Recently I traveled to Leon, Nicaragua, along with Dr. John Paar,  to participate in a study through the National Institute of Health to determine the prevalence of rheumatic heart disease in children ages five to fifteen years old. There are other technologists and cardiologists participating in the study as well, including Ruben Centeno from UNC Hospital Pediatric Echo.   I truly believe that one of the greatest assets a sonographer can hold is a willingness to continue learning.  There are many opportunities for learning but this kind of experience carries a variety of thresholds to education.

The study I went to work on is being done in order to determine whether or not there is a need to develop a vaccine against the serotypes of group A beta hemolytic streptococcus which cause rheumatic fever.  In this study several teams consisting of a cardiologist and an appropriately credentialed echocardiographer travel to Leon to evaluate a randomly selected group from specific regions of the area being studied.  

The team, along with specially trained nurses at the site examines approximately forty to fifty children each day for a week using World Health Organization criteria.  The nurse takes a clinical history, including questions concerning past history of rheumatic fever, frequency of sore throats, and symptoms of acute rheumatic fever. The nurse auscultates the lungs and the heart, and examines the patient for joint swelling or rash. The cardiologist will review the data and also examine the participant. A brief screening echocardiogram is then performed. The echo includes a minimum of two views, with color Doppler, employing the parasternal long axis and the apical 4 chamber views. If indeed no abnormality is found, the child will exit the study. If the examination reveals an abnormality, a complete echocardiogram with Doppler is performed.  The echocardiogram is evaluated for the presence of mitral stenosis, mitral or aortic regurgitation, and thickening or deformity of the mitral or aortic valves.    All probable and possible RHD patients will be referred for secondary prevention of streptococcal infections with monthly benzathine penicillin injections and scheduled for a repeat echocardiogram after 6 months. Based upon this repeat echocardiogram, a decision will be made concerning continuation of secondary prophylaxis, but it is anticipated that these cases will continue to be regarded as probable of rheumatic origin and thus continue on prophylaxis according to World Health Organization recommendations.  If the criteria for definite rheumatic heart disease are met on repeat clinical and echocardiographic examination, the patient will be reclassified in the definite group for the final analysis. (Information obtained from the DMID protocol for the Study of the Prevalence of Rheumatic Heart Disease in León, Nicaragua version 1, December 12, 2005)

Many people are being helped because of the study in Leon and other parts of the world.  The study provides a diagnostic test to determine the presence of rheumatic heart disease as well as penicillin to treat the patient if RHD is found.  Without this study many of these patients would not be treated early enough to prevent further complications and many would eventually require surgical intervention.  Numerous people in Nicaragua are too poor to receive health care and the quality of the care available is suboptimal by US standards.  

The level of poverty that I witnessed in Nicaragua was beyond compare to anything I have ever seen.  On the second day of my trip, before we started work on the study, we visited the basurero to take some items that Dr. Paar brought with him to give to the children who dwell there.  For those of you who do not know, the basurero is the local garbage dump.  The children, some adults, dogs, and cattle were all scavenging through the landfill competing for food and items of value.  One of the local pastors provides meals for the children twice a week through his church, and is trying to do as much as he can for all of these children.  There is just so much need, and so little resources here.  To be able to give my very tiny part in this area has been a colossal blessing for me and I wish that everyone could experience what I did this week.  Among all of the things that I learned this week, the most important is that no matter how small your gifts and talents are, they are always bigger when they are shared.