By LUKE MORTIMER

A series of rheumatic fever outbreaks crippling remote indigenous communities is behind rising rates of the disease that is hitting children worst, a doctor has warned. 

Leading paediatric cardiologist Dr Bo Remenyi, who was deployed to Arnhem Land’s Maningrida community during an outbreak last year, said rates skyrocketed to six times higher than normal. 

Rheumatic fever is caused by a streptococcus bacteria which can affect the whole body and can cause permanent heart damage.

“It creates fear," she said. "The consequences of the disease are pretty serious. Open-heart surgery. Monthly injections – painful injections for decades. It causes significant stress in those communities.

“Once a community is concerned by looking after sick people, then life just revolves around sickness.”

An Australian Institute of Health and Welfare report revealed rates of rheumatic fever nearly doubled in Queensland, Western Australia, and the Northern Territory from 37 per 100,000 in 2010 to 73 in 2012, before reducing to 54 in 2013. 

The August 2015 report, a benchmark for a Federal Government initiative that aims to close the gap in Indigenous cardiac health, found children aged 14 and under accounted for almost 55 per cent of cases. 

More than nine in 10 Australians on the rheumatic heart disease register are indigenous. 

Chart: The spread of rheumatic fever

Click here to see interactive charts on rheumatic fever and rheumatic heart disease.

Rheumatic Heart Disease Australia (RHDA) deputy director Claire Boardman said poverty plaguing remote indigenous communities provided a breeding ground for nasty strains of the streptococcal virus that trigger the fever. 

“Instead of having eight people per bedroom, having two or three people per bedroom, if you could, would help prevent it,” Ms Boardman said.

“If people had access to hot running water, so that they could regularly access showers. 

“All those basic things, which are lacking from so many remote communities and so many houses. It’s a disease of poverty and social disadvantage.”

A July report found 53 per cent of Australia’s remote Indigenous population is more than an hour’s drive from a health clinic. 

It prevents doctors from treating an infection before it triggers a fever, or medicating to stop progression to rheumatic heart disease.  

More than 67 per cent of indigenous sufferers received less than 80 per cent of the recommended treatment and nearly a quarter received less than 50 per cent, which led to

relapses in a third of rheumatic fever cases. 

But Dr Alan Thompson, a clinic manager in central Australia’s remote Elliot community, said sufferers often opted out of medicating.  

“If I was a young lad and I felt okay, and somebody kept coming to me every month, and said, ‘I want to give you this painful injection,’ I’d think, ‘I’m not sure I want that’,” Dr Thompson said. 

Chart: The problem of treatment

Click here to see interactive charts on rheumatic fever and rheumatic heart disease. 

“But we try to educate as well the fact that if they don’t do that, the alternative is they might end up with heart damage, which involves surgery.”

The RHDA posted a video in the local indigenous language during the outbreak in Maningrida, which educated the community on symptoms and prevention. 

Dr Remenyi said public health officials didn’t identify a genetic pattern or a strain, but clusters in households and schools left families devastated. 

“You have families who have three or four people with rheumatic fever, and then their lives just revolve around hospital trips and getting needle wounds,” she said.  

“It’s a preventable disease and then you see kids coming in. I think it’s pretty heartbreaking.”