Hearts Knit Together

Saving a life can be a simple thing—as long as one knows how. And that’s where the Rheumatic Relief program comes in. BYU’s Rheumatic Relief program unites undergraduate students, professors, cardiologists, sonographers, and the American Samoan Department of Health in its cause to educate, screen, diagnose, and set treatment plans for children in American Samoa.

“The most exciting part of the program is that we truly are saving lives,” says David Cragun, a BYU alumnus and cardiologist who volunteers for the Rheumatic Relief program. “We’re learning to serve together, and it impacts all of us.”

Since the program’s inception, volunteers have screened more than 50,000 children in Samoa and American Samoa, and about 2.5 percent of them have been diagnosed with this serious heart condition and then referred for lifesaving treatments.

HIGHEST IMPACT IN LOW-INCOME COUNTRIES

Rheumatic heart disease (RHD) causes more than 300,000 deaths annually across the world but is fully preventable. It is caused by an abnormal immune response to pharyngeal group A streptococcus infection, also known as strep throat. This disease primarily impacts children between the ages of five and fifteen who live in low- and middle-income countries. American Samoa, a small island between Hawaii and Australia, has especially high rates of RHD.

“Seeing that even kids as young as five years old can have severe cases of rheumatic heart disease was really shocking to me and really saddening. But it’s also awesome to know we’re here for them. We can catch this early and save their lives,” says Meg Takara, a BYU cell biology and physiology major and participant in the May 2023 program.

Left untreated, RHD can lead to heart failure and even death. If caught early, this condition can be treated with antibiotics to prevent further progression. RHD is especially troubling for young women who are pregnant.

BYU alumnus and cardiologist Marv Allen shared an example of a case the program diagnosed and treated. “We saw a young woman about nineteen years old who had mitral stenosis and mitral regurgitation, which basically means she had a fairly advanced stage of rheumatic heart disease,” he says. “In the very near future, especially if she were to become pregnant, the rheumatic heart disease could cause heart failure and even death. Identifying her condition was very rewarding. It feels good to know we possibly saved her life.”

The Rheumatic Relief program hopes to find RHD in early stages to prevent damage and limit suffering. “The goal overall is prevention,” says Owen Demitz, neuroscience major at BYU and participant in the May 2023 program. “As students involved in this program, we focus on teaching the children how to help prevent this problem so that it doesn’t happen to more children in the future.”

Demitz talked about the impact spanning generations. “When the children we are educating now have their own children in the future, we hope they can recognize the symptoms in their children and get treatment before it’s too late,” he says.

PROGRAM DESIGN LEADS TO LONG-TERM RELIEF

In the Rheumatic Relief program, students have the opportunity to shadow and serve alongside board-certified cardiologists and sonographers. Visiting primary schools in American Samoa, the volunteer sonographers and cardiologists use echocardiography (ultrasound of the heart) to identify rheumatic heart disease in children and refer them for treatment.

“During the echocardiogram, we’re looking at the heart valves to see how well they’re opening and closing in addition to how well the heart is squeezing,” explains Patty Slack, echocardiography director of the Rheumatic Relief program. “If we see any leaks, then we know that there’s a possibility they have rheumatic heart disease or some other heart condition.”

A unique aspect of this program is BYU’s strong partnership with the Department of Health (DOH), which organizes and coordinates the Rheumatic Relief program visits with the schools. “The Department of Health in American Samoa has been fantastic in large part because they understand the danger these children are in from rheumatic heart disease. Because of this, the DOH is very anxious for us to be here and to work with them,” says Paul Savage, professor of chemistry and biochemistry at BYU and faculty director of the Rheumatic Relief program.

Many of the children that the Rheumatic Relief program screens do not have the resources to travel outside of their country for diagnosis or care. The DOH provides diagnostic access, publicizes it to local families, and manages the treatment plans for children diagnosed with heart problems that need outside attention. “The DOH leaders show that they’re grateful we are here by supporting us extremely well. They set up the screening schedule for where we go every day and have been very proactive in advertising the program. They help make our diagnostic events a great success with a huge turnout,” Savage says.

“This partnership has been such a great initiative for American Samoa because we don’t have specialty sonographers or cardiologists on the island,” explains DOH representative Ipuniuesea Eliapo-Unutoa. “Rheumatic Relief doesn’t just come in and screen. Rheumatic Relief trains our local people and sets the children who are diagnosed up for future success. What this program does helps us provide for our children in need.”

Sharon Sanyo also works for the DOH in American Samoa. Thanks to Rheumatic Relief, she’s training to be a cardiac sonographer. “We don’t have any cardiac sonographers on our island, so this training is critical,” she says. “It’s been awesome to learn and gain the skills needed to look after the children on our island who have rheumatic heart disease. I’m so grateful to the professionals and the BYU students and anyone who helped donate to make it possible for us to save these lives.”

PROVIDING EDUCATION TO AMERICAN SAMOAN FAMILIES

While the medical professionals are carrying out medical exams, the BYU students are primarily in charge of public health education for the primary school children. This is an equally important element of the work.

Tasi Pauga, a graduate of the BYU exercise science program, was in charge of the health promotion during his visit in May 2023. “We did a puppet show in their native language, sang songs, and did dances—all focused on their culture,” he says. “It’s really awesome to see how excited these children are to learn and to engage with us. We are teaching them lifesaving information, but we share it in a fun way that aligns with their culture, which is really important.”

Pauga’s father is from Samoa, which brings a special element to this work. “Being able to be here so close to where my dad is from is really special,” he says. “The love I feel from the people has been huge for me. It’s the best part of this program. It’s amazing to know we can help this community by serving and teaching them.”

The BYU students prepared for this trip months in advance by learning the educational materials and the language. Spencer Shin, a recent BYU graduate in nutritional science, loved teaching and interacting with the children through the program. “It’s funny how we prepare so much to teach these people something they’re not familiar with, but I ended up learning something much bigger from them,” he says. “I learned a lot about myself, and the people taught me through their humility, love, and acceptance. This experience has taught me to be more Christlike back home and wherever I go.”

In addition to teaching the children, students can try their hand at imaging while being supervised by professionals. “If they are interested, we’ll even let students do some imaging and try and get their hands on a little bit of what patient care is like,” says Marv Allen. “It gets them excited about going into the medical field in their careers, and it’s something that’s rare for undergraduates to experience.”

STUDENTS SET PATHS FOR THE FUTURE

Lori and Marv Allen have been traveling to Samoa to provide rheumatic relief since 2009, and the couple has loved being able to serve together in this program. “This has been a lifelong dream of ours,” Marv Allen says about founding Rheumatic Relief with his wife.

The Rheumatic Relief program has blessed the lives of hundreds of thousands of children and families in American Samoa, but it has also blessed the lives of the 112 BYU students who were able to participate in these trips over the years. “We’ve had opportunities to talk about our careers and about family,” Marv Allen says. “We get to share how to balance things like church, family life, and advancing our careers. We feel very blessed to have been at BYU, and now we have the opportunity to go out and serve—specifically serving students at BYU.”

Student volunteers get a rare, invaluable opportunity to learn from professionals with decades of experience in cardiology and sonography. Marv explains, “A lot of these students are preparing to apply for medical school, PA school, or nursing school. They leave this program being able to articulate very well what rheumatic heart disease is and what they’ve learned about diagnosis and treatment. This is a great addition to their résumé.” Lori Allen agrees, saying, “This program gives both the children of American Samoa and the BYU students a future.”

The students feel the same way. “This experience has benefited me far more than I think I’ve benefited American Samoa,” Takara says. “I’ve been able to learn what it means to be a true physician and to care about people and to serve and to love them. This is really going to impact my future as a physician.”

Rheumatic Relief gives BYU students real-world experience they can take with them in their future careers in medicine.

“We’re not just here to go to university and to learn and do our best in the classroom,” Pauga says. “It’s really about what we can do outside of the classroom. Seeing the professionals here serving and taking time out of their busy lives has given me a lot of faith in the future of our healthcare. It is something that I definitely want to do in my own life as a future doctor. The fellow students I’ve met and served alongside come from all different cultures, know all different languages, and are ready to serve.”

The experiential learning opportunities in this program are funded by BYU and donors who make it possible to continue this lifesaving work.

“None of this would be possible without the donors,” Shin says. “I share that to say that I know the American Samoan children and the families here are so thankful. But also I, as a BYU student, am so thankful for this opportunity. It’s changed the way that I plan to practice medicine in the future. It’s even changed the way I want to treat people around me.”

The Rheumatic Relief Program will continue, with the next group of students preparing for a trip in May 2024. For more information about how to get involved, visit rheumaticrelief.byu.edu.