Originally posted by the Morbidity Management and Disability Prevention (MMDP) Project.
“Before the surgery, I was always in pain and I couldn’t see properly. I was afraid to go outside. I rarely socialized. We had a good rainy season this year, but I wasn’t able to harvest anything.”
Christine Korogo was describing the effects of trachoma, an infectious eye disease caused by the bacterium Chlamydia trachomatis. In the final stage, scarring causes the eyelid to turn inward and the lashes to scrape the cornea. If untreated the condition, called trichiasis, leads to blindness – and, all too often, loss of livelihood.
When I met Christine, her face was covered in a sterile blue drape, just one eye showing through. As a surgeon delicately operated, Christine conversed and laughed.
Yaaba (grandmother) Christine is 67 years old and lives with her disabled husband, a co-wife, and elderly relatives in a village in Burkina Faso. Her five surviving children have grown and moved away. She and her husband scrape by on remittances from their migrant children, but making ends meet is a struggle. The prospect of seeing more clearly and being able to farm filled Christine with hope.
Surgery for trichiasis involves restoring the eyelid to the normal position. Christine’s surgery was provided by the Burkina Faso Ministry of Health, with support from the Morbidity Management and Disability Prevention (MMDP) Project, a multi-country project funded by the United States Agency for International Development and managed by Helen Keller International.
The tent in which Christine’s surgery took place. Inside is a simple operating room with a small table for instruments, an operating table, equipment for sterilizing instruments, and a surgeon’s stool.
The MMDP Project helps countries provide trichiasis surgery for populations in need. But even more important than the number of surgeries done is the quality of the surgeries. The MMDP Project’s mission is to ensure that patients receive the highest quality surgery possible. It does so by supporting rigorous training and certification for trichiasis surgeons, ensuring that surgical practices meet World Health Organization (WHO) standards, and by checking surgical outcomes to assure that quality controls are working.
During surgery campaigns, medical teams set up temporary operating rooms close to affected populations, whether in local clinics, schools, or special tents. The surgeon is typically a local Ministry of Health technician who has been trained by a national expert.
Christine rests after her surgery. The bandages will be taken off the next day. Stitches in her eyelids will remain in place for a week.
Trachoma, the world’s leading cause of preventable blindness, has long plagued areas where sanitation and water for washing are scarce. Today, 1.9 million people are blind or visually impaired because of trachoma, and 42 countries need interventions to eliminate the disease, according to WHO.
But a major battle against trachoma is making progress. In one of the largest public health endeavors in human history, WHO is leading an international alliance of Ministries of Health, nongovernmental organizations, research institutions and donors working to eliminate trachoma by 2020. Since 2011, the number of people at risk of trachoma has fallen nearly 40%, from 325 million to 200 million.
Through a national program that combines mass treatment with the antibiotic azithromycin and surgery for individuals with trichiasis, Burkina Faso – with support from USAID has dramatically lowered trachoma prevalence and is well on its way to meeting WHO criteria for elimination. In the process, the country’s health system is growing stronger, with a newly trained cadre of health professionals prepared to provide high-quality, sight-preserving surgery for emerging trichiasis cases.
In her village of Basnéré, Christine got the news that a surgery team was coming from a town crier. The next day, inside a tent in a shady grove, Christine had the simple, quality surgery that will prevent her from going blind – and move her country and the world one step closer to ending the age-old scourge of trachoma.
John Uniack Davis is the West Africa Regional Director for Helen Keller International. He gathered impressions for this blog while observing a trichiasis surgery campaign in Burkina Faso in October 2016. Photos were taken by staff from the HKI Burkina Faso office.
By CBM UK
This blog post is part of Global Networks #G7forHealth series, which highlights the current and potential impact of G7 countries on those suffering from neglected tropical diseases.
Hadiya is 9 years old. When CBM community workers met her in her village in Amhara, Ethiopia, her eyes had been itching and watering for three days. It keeps her from being able to see others. She cant see them clearly because of the tears, explained her father Ali. But it wasn’t the first time Hadiya has experienced trachoma and she’s not alone in her village. 6 out of every 10 children in this region of Ethiopia suffer from an active trachoma infection.
Hadiya’s infection was treated with Zithromax, and her family now knows how face washing can help prevent the disease. CBM’s partner, Organisation for Rehabilitation and Development in Amhara (ORDA), has been working with the community to ensure that the village well is protected with the source capped and a retrieval unit fitted so that the water used for drinking and washing stays clean.
These interventions will make a huge difference to Hadiya. Not only will she be free from the itching and pain of the trachoma infection, but she is no longer at risk of losing her sight to the disease. And in a poor community like Hadiya’s the consequences of sight loss can be utterly devastating. Her chances of completing her education would be much reduced – only 1 in 10 children with disabilities in the global south goes to school. She would be at 2-3 times greater risk of violence or abuse. Her access to healthcare and opportunities to earn a livelihood would be far more limited. Like millions of people with disabilities worldwide, she could very easily find herself trapped in a cycle of poverty and disability.
Neglected tropical diseases (NTDs) such as trachoma are caused by poverty, flourishing under conditions characterised by poor housing and sanitation, unsafe water and limited access to basic health care. But by causing disability, they also lead to increased poverty for individuals and communities. This is why we believe investment in the fight against NTDs should be a priority for the world’s leading economies and why CBM UK — alongside 100+ international institutions and experts working on NTDs — is one of the signatories of an open letter to G7 leaders, asking them to sustain their current support for NTD control and elimination as well as to address current gaps.
Tackling disability is vital to ending extreme poverty, and eliminating NTDs like trachoma is a key way to prevent disability – 2.2 million people are visually impaired due to trachoma, and of them 1.2 million are irreversibly blind.
CBM has been working to prevent and treat blinding NTDs such as river blindness (onchocerciasis) and trachoma for over 20 years. CBM UK is currently involved in the Queen Elizabeth Diamond Jubilee Trust’s programme to tackle blinding trachoma in 10 out of 18 Commonwealth countries where trachoma is confirmed or estimated to be endemic.
Within the Trust’s programme, CBM UK is an implementing partner in Kenya, Uganda and Malawi, aiming to eliminate trachoma as a public health problem in each of these countries. This is done by implementing the ‘SAFE’ Strategy which consists of Surgery, Antibiotics, Facial Cleanliness and Environmental Improvements. The programme has recently completed its first year. During this time, CBM has held a number of community outreach camps to conduct trachoma surgery, which is used to treat the more advanced, blinding stage of the disease. The surgery element of the SAFE Strategy is used to address the backlog of trachoma cases, whilst the other elements are aimed at prevention and stopping (re)infection.
Funding programmes like the Trust’s initiative make a crucial contribution to the World Health Organisation’s (WHO) Alliance for the Global Elimination of trachoma by 2020 (GET 2020). The UK and the other G7 members must now ensure that this moment is sustained to permanently eliminate trachoma and other NTDs.
CBM is in international Christian disability and development organisation improving the quality of life of millions of people living with or at risk of disability in some of the world’s poorest communities. CBM UK programmes include a range of NTD programmes and other disability related programmes in Health, Livelihoods and Inclusive Education.
By Elizabeth Kurylo Communications manager, International Trachoma Initiative
Every morning and every night, I turn on the hot and cold water taps, adjusting them so the temperature is just warm enough to wash my face. I take for granted that the water will flow. I would be shocked if it didn’t. This easy access to water is a luxury not enjoyed by hundreds of millions of people around the world.
As we mark World Water Day, it is worth noting that 748 million people do not have access to an improved source of drinking water and 2.5 billion do not use an improved sanitation facility. For them, the lack of water can mean poor health, disability and even death.
Water and sanitation is especially important in the prevention and control of trachoma and other neglected tropical diseases (NTDs). Trachoma is an ancient eye disease caused by a bacterial infection. Left untreated, it can lead to blindness. But we can stop it with the World Health Organization-endorsed SAFE strategy Surgery, Antibiotics, Facial cleanliness and Environmental improvement.
Water is crucial to facial cleanliness, and key to ending blinding trachoma. But in many places where trachoma is endemic, water is scarce, and rationed for uses other than hygiene, such as cooking. Face washing is not a priority.
The global trachoma community has made much progress since 1998, when Pfizer began donating the antibiotic Zithromax®, which treats and prevents trachoma. More than 444 million doses of Zithromax® have been shipped to trachoma endemic countries to date. And seven countries have reported reaching their elimination goals.
Under the leadership of WHO and the Alliance for the Global Elimination of Blinding Trachoma by the year 2020 (GET 2020), national trachoma programs have steadily scaled up implementation. In 2014, WHO’s Weekly Epidemiological Report (WER) said trichiasis surgeries and antibiotic distribution were tenfold higher in 2013 compared to 2004.
The International Coalition for Trachoma Control (ICTC) has galvanized the global trachoma community’s commitment to reaching elimination by 2020. Collaboration on game-changing initiatives with governments, health officials and trachoma endemic communities has led to the mobilization of more than 150 million dollars of new funding from DFID, USAID and the Queen Elizabeth Diamond Jubilee Trust. That is in addition to the national government domestic budget allocations and support already provided by many non-governmental development organizations as well as other donors such as the Lions Clubs International Foundation, Conrad N Hilton Foundation and the Bill & Melinda Gates Foundation. The WASH sector also is collaborating with the NTD sector to achieve shared goals of improving health and eliminating disease.
Still, there is much work to do. An estimated 232 million people in 51 countries live in trachoma endemic areas. Globally, 31 countries are implementing the SAFE strategy to eliminate trachoma, which signifies that 20 countries are still in need of help.
In 2015, ITI plans to ship 115 million doses of Zithromax®, donated by Pfizer. That is more than twice the amount approved for shipment in 2014. We are doing everything we can to accelerate access to Zithromax® needed by people who are at risk of blindness from trachoma, said Dr. Paul Emerson, Director of ITI. We are empowering national programs so that those at risk of going blind from trachoma can be treated.
Empowering people in trachoma endemic communities to prioritize water for hygiene also has lasting benefits. I saw this in Ethiopia, where I met Amarech Haluka, the mother of three young girls, one of whom had experienced the pain of trachoma. Health workers introduced the SAFE strategy to Amarech’s community, which received donated Zithromax® and education about the importance of using latrines and keeping their faces clean to avoid trachoma. Amarech and her husband got a loan to install a water pump in their back yard, and she now routinely washes her children’s faces twice a day. Even though she cannot adjust the temperature of the water that flows from her pump, her children’s faces are clean, and her family is free of trachoma.