Being on the list of the most developed countries in the world, it is more than uncommon for a country like Australia to be unable to deal with a disease, very often fatal and uniformly linked to poverty; a disease of the past in wealthy countries.
Rheumatic heart disease was relatively common 50 years ago in Melbourne. Data from Melbourne from 1930 and 1940, show it was the most common cause of children being admitted to hospital. Nowadays, almost all of the cases of this disease come from developing countries. The latest data suggest there are almost 30 million people suffering around the world, and somewhere between 300, 000 and 500, 000 of them die every year.
Rheumatic heart disease has reached world levels in Australia, occurring at record rates in Aboriginal populations living in remote areas. Generally speaking, diseases that Aboriginal people are suffering and dying from in Australia are the same diseases that non Aboriginal people are dying of, with the addition of infectious and other diseases that appear due to specific living environment; diseases of poverty, living conditions, unemployment.
The difference is great, however – Aboriginal people are dying prematurely, at a much younger age and at higher rates.
Recognised as a leading mind in the Australian health field, with expertise in Indigenous child health, Dr John Carapetis has made a commitment to the reduction of rheumatic heart disease. In doing so he has tackled an issue of enormous complexity, linking the poor education of Indigenous populations with their poor health.
The passion and inspiration of Dr Carapetis – once named on a list of the 100 most intelligent Australians – is helping our most disadvantaged children. Whether it is children from Aboriginal and generally indigenous communities, refuge families or developing countries, the aim is the same for this top child health researcher – Australia must do more to help its most disadvantaged children.
One of the focuses of his broad field of interest is rheumatic heart disease, caused predominantly by an infection due to the streptococcus bug. Even in cases where the infection is cleared, there is one part of the body that may not get better, and that is the heart valve.
Australia today finds itself amongst countries with the highest rates in the world, of the disease that can be put under control with a small investment.
“Australia as a country is seen as the world leader in controlling rheumatic fever. I’m optimistic that in next 5-10 years we’ll see this disease reduce in Australia. For me, another challenge is to take what we learn to the Pacific and Asia and Africa, and get the disease under control in those countries as well,” Carapetis tells Neos Kosmos.
In July 2012, Professor Jonathan Carapetis has been appointed as director of Perth’s Telethon Institute for Child Health Research, after six years of leading the Menzies School of Health Research in Darwin.
After years of working on Indigenous child health research and working closely with Aboriginal communities, Carapetis’ says poor education and poor health are closely intertwined.
“It’s almost impossible to live a full, healthy, active life if you are not properly educated and vice versa.
“When you go to a remote community and see that, not only kids but sometimes their parents can’t even read and write, the picture is clear. We can keep someone healthy – vaccinate them, treat their diseases, make sure they are fed. But, if they can’t read and write, there is no hope. This is a message that leaders in some African countries understood some years ago. If there is one exit from social depravation, I’m giving people good education. I remain absolutely convinced that if there is one thing that we could do, that would make the biggest difference to Aboriginal health, it would be to get the message through the schools,” Jonathan explains.
This was one of the reasons why, when in 2006 he was appointed to Menzies School of Health Research in Darwin, Jonathan challenged the staff and said: “If one of the biggest issues in Aboriginal population is education, than it’s a health issue”. This was a starting point for Menzies School to start working to bring health personal and education specialists together.
Helping developing countries
For the former Northern Territory Australian of the Year, the initial focus that sparked his interest in medicine was not so much about providing good health for Aboriginal people.
After Jonathan’s childhood spent in Adelaide, the family Carapetis – who cherish a long Australian Greek history with Jonathan’s grand grandfather being the first one to migrate – soon moved to the USA, where father of then 14-year-old Jonathan got a job with the World Bank.
Jonathan’s frequent travels to Africa, as well as attending international school, seeded in him a real interest in issues that developing countries are dealing with. Once he came back to medical school in Australia, he carried this interest with him. With his father moving to Tanzania during his medical studies, Jonathan had the opportunity to experience working for a local hospital.
“That really made me focus entirely on the issues of people living in poverty. And this sort of social justice side of things really inspired me to contribute to people being empowered and to teach them to be healthy.”
It was in 1993, while Jonathan was doing his training as a paediatrician and infectious diseases specialist in Melbourne, that he realised he also had interest in research and Aboriginal health.
Since then, he has remained faithful to working in Aboriginal health research, but still maintains the link with health in developing countries.
Rheumatic heart disease in Australia
With Australia carrying the title of a developed country with one of the highest rates of rheumatic heart disease, Jonathan draws parallels and contrast, comparing the treatment of Indigenous people in Australia, and in developing countries.
“In Australia, it’s a national travesty that we have people living in such circumstances of poverty. Whilst I wouldn’t overplay it compared to some of the extreme poverty you see in some parts of Sub-Saharan Africa, it’s still quite confronting when you go to remote communities, look at the poor quality housing and the malnutrition amongst kids, the high rate of infectious diseases that have been actually eradicated from the rest of this country. There are parallels, and what we can learn is how many of developing countries have managed to emerge out of these situations, become powerful economies and much healthier populations,” Jonathan tells Neos Kosmos.
Issues around the modern history of Australia and Aboriginal people feeling oppressed in their lives, have to be taken into account, to find out what obstacles Australia must deal with, issues that not many developed Western countries need to nowadays.
“There is, for Aboriginal people in this country, a couple of hundred years of feeling disenfranchised from their own environment. Yes, Australia has to take responsibility for past injustices, but at the same time, Aboriginal people have to take some control themselves, as parents, as leaders. And they can only do that if they have the education, the living environment that allows them to be healthy,” he says.
Beside the fact that there are some signs of improvement in Aboriginal child health, Jonathan emphasises what we need is a seismic change. He stays devoted to helping Indigenous people, to health research that will benefit their communities, as well as to passing knowledge on to developing countries. His aim is simply to make a difference.
“My passion is to bring together research with clinical work, with advocacy, with policy. I’m also very dedicated to that concept of ‘it’s not all about science’. Science is critical, but it is also about us as scientists working as advocates, advisers to policy makers, as part of a much bigger team. I would like, before I retire, to see the rheumatic fever on its way down as a major health issue in Aboriginal population and in developing countries around the world.
“We, as a wealthy country, recognise there is a responsibility for people that are not as fortunate as us. We have to understand that it can manifest in many ways. For me, as a scientist researcher and advocate, it means let’s focus on the things that are killing people, unfairly, not due to their own mistreatment of themselves but due to the circumstances in which they live. We have something to offer, we have expertise, we have resources, and we can help you. It also means working in a partnership. That’s the model we are trying to establish here in Perth’s Telethon Institute for Child Health Research as well.
“I would appeal to the Greek community to be a part of a much more holistic and global approach, of Australia’s role in the world; in particular, have a look at some of the things we are doing in Aboriginal health and developing countries health, and ask yourself how can you become a part of it,” Jonathan concludes.