Third world diseases persist in remote communities

Sydney nurse Alanna Maycock shared a New York stage with world leaders who were horrified by her account of the abuse she witnessed on Nauru.

Indigenous Australians are 122 times more likely to live with the life-threatening rheumatic heart disease than their non-Indigenous peers. An eye infection called trachoma is contributing to rates of blindness six times higher in Indigenous communities than among non-Indigenous adults. And in some remote communities, up to 90 per cent of Aboriginal children have some form of the ear infection otitis media, which can lead to hearing loss.

“Trachoma disappeared from white Australia more than 100 years ago as living conditions improved, and Australia is the only developed country that still has the disease,” Professor Hugh Taylor, the Harold Mitchell Chair of Indigenous Eye Health at the University of Melbourne, told The Lamp.

“The blinding trachoma requires repeated episodes of reinfection and the transmission of infection from one kid’s eye to another, so to stop trachoma we really need to stop these frequent episodes of infection.”

Trachoma (see box on page 25) persists in some remote Aboriginal communities because of poor hygiene that is exacerbated by poor standards of housing and washing facilities.

Preventing trachoma “comes down to keeping every kids’ face clean, and to do that we need to make sure the kids know their faces are dirty, but also to make sure there have adequate washing facilities,” Professor Taylor said.

Nurses in clinics play a role: “Every kid who walks into the clinic who has a dirty face, snotty hair and snotty eyes should be asked to wash their face and be reminded to keep it clean,” Professor Taylor said.

“And you can’t wash your face without washing your hands, so by blowing your nose, washing your face and using clean towels you are going to dramatically reduce trachoma, otitis media, respiratory infections, diarrhoea and skin infections, including those that lead to rheumatic heart disease.”

A massive drop in trachoma but hotspots remain

In 2009, the Australian government committed to eliminating trachoma by 2020. At that time, disease rates ranged between 15 per cent and 20 per cent. Data from 2015 show a massive drop, with the national average for children in endemic areas at 4.6 per cent. The results are encouraging says Professor Taylor, but there are many “hotspots” where the disease persists.

The middle ear infection that can cause hearing loss, otitis media, affects nearly every child in remote indigenous communities from soon after birth, says Professor Amanda Leach, Leader of the Ear Health Research Program (EHRP) at the Menzies School of Health Research.

“What is happening in remote communities is that it is progressing to the most severe form, to suppurative otitis media, or chronic running ears. The longer the infection is left untreated, the further risk it poses to hearing.”

Professor Leach says that at twelve months, just 5 per cent of babies have normal eyes in three of the largest remote communities in the Top End and Western Australia. In some areas, 4 per cent of Indigenous children aged from five to nine years old have an active trachoma infection. In the Northern Territory, that rate is 5 per cent, which is considered an endemic level.

“Much more needs to be done,” she says, starting with vaccines at an early age, antibiotics to address cases caused by bacteria, education about hygiene, and more effective programs to address the overcrowding and substandard housing that contributes to diseases spreading. ■

The diseases plaguing remote communities

Otitis media*

Otitis media is a middle ear infection that causes hearing loss. It is sometimes called bulging eardrum (acute otitis media), glue ear (otitis media with effusion) and runny ear (chronic suppurative otitis media). It is caused by multiple strains of three bacteria common in the nasal passages of young children: Streptococcus pneumoniae, non-typeable Haemophilus influenzae and Moraxella catarrhalis.

The longer the infection is left untreated, the greater risk it poses to hearing. One study found Indigenous children were five times more likely to be diagnosed with severe otitis media than their non-Indigenous counterparts.

Early hearing loss is associated with lower rates of school attendance in Indigenous students, while later in life hearing loss is linked to problems securing and keeping employment.

Depending on the diagnosis and the specifics of each situation, treatment can involve antibiotic (amoxycillin). Surgery, where devices known as tympanostomy tubes (grommets) are inserted into the ear drum to prevent accumulation of fluid, may be needed.

*Information edited and adapted from a three-part series of articles on Indigenous Health published in The Conversation between 14–16 September 2016.

Acute Rheumatic Fever

Acute rheumatic fever is an abnormal immune response to throat and skin infections from the bacteria group A streptococcus. Usually, the bacteria are harmless colonisers of the nose and mouth, but an active infection can cause a “strep throat”.

This prompts the body’s immune system to respond. In most cases, the immune response is appropriately targeted to kill bacteria and the infection resolves.

In some cases, the body mistakenly targets normal tissues in the body, including the heart, skin and joints.

The fever and joint pains that typify acute rheumatic fever tend to resolve over a period of weeks, but damage to the heart valves generally persists.

Each recurrence causes further heart damage. Eventually, the heart valves become scarred. This chronic phase of the disease is called rheumatic heart disease. Over time, it increases the risk of heart rhythm disturbances, stroke and heart valve infections, and culminates in heart failure.

Trachoma

Trachoma (sometimes known as sandy blight because the eyes feel full of sand), is the world’s leading cause of infectious blindness.

It’s caused by the bacterium Chlamydia trachomatis, which creates swelling under the inner eyelid leading to scarring. The scars cause the eyelashes to turn inward and scratch the eye, which is intensely painful and made worse by blinking.

If left untreated, the scratching will result in the cornea going cloudy and irreversible blindness.

Trachoma easily spreads from one child to another through infected eye and nose secretions.