C.J. is an 8 year old girl with a very loud heart murmur. She was referred to a cardiologist more than 4 months ago for an echocardiogram to determine the cause of the heart murmur. But her mother has not taken her due to gang activity on the roads. She most likely has damage to 1 or more heart valves from rheumatic heart disease, though she needs an echocardiogram to determine this and to determine the severity of the damage.

Rheumatic heart disease is caused by the body’s reaction to infection with Streptococcus pyogenes which is the bacteria that causes strep throat. This heart condition is very rare (1/20,000) in developed countries but is much more common in developing countries where people have decreased access to healthcare. It typically affects children and significantly decreases the lifespan.

I suspect that C.J. has significant heart valve damage and will require cardiac surgery. Unfortunately, cardiac surgery is not available right now in Haiti. And given the current instability caused by gangs, it is unlikely that foreign surgical teams will come to Haiti anytime soon. So for now, we are giving C.J. medication to prevent recurrent episodes of rheumatic fever and monitoring her for signs of heart failure.