“Left eye, TT absent. TF absent. TI absent.” Eight-year-old Dawit sits bravely still while surgery assistant Bonso examines him for signs of trachoma. This involves folding Dawit’s eyelid upwards and inspecting the eye itself as well as the connective tissue. There are no indications of inflammation, Bonso is able to reassure the boy.
Fortunately, little Dawit’s eyes are healthy and he will be sent back to his friends again with a warm “Off you go, brave lad!” from Bonso. “I’ve been involved in these kinds of evaluations for four years,” says the young man, who usually works in a hospital near the town of Shashemene. Currently, however, he is on the road with seven other colleagues in the project regions of Abune Ginde Beret and Ginde Beret to check whether the main five-year campaign for fighting trachoma has actually borne fruit. “I also participated in the studies to produce the World Trachoma Map,” says Bonso while disinfecting his hands for the next examination. The trachoma atlas shows the regions of the world where trachoma is still found – and to what extent. Countries such as Austria are shown in white on this map. But a good hundred years ago, it would have looked very different.
A disease with a history
At the beginning of the 20th century, trachoma was still one of the main reasons why potential emigrants were not permitted to enter the United States. An examination for signs of trachoma was part of the standard procedure in the immigration halls on Ellis Island – the gateway to New York City.
The bacterial disease first makes its presence felt in the form of inflamed follicles on the inside of the eyelids. At this stage, the disease is easily treatable: antibiotic eye balms usually remedy the problem. In countries such as Ethiopia, however, children and especially women frequently come into contact with the bacterium. Chronic trachoma infections can lead to the inside of the eyelid becoming scarred and slowly turning inwards. The eyelashes start to scratch the cornea. It’s a particularly painful experience that can lead to irreversible blindness if left untreated. At this stage, relief is only possible in the form of an operation, which can also be performed by trained health professionals.
Better S.A.F.E. than sorry
Care workers and nurses from Menschen für Menschen regularly conduct such trichiasis operations to save the sight of patients. However, in order to finally root out trachoma and its serious consequences, hygiene standards also have to be improved. Right at the top of the list in this regard are the construction of latrines and access to clean water. The World Health Organization has summarized this approach as the so-called S.A.F.E. method: Surgery (operations), Antibiotics (antibiotic drugs), Facial Cleanliness (hygiene measures) and Environmental Improvement (clean water and latrines).
The consistent implementation of this approach enables the long-term fight against trachoma. That is also shown by the investigation that Bonso performed with other colleagues in the project regions of Abune Ginde Beret and Ginde Beret. At the beginning of our work here, over half of the children under ten years of age had a trachoma infection. The World Health Organization requires an increased need for action once just 10% of children are affected. That’s why Menschen für Menschen launched a campaign for the treatment and prevention of trachoma in May 2012. As recommended by the WHO, the population has been supplied annually with anti-inflammatories. 85% of the population also had to be reached each year – a big logistical challenge for the employees in these remote regions. On average, over 200,000 people were taken care of every year. In addition, operations were performed in order to save the sight of people already affected by the final stage of the disease.
Hygiene & water: An unbeatable duo
While the distribution of medicines and the performing of operations concentrate on the pure treatment of the disease, it is important to implement hygiene measures and ensure access to clean water. Both measures are essential elements of how Menschen für Menschen approaches the issue.
5 years later: The result
So what did Bonso and his colleagues find out during their investigation? Well, the number of children under ten years of age affected by trachoma has fallen dramatically: in Ginde Beret from 62% originally to 6.2% today, and in Abune Ginde Beret from 50% originally to 3.2%. An immense improvement and therefore a big success in the fight against trachoma.
In Abune Ginde Beret, the WHO target of “less than 5%” has been reached. This means that measures will continue to be implemented here in order to improve hygiene standards, although there will no longer be a blanket issuing of anti-inflammatories.
The situation is different in Ginde Beret: there will another round here before a further investigation determines whether the campaign has made an impact. However, it will take a while before both regions can finally be declared “trachoma-free”. Because it will be three years before the medical professional will say “Look me in the eyes, little one!” again, at which time a follow-up examination will show whether today’s success has lasted. Good things come to those who wait.
You can help and rescue a person’s sight with a relatively simple and inexpensive operation.