The End of Trachoma, World’s Leading Cause Of Preventable Blindness, Is in Sight

December 13, 2016
This woman, who has just been examined by a local health worker at a clinic in Ressa Kebele, Kallo District, Amhara, Ethiopia, will receive trichiasis surgery. The arrow indicates which eye will be operated on. Credit: The Carter Center.

This woman, who has just been examined by a local health worker at a clinic in Ressa Kebele, Kallo District, Amhara, Ethiopia, will receive trichiasis surgery. The arrow indicates which eye will be operated on. Credit: The Carter Center.

By David J. Olson

In 1988, as a young development worker for Lutheran World Relief in Mali, I was showing a group of American Lutherans our development projects in Dogon Country, when we came across a tragic situation a young boy with a severely inflected eye, where he had lost his sight, with menacing flies hovering around the other, still good eye.

It was a heart-wrenching scene for these people, most of whom were on their first trip to Africa. One woman took pity on the boy and, after returning to the U.S., raised money for his treatment. I took the boy to the best hospital in the country in the capital Bamako. Doctors removed his infected eye, and replaced it with a glass eye. Without treatment, he surely would have gone completely blind.

That was my first exposure to trachoma, the world’s leading infectious cause of blindness in the world. Trachoma a bacterial eye infection found in poor, isolated communities lacking basic hygiene, clean water and sanitation – continues to plague Mali and 40 or so other countries.

What is trachoma? It is a disease of the eye caused by infection with the bacterium Chlamydia trachomatis that is spread through personal contact and by flies that have been in contact with discharge from the eyes or nose of an infected person. If the infection persists, the inside of the eyelid becomes so scarred that it turns inward and causes the eyelashes to rub on the eyeball, causing pain, discomfort and permanent damage to the cornea.

The World Health Organization estimates that trachoma is responsible for the blindness or visual impairment of 1.9 million people in 42 countries, with just over 200 million people at risk of trachoma blindness.

The Carter Center, best known for its work on Guinea worm (which is close to elimination), is now focusing on its next miracle – the elimination of blinding trachoma by 2020. The Center works to control and prevent trachoma in six of the 31 countries actively implementing a prevention strategy (Ethiopia, Mali, Niger, Sudan, South Sudan and Uganda).

Just last month, WHO declared Morocco to be the eighth country to eliminate trachoma as a public health problem. The other countries are China, Gambia, Ghana, Iran, Mexico, Myanmar and Oman.

The Carter Center says that in order to eliminate blinding trachoma, all four components of the SAFE strategy must be implemented: Surgery for advanced disease, Antibiotics to clear infection, Facial cleanliness and Environmental improvement to reduce transmission (particularly, improving access to water and sanitation).

In September in Washington, D.C., the Carter Center screened a documentary film from award-winning producer Gary Strieker and Cielo Productions called “Trachoma: Defeating a Blinding Curse,” in which a film crew followed Carter Center staff and other health professionals around Ethiopia for seven years in the Amhara Region, Ethiopia, the most endemic region of the most endemic country.

Strieker, a former CNN correspondent based in Africa, talked about the power of the story of the fight against trachoma.

“Most of the stories I covered in Ethiopia over the years were not very encouraging – famines, droughts, revolutions,” he recalled. “Ethiopia was always in the portfolio – one of those hopeless cases where you could be sure that whatever was coming out of Ethiopia would be bad. People had no hope. You could see it wherever you went.”

“But as we watched the trachoma campaign develop, the sustained effort by the government and the people to carry this out, we saw thousands of health workers mobilized, so much enthusiasm and making it happen in front of our eyes, year after year. They set an example for the rest of Africa and the developing world. It’s a great testament to what can be done if the government has the political will and actually reaches the people and gets them to work in their own interests. It’s been so encouraging and such a wonderful story.”

Kelly Callahan, the Carter Center director of the Trachoma Control Program, said that the trachoma campaign success happened because it was done with a “bottom-up structure.”

“The government is not telling people what to do, when to do it and how to do it,” she said. “It’s the people that are driving the force. If the people are driving it, they own it, they feel empowered and they feel they’re doing something together. If the community doesn’t own the program, then it’s not sustainable and it will not improve their lives.”

Trachoma foes believe the goal of elimination by 2020 is realistic even though much works remains to be done. A massive mapping exercise was conducted in 2013 to help understand better the scale of the problem outside of the Carter Center-assisted countries. Since then, activities have increased in most of these places. The Carter Center-assisted countries should achieve 2020 goal, Callahan said, through a strong commitment of the government in each country, the communities, the partners and the global alliance.

Trachoma control is not only the moral thing to do, it makes good economic sense. Trachoma prevention and treatment is one of the best buys in global health, according to Paul Emerson of the International Trachoma Initiative. Every dollar invested in trachoma reaps thousands of dollars in savings, Callahan said.

Callahan thinks the elimination of trachoma will have an impact beyond trachoma. “If someone’s suffering from trachoma, they’re probably suffering from river blindness, probably co-endemic for schistosomiasis, soil-transmitted helminths and lymphatic filariasis. If you pile on these diseases, their immune systems are so suppressed that HIV, TB and malaria – the big killers – can come in. So if we can get rid of Guinea worm and trachoma and pluck every single one of these diseases, imagine immune systems that are not suppressed from neglected tropical diseases. Just think of the quality of life. That’s immeasurable.”

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