Going against the flow: a sociotechnical network analysis of endemic acute rheumatic fever and rheumatic heart disease in remote indigenous communities of Australia

Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are autoimmune conditions caused by Group A Streptococcus (Group A Strep) infections. ARF/RHD are mostly eradicated from the Global North yet are endemic in many remote Aboriginal and Torres Strait Islander communities of Australia. The risk factors for ARF/RHD are similar to the material conditions of poverty, including overcrowded housing and poor access to health services. Despite extensive interventions, surveillance, and evaluation of these conditions over many years, an entrenched experience of illness persists due to a complex array of social, material, political, cultural, and economic factors. Using actor network theory (ANT) as a primary analytical lens I will examine processes leading to the current socio-technical network conformation of ongoing ARF/RHD. I focus on three nodes, each centring on a different element of this network: firstly, benzylpenicillin G (BPG) antibiotics used for prevention, secondly, echocardiograms (ECGs) used for diagnosis and screening, and finally, Group A Strep vaccines that are yet to be developed into a useable product. For each node I analyse the scientific, policy, and sociological literature by mapping and tracing associated human and non-human elements and considering how their configurations have changed over time. Further, I explore the contingent ways in which these nodes have become important elements in temporarily stabilised network conformations. Despite the persistent and embedded presence of ARF/RHD in remote Indigenous communities for many decades, the dynamic nature of the network reveals that this is not an inevitable inequality. Rather, there is vast potential for socially just change through local Indigenous-led approaches to holistic healthcare.