them home to improve their home countries. With an intact health care system, these people wouldn't need expensive operations and everything from simple infections to women's health care and birth control would all be improved. Instead we let our multinational companies plunder places like Nigeria, which has tremendous resources and yet is a basket case, while we encourage their best people to come here worsening the situation.
52
@Al : Perhaps we ‘plunder’ other countries for health care practitioners because we do not have a sufficient number of American physicians willing to bring their skills to bear where they are most needed: among the millions of their fellow citizens who are poor and poorly educated.
Becoming a doctor in the U.S. is a very expensive proposition; and the majority of med school graduates in this country pursue lucrative specialties, showing no interest in general practice. We have the most expensive health care in the world, yet it fails to reach a vast number of our own people who can’t begin to afford it.
I agree we should not plunder the rest of the world, including its most talented and motivated people. But if you think America doesn’t need outside help to bring health care to its own citizens, think again. The rest of the world apparently doesn’t agree. You might consider this, for example:
https://www.washingtonpost.com/local/virginia-politics/thousands-flock-t...
16
@chambolle. Helping the rest of the world doesn't mean we don't have problems here. Believe it or not, we could improve our health care AND help the developing world. They are not mutually exclusive and I never said they were.
Thank you for this article. Before I came to the United States, I hadn't even heard of strep throat, and I had access to medical care. More awareness is needed in other parts of the world to prevent these life-threatening complications.
18
Thank you so much for this article. Though it was heartbreaking, it was news we really need to know. Now I can look for Team Heart to donate, and I can let my students and colleagues associated with medical education know.
18
I was overwhelmed by emotion reading this article. I was diagnosed with rheumatic fever when I was 6 years old. Luckily, even though I was born and raised in “third world” Brazil, I had access to excellent doctors who treated me and followed up on my health for 12 years straight. Finally, at age 18, my doctor declared me out of risk for developing rheumatic heart disease. Now living in the USA, many times I have to explain what rheumatic fever is to doctors and nurses who have never seen it before. How lucky I was for having access to treatment, and how very lucky we all are in this country where many doctors don’t even know what this disease is.
77
In general a fairly well done article, but as an
ostracized American Board Certified Otolaryngology-
Head and Neck Surgeon (if education and training means anything anymore) I am qualified to say that the writer omitted comment on several very important points related to these patients which
is that “Strep Throat” is from bacterial infection of the
tonsils in the back of the throat.
Surgical removal of the tonsils which when done in
pediatric age patients is a simple out-patient surgical
procedure that eliminates rheumatic fever very simply from an early age.
No mention of the fact that “strep throat” is a form of
tonsillitis and removal of the tonsils in a young pediatric age child eliminates rheumatic fever
(and all of the attendant complications of congestive
heart failure due to valvular disease of the heart) at
the earliest stages of the series of health problems
that the writer describes which should have been
discussed.
23
@R. E. Branch, M. D.
Strep throat can spread to the tonsils, but isn't necessarily a tonsil infection.
And I'm not surprised that you're "ostracized" for suggesting pre-emptively removing a body part to prevent a treatable infection.
28
Good point. Curious - why ostracized?
SF’s comment is not valid fact.
Plus, it’s inflammatory and angry for unknown reasons.
Thank you for highlighting this program and the dedicated team that works to save the lives of these young people. I'm proud to say that my niece, Dr. Amy Fiedler of Massachusetts General Hospital, (the surgeon with the pearl earrings) has made the journey to Rwanda for several years. There are many happy success stories of the when the recovered patients come back a year after their surgery--riding their bikes and wearing big smiles-- to thank the doctors and nurses. Please donate to help Team Heart if you are able.
94
With so much overuse of antibiotics in most of the developed world, it is tragic that they have this complication of such an easily treatable disease.
16
@Vincent. There is definitely over use of antibiotics in the developed world, especially in agriculture. However, in most of the developing world one can simply walk into a pharmacy and get whatever you want. Currently, the microbes are winning and it will require a worldwide effort to reverse this.
14
@Vincent There are also enormous problems with overuse of antibiotics in what is referred as third world countries.
@Al In the US you can't walk into a pharmacy and get an antibiotic, you have to see a health care provider first which in many cases isn't that easy, several day wait in many cases and maybe hundreds of dollars.
A brilliant article, about how people can change the world.
Congratulations to Team Heart and all their volunteers.
57