In Addis Ababa, Ethiopia, a city of 3.3 million, the lives of six children and their families changed forever last month, thanks in part to resources and health professionals from Montana.
Dr. Robert Amado-Cattaneo spent 10 days in the capital city with his partner, an anesthesiologist and a team of three nurses performing heart surgeries on children between the ages of 10 and 20.
The children, suffering from rheumatic heart disease, needed heart valve repair or replacement to save their lives.
A complication of strep throat, rheumatic heart disease kills about 230,000 people every year, according to Cattaneo, a cardio-thoracic surgeon at Benefis Health System.
“It’s a disease that has been forgotten by us in the western world. It doesn’t exist here anymore,” Cattaneo said.
Thanks to penicillin, which is used to treat strep throat, children in developed countries no longer develop rheumatic fever, which leads to rheumatic heart disease, and, without treatment, death.
While penicillin is available in some parts of Ethiopia, access to health care is an issue for people who live in rural areas, and even in Addis Ababa, the nation’s capital.
Near the Cardiac Centre of Ethiopia, a simple, three-story building where Cattaneo performed the surgeries, is the large Black Lion Hospital. Cattaneo visited the hospital during his February trip, his second to the country, and saw people sitting or lying in the hallways waiting to be seen by a physician.
“Access is not easy even if you live in the city,” he said.
‘These kids will die’
The Cardiac Centre of Ethiopia is a charitable institution built by a wealthy benefactor. Even so, the center does not employ cardiac surgeons who can perform the needed valve repair or replacement surgeries. The Children’s Fund of Ethiopia supports the cardiac center by organizing volunteer groups such as Cattaneo’s and Tahta’s to come to perform procedures and train staff, according to Children’s Fund of Ethiopia’s website.
When they go to Addis Ababa, medical teams are expected to bring their own materials for surgery, including the heart valves, which cost between $5,000 and $10,000 each.
“It’s not exactly peanuts,” Cattaneo said.
He lauded medical equipment manufacturers and Benefis Health System for their donations to the project.
“The generosity of these companies makes this possible,” he said.
When Cattaneo’s team, composed of Dr. Stephen Tahta, of Missoula, anesthesiologist Doug Maguire, and three Great Falls nurses, Adessa Bentley, Sandy Einan and Jamie Warcken, there were 10 candidates for surgery. The team had supplies and the time to do only six surgeries, so they chose the six most-severe cases for surgery.
“It’s terrible to choose,” he said, knowing that some of the children who aren’t chosen may die before their next chance for a surgery. “You want to operate day and night and do them all.”
Rheumatic heart disease was eradicated from the United States decades ago but still persists in developed countries. The disease’s source is strep throat infection, which can be treated with penicillin. Without that, about 3 percent of children will develop rheumatic fever a few weeks after the strep infection, symptoms of which include joint pain, fever, skin changes, abnormal muscle contractions and inflammation of the heart and heart valves.
Eventually, rheumatic fever subsides, but the damage to the heart valves is permanent.
Repeated episodes of strep throat and rheumatic fever can lead to more damage of the heart valves.
According to the World Heart Federation, rheumatic heart disease is the most common acquired heart condition among children in many developing countries. About 15.6 million people now have rheumatic heart disease, many of whom live in sub-Saharan Africa.
Next year, Cattaneo hopes to go for two weeks so he can do even more surgeries. He does the multiplication quickly in his head — if he can get financing for the next five years and to 10 to 12 children each year, that means he can save 60 to 70 lives.
“It’s not even close to enough but it’s better than nothing. Otherwise, these kids will die,” he said.
Hope for the future
Before Cattaneo set out to Ethiopia, he met at Starbucks with members of the Rotary Club of Great Falls. The members surprised him with a $5,000 check to use on his trip.
President-elect Tim Peterson hopes that they’ll send more funds to Ethiopia.
Peterson, who becomes president of Rotary Club of Great Falls in July, plans to apply for some big-ticket grants from Rotary International. The $50,000 to $100,000 grants will be used to purchase needed equipment at the Cardiac Centre of Ethiopia to help Cattaneo and other teams perform surgery.
But Peterson and Great Falls Rotarians are looking at the big picture too.
Inspired by Rotary’s near-eradication of polio worldwide, local members hope to apply funds and work with Ethiopian Rotary clubs to help improve access to penicillin.
“We’re looking at finding a way to see if we can take this a step further and find ways to get penicillin to kids when they’re little and develop strep infections to the point where we don’t even have this problem,” he said.
That’s a big job that Cattaneo says will likely take help from the Ethiopian government. Peterson hopes the first step of purchasing equipment will move Rotary toward the ultimate goal.
Children’s Fund of Ethiopia has as part of its mission to make the Cardiac Centre of Ethiopia more self-sufficient, both in terms of equipment and staffing, according to its website.
Peterson recently attended a Rotary international convention in Denver. The topic of polio came up — what to take up next when polio is truly eradicated? There are many possible projects, like looking at ways to get clean water to people living in developing countries. But Peterson said other Montana Rotarians he met were enthusiastic about helping combat rheumatic fever and rheumatic heart disease.
“It’s a huge project, and we’re going to at least take the first step and help Roberto with the operations,” Peterson said.
The grant process will begin next summer, and Peterson will know by March 2016 whether the application is successful.
Need for care
The six children Cattaneo and Tahta operated on went through surgeries that were four to five hours long. Two children needed valves repaired; the others needed one to three valves replaced. The youngest was 10. Before their surgeries, they were fatigued, short of breath, losing weight and retaining fluids. X-rays show the hearts had ballooned so large that their ghostly white outlines seem to take over the thoracic cavities of the patients.
Rheumatic heart disease, Cattaneo says, is a disease of poverty and overcrowding, a reflection of a country that largely lacks basic health care.
Cattaneo, himself a Rotary member, admits the chance for the disease to disappear within the next several years “is not very good.”
Aid workers would need to be trained to travel from community to community in the rural areas of Ethiopia and diagnose and treat strep throat and rheumatic fever, he said.
Even with a daunting task, Cattaneo continues enthusiastically.
“I can do something to help people. I have the ability to do it,” he said.
Anyone else in his situation would do the same, he says.
For more information on the Children’s Fund of Ethiopia or to make a donation, go to http://www.cfethiopia.org/. For more on Rotary Club of Great Falls, visit http://portal.clubrunner.ca/1849.