Foreword
The Challenge of the Familiar or Everybody's Stepchild
Prof Angelo Taranta , Cabrini Medical Centre, New York, U.S.A.Is rheumatic fever worth the trouble? This nagging question must have bothered many a cardiologist, as well as rheumatologist, pediatricians, internists (even "general internists"), public health experts and policy makers. (It's no coincidence that rheumatic fever, located at the inter-section of the interests of all these professionals, often ends up as their stepchild!). After all, competition is keen for the attention of each of these professional groups, and a case can be made that each has weightier problems on its collective mind from arteriosclerosis to diarrhea, not to speak of AIDS. Yet, rheumatic fever has a special hold on the medical imagination, and this gathering, or rather this series of seminars bears witness to its enduring appeal.
Five major seminars have been previously held, in the Asian Pacific region, on this subject: the first at Hakone, Japan, in 1973, sponsored by the Japan Heart Foundation the second at Manila, Philippines Heart Center for Asia, the third at Otsu, Japan, 1976, sponsored by the Japan Heart Foundation, the fourth at Sunmoon Lake, Taiwan, in 1983, sponsored by the Asian-Pacific of Cardiology and the fifth at Rotorua, New
Zealand in 1987, sponsored by the Asian Pacific Society of Cardiology. Rheumatic fever is said to be a social disease, in the same sense that TB is; it correlates with social ills greater that itself poverty, lack of medical care, and especially over crowding in the home. By the same token, the process of rheumatic fever control is an intensely social process not limited to the hospital but optimally involving the schools, the media, the social worker, and the community-based health worker.
The "raising of consciousness" symbolized by the effective poster of the Pakistan Heart Foundation is itself a social process, which brings all of us together: patient, potential patient, parents, physicians and other health professionals. Since rheumatic fever as yet is treatable but not curable (in the sense that pneumococcal pneumonia or syphilis are curable). Rheumatic fever control relies heavily on prevention, and therefore on education (or even indoctrination) of the patients, their parents, and potential patients, as well as on education of health professionals.
It is this feeling of working together towards a desirable and attainable goal that makes rheumatic fever control such an engaging vocation, and the community of rheumatic fever workers such a community of friends. But it's not only its social aspects and the attainability of success, which make rheumatic fever so engaging; it's alas, the remaining mystery of how the strep does it? Who doesn't like a good mystery? And rheumatic fever,
is suitably mysterious - no one knows for sure, why it has been disappearing in "developing nations", nor why it is coming back now, or how the strep, which is never isolated from the rheumatic fever lesions but only from the distant portal of entry in the throat, causes damage in the heart. These questions are likely related _ if we knew more about the strep and its interaction with man we would also know why rheumatic fever waned and waxed, and how to make it wane for good.Before the advent of that millennium, we must continue our work, sometimes elating other times boring ("Did you take your pills? May I count them? Why didn't you come to the last appointment?"), but always necessary.
Prof. Angelo Taranta M.D.
Cabrini Medical Center
New York, USA.