Access to secondary prevention for Rheumatic heart disease (RHD) among chronic patients after surgery remains limited in Rwanda and both patients and government officials have called for improved post-surgery care. 

RHD is a chronic heart condition caused by rheumatic fever that can be prevented and controlled. It is also a common and dangerous disease that can lead to loss of life if not well treated. 

According to the World Heart Federation, people who have had a previous attack of rheumatic fever are at high risk for a recurrent attack, which worsens the damage to the heart. 

The Federation says prevention of recurrent attacks of acute rheumatic fever, which is known as secondary prevention, involves regular administration of antibiotics and has to be continued for many years. 

While secondary prevention programmes are currently thought to be more cost-effective for prevention of RHD than primary prevention and may be the only feasible option for low and middle-income countries, access to the care in Rwanda remains an issue.

Evariste Munyensanga got a new lease of life after a heart operation in 2011, but admits that he is now challenged on a daily basis as he still has to take medicine and go for regular medical checkups to monitor his health condition after the surgery. 

"The Ministry of Health should help people with heart problems have access to medicine and make a follow up on our health condition because there is a lifestyle we are supposed to live after surgery. This may be hard for some people especially those in rural areas and yet we all have the right to health care regardless of our situation,” Munyensanga said. 

To avoid the recurrence of RHD, Munyensanga has to take two tablets of penicillin every day, one in the morning and another one in the evening, as well as the walfarin anticoagulant.

He says the drugs are provided by US heart surgery volunteers from Team Heart organisation because he cannot afford them since they cost more than Rwf40,000 and are not covered under his community-based health insurance scheme called Mutuelle de Santé.

 Munyensanga urged government to include medicine for after cardiac patients on the Mutuelle de Santé (health insurance) coverage and make the medicine accessible in all health centres across the country. 

Jovia Umudahogora, 20, from Kinyinya in Kigali, who also underwent cardiac surgery in 2012 by Team Heart, agrees that cost and access to their post-surgery medicine is a challenge. 

"We would like to be given a card that we can move with at all times for easy identification and be given special treatment since it is different from the rest of diseases. We also want the ministry to intervene especially on the cost of our medicine because it is very expensive at 40,000 to 50,000 Rwandan francs,” she said. 

Ministry to address the challenge 

Alex Mucyo Katabarwa, national nurse coordinator for cardiac care programme in the Ministry of Health, says several interventions are being put in place to create awareness on prevention and post-surgery care for RHD.

"We started advocacy with different people. We initially had Team Heart from Boston that comes to Rwanda once every year to carry out cardiac surgery and we are working with this team to reinforce advocacy for cardiac patients. We are also planning to have a partnership with local artistes to create awareness about RHD and other heart diseases,” he said. 

Regarding access to medicine for patients that have undergone cardiac surgery, the official said that the ministry is working to ensure that community health insurance can integrate walfarin on its coverage. 

"We want to talk to the team in charge of medical insurance at the national level to at least make walfarin available at the district level because now all these people have to come to Kigali to get medicine. It is a process that we started long ago and we hope this medicine will be available at the district level and those with health insurance are able to access it,” he said. 

Ceeya Bolman who leads Team Heart in Rwanda said that post cardiac surgery patients have some challenges in their physical life that require careful watch along with medical check-ups for the rest of their lives. 

Team Heart was in the country recently where they operated on 16 heart patients, bringing the total number of patients the volunteers have so far operated in Rwanda to 100.