May 2018: Focus on the RHD course

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May 2018: Focus on the RHD course

Written by Tara Geoge, RM, MEAC Member, ACM Representative on the RHD in Pregnancy Steering Committee

About Rheumatic Heart Disease (RHD)

Rheumatic Heart Disease (RHD) is a serious complication of Acute Rheumatic fever (ARF). ARF is an acute illness caused by a Group A Streptococcal bacterial infection of the upper respiratory tract and/or skin. Recurrent episodes of ARF lead to RHD, resulting in damage to the heart valves and reduced cardiac function. Education among high risk groups and antibiotic therapy can reduce the impact of this disease. (RHD Australia, 2012).

ARF and RHD are rare in industrialised countries, but highly prevalent in Aboriginal and Torres Strait Islander communities within Australia and cause significant morbidity and mortality among this group (RHD Australia, 2012). In Australia there is a significant difference in prevalence between the Aboriginal and Torres Strait Islander communities and the non-indigenous population. The Australian Government’s Rheumatic Fever Strategy aims to reduce the impact of this preventable disease. As part of this strategy, RHD Australia is funded to support the control of Rheumatic Heart Disease in Australia. RHD Australia is based in Darwin at Menzies School of Health Research.

Women with RHD should be assessed pre-conceptually because the effects of pre-existing vascular disease become worse during pregnancy. Some women are first diagnosed with RHD when they become pregnant as the exacerbation of symptoms makes the pre-existing condition apparent. Other women do not understand the impact of pregnancy on RHD and the importance of monitoring their condition during their pregnancy to prevent maternal and fetal complications. It is important for midwives to be able to assess for RHD and understand the implications for care of a woman with RHD. RHD Australia has been working to address the needs of women with RHD in pregnancy. They have also developed the RHD in pregnancy steering group specifically to focus on the education of midwives.

ACM engaging with RHD Australia, for Midwives

In 2017 I responded to a request to the members of the Professional Development Advisory Committee for a volunteer to represent the ACM on the RHD in Pregnancy Steering Committee. Representing the ACM on the RHD in Pregnancy Steering Committee involved attending a number of teleconferences and communication by email. Members of the committee were expected to complete the RHD Australia online modules for Health workers and the RHD in pregnancy module for background reference.

Expanding my network

The RHD in pregnancy steering committee included representation from academics, health professionals, public health professionals and educators from many organisations. This group was formed to target education development for undergraduate midwives and post graduate education. The committee explored ways of increasing awareness about RHD in pregnancy, and creating consistency in education provided around RHD in pregnancy. As such we spent time discussing the current Midwifery Education framework in universities, both undergraduate and postgraduate, and exploring ways to consolidate this. We received pertinent articles and information to read and were asked to comment on education tools and case studies that were developed. We also discussed ways midwives could access information about RHD in pregnancy as part of their ongoing professional development. We brainstormed ideas to increase awareness amongst midwives and reviewed promotional materials developed by RHD Australia, such as a poster promoting RHD in pregnancy awareness for use in clinics and antenatal visit sites and an A6 postcard promoting RHD Australia resources for health professionals (specifically the RHD in pregnancy online learning module and an app to assist with acute RHD diagnosis and treatment).

Growing skills

Although I have worked on committees within the ACM, this was the first time I have represented the ACM on an external committee so it was stretching me out of my comfort zone. As a clinician with little background knowledge about RHD, I was a bit nervous about representing the ACM in a group of policy developers and academics. Although I initially wondered what I would be able to contribute, I quickly found my niche. In fact the things that made me most nervous helped me do this.

Developing and assessing content

The fact that I had very little background knowledge about RHD proved useful in providing feedback about the RHD online modules. We were looking at the modules to assess which would be useful to direct students and midwives to as part of their learning. There was a point in the course that didn’t make sense and I felt I was missing something. After a search on Google I found the missing link and realised that this knowledge was assumed in the course. I was able to offer constructive feedback about this. It meant admitting my lack of knowledge, but improved the course. I was also able to offer additional information about the course from an editorial perspective using skills that I have developed in reviewing and piloting courses through my work in the ACM Professional Development Advisory Committee.

Providing input

I found that my perspective as a clinician, and thus part of the target group, was beneficial. For example, when we were asked to review a poster promoting RHD in pregnancy awareness for use in clinics and antenatal visit sites, I spent some time looking at the posters in the areas I was working and was surprised by how many there were. There are so many conferences and online courses that would be interesting and valuable but I have limited time. As a result I recommended that they use an impact statement at the top of the poster to explain the importance of RHD in pregnancy.

Disseminating information and resources

I was also able to advise the committee about opportunities to disseminate information to midwives through the ACM, including webinars, presenting at the conference in October 2017 and the Australian Midwifery News.


RHDAustralia (ARF/RHD writing group); National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand. Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease (2nd edition). 2012

Resources available