Lessons from World Congress of Cardiology for Samoa

Rheumatic Fever and Rheumatic Heart Disease Samoa has one of the most successful programs in the world.

The success has been attributed to the leadership in the Health and Education sector, and the workforce driving the program in all levels of society. Samoa has done the most RHD Echo screening in Primary School children (over 20,000 kids), and has also done over 1,500 students in secondary schools, in Government, Non-Government and Private Schools.

RF and RHD are still very common in Samoa, but the rates are far lower than the Aboriginal population in Australia but similar to Tonga and Fiji.

The compliance to monthly Penicillin injections around 79-80per cent is one of the highest in the world and this is attributed to a dedicated Nursing workforce responsible for administering the injections.

This compliance is much better than New Zealand, Australia, Fiji (30-40per cent compliance) and other countries. RF develops from a throat infection with a germ called Group A Streptoccocus. The symptoms of RF include sore or swollen joints, rash on the body, “funny movement of the hands or legs” (chorea), fever, sore throat, and heart involvement.

Blood tests will assist the diagnosis. After the development of RF, some kids will develop RHD. Not every one who had RF develops RHD. From the RHD Screening program, the current prevalence of RHD in Samoa showed that for every 1000 students that were screened, between 12 and 14 kids were picked up with RHD. Unfortunately, majority of kids picked up with RHD cannot remember developing symptoms of RF at all.

A few students had been sent for major heart operation under the Government Treatment Scheme, while 95% were treated with monthly Penicillin injections in Samoa. The majority of students with mild or moderate RHD on Penicillin injections would get better and their heart disease would disappear.

So, it was a curable form of heart disease but compliance to Penicillin injection had to be encouraged and maintained. The parents are urged to bring their children for Penicillin injections, as this is free in Government facilities. The RF/RHD program will continue to strive to follow-up all the known people with RF/RHD and will continue to screen the population for undiagnosed RHD.

Smoking
This was one of the most discussed topics in the conference, since it was one of the leading causes of Death from Heart Attacks, Strokes, High Blood Pressure, Kidney Failure and Cancer. “No amount of smoking is good for health”. Smoking is bad for health. We have lost a lot of our own loved ones to smoking-related complications.

The youngest age of heart attack in Samoa was 21 years old, and the vessels around the heart (coronary arteries) were blocked from smoking. We have lost a lot of our prominent leaders to cancers due to smoking.

The science is very clear and there is no shadow of doubt – smoking kills. The expense to a country from smoking related diseases and complications far outweighs the benefits they get from tobacco related incomes.

The cost to health far outweighs the benefit from the finances contributed by tobacco. The conference discussed many ways of fixing a blocked coronary vessel of the heart from smoking related complications, and all these old and recent advances are very expensive, which usually cost about NZD$20,000 that our Government pay for one of these procedures in New Zealand under our treatment scheme. We usually send about 20-30 people per year for these heart procedures, and the cost is very expensive.

The cheapest thing to do is to stop smoking, and this will save the heart from a heart attack, save the brain from a stroke, save the lungs from developing cancer, and will be a lot cheaper to the individual and to our country. I see many patients with heart diseases related to smoking, and it is a constant struggle to give up smoking.

The struggles to give up smoking is never easy, but achievable. The best prevention for heart disease, stroke, high blood pressure, kidney failure and cancers – is to stop smoking. The possibility of asking the countries to BAN smoking was also discussed.

Though this will be a “dream come true” from the medical perspective, it is difficult for each individual countries to balance the forces that govern finances, health, the greater population benefits and individual choice. Through legislation and policy, it is hoped that the prevalence of smokers will reduce sufficiently, so that there are less people smoking reducing the need for the tobacco industry. Australia is leading the world in its campaign against smoking.

Samoa has done well in its reduction of smoking. The prevalence of smoking in 1978 was 42.4%, in 1991 it was 35.3%, in 2002 it was 34.6%, and in 2013 the preliminary result suggest 21%. Stop smoking is the best strategy of prevention for many diseases.

Some alcohol is good for health, but no amount of smoking is good for health.

Salt
Too much salt has been associated with High Blood Pressure. High blood pressure is associated with heart diseases, stroke and kidney failure. The higher the amount of salt consumed, the higher the blood pressure.

The amount of salt that we should reduce our individual consumption to, is less than 5 grams per day or less than 1 teaspoon of salt per day. The preliminary results from the recent salt health research suggest that we are consuming about 7 grams per day in Samoa. United Kingdom was able to lower their salt consumption from over 9 grams per day to about 8grams per day. It is not easy to change the taste buds to the salty taste, but it will take time to reduce the over use of salt in our daily consumption. Salt is still necessary for our health, but TOO MUCH salt is not good for health as it will increase the blood pressure.

Sugar and Diabetes

Prevention of the development of diabetes is very feasible. Diabetes causes many medical problems like heart disease, kidney disease, stroke, eye problems, and nerve problems. If the diabetes is well-controlled with dietary intake and medications, none of the other medical problems will develop.

Heart Diseases due to diabetes can be prevented with medications, exercise, and dietary intake.

High Blood Pressure
High blood pressure can cause heart disease, kidney failure and stroke. Salt reduction is one of the best strategies to reduce high blood pressure. Regular exercise helps to bring down the blood pressure.

Reducing stress levels also helps a lot with reducing blood pressure. A good night’s sleep will also help reduce the blood pressure.

There are very good medications developed for treatment. The conference also discussed newer treatments.

Heart diseases
The best prevention is stop smoking.

Exercise is very good for the heart, and exercise for ½ - 1 hour per day prolongs life.

Even walking for ½-1 hour per day is very beneficial, or swimming, or doing chores around the house are all very beneficial.

Zumba exercise is also very beneficial for health. As long as we are moving for a longer period of time (1/2 – 1 hour per day) and sweating during the process and elevating our heart rate, that is much better than sitting doing nothing.

People who exercise regularly have much better hearts. If someone has heart disease already, exercise is also very beneficial. The amount of exercise needed is dependent on the symptoms and severity of the heart disease. A good night’s sleep will assist in reducing heart disease. Reducing stress levels will reduce heart disease. There are already very good medications developed for heart disease but people need to take these medicines to benefit. There are many new medications that were discussed in the Conference from recent researches, but these will take some years to be available in Samoa.

Treating elevated cholesterol (fat in the blood) and treating high blood pressure will assist in reducing heart diseases.