How sore throats are making children sick in the heart

Charles Muteti, 24, has to remind himself that it is okay to take a flight of stairs.

He has to remind himself that he won’t faint and collapse if he walks briskly and that he can now run as much as he wants – lessons he is embracing as he comes to terms with his six-month-old “new” heart.

Charles was diagnosed with a heart condition in 2013 after going to hospital coughing blood. Doctors ruled out tuberculosis, but a chest x-ray showed that he had an enlarged heart (cardiomegaly), that needed prompt specialist attention. The cardiologist who reviewed him after a referral came at a fee of Sh4,000 per session, money that was hard to come by. Worse still, Charles needed Sh250,000 to repair his heart valve. With no money to spare for treatment, Charles enrolled for a hospitality course, but he couldn’t cope.

“I couldn’t walk up the stairs to attend class and I couldn’t lift anything heavy. Over time, I became a recluse,” he says.

He turned to work, but that also didn’t work.

“In 2015, I got a job in Dubai. I had my visa ready and all that was left was the medical tests. When the doctor saw my heart problem, he said I couldn’t travel. Just like that, I lost a job,” he recalls. His ailing heart had come in the way again.

Charles went back to the heart specialist, ready to sell land to get the Sh250,000 needed to fix his heart. He was referred to the Kenyatta National Hospital to book surgery in January 2016. There, he was put on a waiting list and the earliest he could be operated on was April 2018. He had to wait two years and two months for the life-saving procedure.

“That signaled the end of the road for me. I was jobless and hopeless and there was nothing I could do, yet I was getting worse by day,” he recalls.

Luckily, Charles’ miracle came at the end of the year when he got a call from Karen Hospital in Nairobi, informing him that he would get free surgery covered by the National Hospital Insurance Fund. And on January 9, 2017, he was wheeled into theatre where his faulty heart valve was repaired.

SCARRED HEARTS

Charles was one of the first beneficiaries of a public private partnership between global healthcare management company A&K Global Health, and NHIF, to offer free treatment for needy heart patients who couldn’t afford cardiac surgeries. The Cardiac Care Programme would link patients to local hospitals with the capacity to offer specialised care and the beneficiaries would be sourced from waiting lists in different public hospitals.

According to data from A&K Global Health, there are currently 1,435 Kenyans on the national waiting list for cardiac treatment across the country. Seventy per cent of those with heart ailments, are between the ages of zero to 21 years. While some of these young patients were born with the heart defects, also known as congenital heart disease, a majority suffer from rheumatic heart disease, a condition in which the valves of the heart become damaged.

Rheumatic heart disease arises from an untreated sore throat. The sore throat — caused by Streptococcus bacteria — looks like an unlikely suspect but it is known to introduce bacteria into the blood stream leading to certain types of heart disease.

The body’s immune system becomes overactive in its response to the streptococcus bacterium. Dr Daniel Nduati, a cardiologist, explains this overreaction leads to release of antibodies which cause inflammation and tissue damage in the heart and other parts of the body.

Overtime, this results in permanent scarring of the heart valves, particularly one known as the mitral valve. A scarred heart valve may prevent adequate blood flow or cause backward flow of blood. Damage to the heart valves may only show up 10 to 30 years after the initial infection.

Rheumatic heart disease causes 400,000 deaths worldwide annually, mainly among children and young adults. Doctors advise parents to take caution if their child has a sore throat that is not accompanied by a running nose. Apart from rheumatic heart disease, Kenyans on the list suffer from endocarditis (heart infection), arrhythmias or abnormal heart rhythms, and pericarditis (an inflammation of the sac surrounding the heart) and heart attacks (myocardial infarction).

But why are Kenyans getting sick in the heart? Other than being born with heart defects, sedentary lifestyle — which involves eating too much fat and sugars, leading stressful lives, smoking and consuming too much alcohol — in turn marked with bulging waistlines, high blood pressure and diabetes, is the root of these ailments.

Dr Betty Gikonyo, the co-founder and CEO of Karen Hospital and a paediatric cardiologist, says that each week, three to four patients with heart complications are picked out at the private facility.

Unlike before, diagnosis and treatment of heart complications is now available through the national health insurer. Mr Stephen Masinde, A&K Global Health, Kenya, national director says the NHIF cover (even the most basic one of Sh500 a month) provides for the pre-evaluation, surgery, and post-evaluation follow-up for about six months.

Initially, it would costs Sh3 million for heart surgeries, but now it’s reduced to Sh1.2million, and is expected to go even lower with time. Cardiac services under the NHIF cover can also be accessed at Aga Khan Hospital, Mater, Kenyatta National Hospital, Nairobi West Hospital and Getrude’s Children Hospital, all in Nairobi, as well as in Eldoret Hospital and Tenwek Hospital.

More than 500 patients have accessed or are currently accessing cardiac management and treatment under the programme and about 128 patients have benefitted from the cover at the Karen Hospital alone.

Both Mr Masinde and Dr Betty Gikonyo agree that lack of finances has stopped Kenyans from accessing the crucial specialised treatment. The problem has also been compounded by lack of local expertise and limited number of cardiac surgeons available to perform the procedures in the country.

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Signs of heart disease 

• Chest discomfort (pain, tightness, pressure) that lasts longer than a few minutes

•  Pain in the arm that radiates down the left side of the body

•  Extreme exhaustion or unexplained weakness

•  Swollen ankles, legs and feet