Back then it was different. Subsistence farmers in Ethiopia owned only the clothes they worked in and did not wish to be photographed barefoot and grubby. There were whole villages without a single pit toilet. Four and five-year-old children, their faces covered in eye-seeking flies from dawn to dusk, were showing the telltale signs of wasting and stunting. And nineteen out of twenty of them had clinical signs of trachoma if we looked under the upper eyelids. Blinding trachoma is a degenerative condition typically seen in elderly patients, but in Ethiopia, children as young as ten years of age were presenting with late stage trachoma – their eyelashes already turning inward and scraping against their corneas in an inexorable, agonizing, descent to a short life of disability and blindness. That was the year 2000, and Ethiopia was just gaining recognition as the most trachoma endemic country remaining in the world.
These days, when a farmer waves at me to lower my camera it is because she wants to rush to her house, rinse her face and put on her best clothes – so she can look her best in the image. In many villages, every household has their own pit latrine, and in most villages at least half do. Instead of sitting listless, the kids are at play or contributing to the household chores. The children with advanced blinding trachoma have received sight- (and life-) saving eyelid surgeries to return the lashes to where they belong, and blinding trachoma is largely seen only in the elderly. Ethiopia is still the most trachoma-endemic country in the world, but a tremendous collaborative effort has been made that has put the disease into a spiral of decline.
The Innovative Lions-Carter Center Sight First Initiative expanded services in the Amhara region, demonstrating that it was possible to deliver the integrated SAFE strategy to a population of almost 20 million people. Ethiopia led the way in the Global Trachoma Mapping Project which identified that over 76 million Ethiopians were living in districts in which trachoma was endemic and gave granularity to our knowledge so that program activities could be focused to the most affected areas. In 2014, the Federal Ministry of Health included progress against trachoma as a target in their national health plan. Although the program outputs for 2016 are yet to be formally announced, we do know that over 50 million people were targeted for antibiotic distribution and over 200,000 lid surgeries were planned.
Trachoma is associated with poverty, but also a cause of it. However, trachoma elimination is not solely dependent on donated medicines. In Ethiopia, community-based health extension workers are tasked with delivering health education messaging. They also promote hand and face washing with soap and water, educate the heads of household on the importance of providing a sanitary way of disposing of human waste for their families, and distribute the annual dose of azithromycin. In this way trachoma elimination goes far beyond the primary goal of ensuring that future generations do not suffer the indignity of having their eyes scratched out by their own eyelashes. It helps to tackle the major causes of ill health and mortality in Ethiopia – respiratory tract infections, diarrhea and malaria – and is therefore a significant contribution to better health.
The scale up and progress in implementation for trachoma elimination in Ethiopia & other countries has been nothing short of phenomenal. The challenge in front of us now is knowing in which areas we need to continue implementation efforts, and in which areas we can stop. The program runs on limited resources and tight budgets, so focusing effort to where it is really needed enhances the efficient use of donor funds. Back in 2005 and 2006, the national survey relied on the use of paper forms. The process of data collection, entry, cleaning, and analysis took two years. Things are different nowadays. The program utilizes android smart phones connected to the cloud. Data collected in the field are streamed to an analyst who can call the field team to correct errors in real time. Collation and analysis is done automatically so that when the last team finishes screening the last person and clicks ‘send’, the results of the survey are available.
The farmers, still barefoot and toiling in the fields with hand tools, understand that using mobile technology accelerates health services. It’s up to us to ensure they get it.
Dr. Paul Emerson with community health agents in Ethiopia.
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This article is part HuffPost’s Project Zero campaign, a yearlong series on neglected tropical diseases and efforts to eliminate them. This series is supported, in part, by funding from the Bill & Melinda Gates Foundation. All content is editorially independent, with no influence or input from the foundation. If you’d like to contribute a post to the series, send an email to ProjectZero@huffingtonpost.com. And follow the conversation on social media by using the hashtag #ProjectZero.