Rheumatic Heart Disease (RHD) has been a prevalent issue in the remote Aboriginal community of Doomadgee for many years, but due to preventative measures and increased engagement between community members and the Doomadgee Hospital staff, all people that require prophylaxis of benzathine benzylpenicillin (Bicillin) injections are up to date.

These injections are prescribed every 21-28 days for up to 10 years, maybe even longer depending on the severity of each individual case of ARF/RHD.

Bicillin is essential to prevent recurring Group A Streptococcal infections leading to episodes of Acute Rheumatic Fever (ARF).

Any subsequent episodes of ARF potentially cause more damage to the heart valves of people with RHD.

When Doomadgee Director of Nursing, Devashrii (Devi) Dobe, first joined the Doomadgee team in late September 2023, on average only 38 percent of the ARF/RHD registered population had received prophylaxis – a treatment given to prevent recurring infectious diseases such as streptococcal infection which leads to ARF – as of end of August 2024, Doomadgee is at 100 percent compliance.

ARF/RHD involves a complex treatment plan that requires patients to attend before the 28-day deadline for each injection to protect the patient from further group A streptococcal infections.

Ms Dobe and her team have been champions leading the battle against ARF/RHD in Doomadgee connecting the community and hospital staff and building trust as the first step to treating this disease.

“All the staff at Doomadgee Hospital are incredibly dedicated, we make it our mission to engage with patients – we educate – we are persistent and sit and listen to what each person needs and what works best for them, this is vital,” said Ms Dobe.

“Patients are people, and they are all individuals that need and respond to information differently, so we need to adapt our methods and our communication styles to best serve the people.

“For me, it’s been putting my money where my mouth is… I sit and yarn and I hope I have shown the people of Doomadgee my dedication through my actions to improve health outcomes.

“Most patients thought they needed their “needle” monthly on the same day – which of course is not correct… so big changes to how we deliver care have been implemented… persistency, kindness and listening are the three vital steps for engaging in my experience.”

As the Doomadgee Hospital team continue to encourage healthy practices and educate on preventative measures to avoid strep infections, many initiatives have been implemented over the past year based on two inquests in 2023 by the Queensland Coroner and the Office of the Health Ombudsman into the cluster of deaths from RHD in Doomadgee.   

In response to the Coroner and Office of the Health Ombudsmen recommendations, multiple initiatives were implemented in Doomadgee to educate and engage community members such as;

• Orange Sky Australia: Providing free laundry services.
• SoapAid: More than 5000 bars of soap have been distributed at various places across Doomadgee.
• QAS CPR training: Providing community members with essential training in CPR and defibrillator usage.
• Cultural training: Co-designed with the Doomadgee community to ensure all clinicians and staff have appropriate training in understanding cultural safety and communicating in a culturally safe approach.
• staff training for RHD: Before commencing at Doomadgee Hospital, all staff must complete 8 training modules in RHD prevention and treatment.

Ms Dobe said communication is vital in high quality healthcare, in addition to staff training, education is provided on the ground opportunistically and through staff meetings and daily morning huddles to discuss vulnerable patients in the community and hospital, so the team can manage cases better.

“Implementing these initiatives has been incredibly fulfilling professionally. We as a Hospital and Health Service (HHS) are uniquely positioned to show just how well we listen, learn, and implement,” said Ms Dobe.

With the new Doomadgee Hospital build on the horizon, the North West HHS will continue to encourage the Doomadgee community to provide input for the new hospital design.

“The new hospital, like our current hospital, will have a dedicated RHD room for patients,” said Ms Dobe.

“This shows respect for the trust it takes for people to come to us for care… it shows we get that this treatment is painful and it’s intimate.  A room with distractions, that is quiet, warm, and private is the least we as a service can do for the people.

“Of course, we will listen to what further people need to make this space their own, after all the hospital is for the people of Doomadgee so must serve them in the best way we can.”