Villagers wait outside a rural clinic in Ethiopia
Health problems that afflict the world’s poor have received unprecedented attention in recent years. Governments and foundations alike are pouring billion of dollars into the fights against diseases such as HIV/AIDS, malaria and tuberculosis. But medical workers who focus on lesser known diseases say their efforts remain as difficult as ever. Reporter Odette Yousef of station WABE in Atlanta traveled to Ethiopia to follow the struggles of one American organization that’s fighting trachoma, a leading cause of blindness in Africa.
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Odette Yousef: A bony, old woman sits in a rural health clinic in northwest Ethiopia. Her name is Asnaku Hussein. She squints in the dim light of a window.
Asnaku Hussein suffers from severe trachoma
Asnaku Hussein (through translator): “The pain in my eye is something as if I have foreign bodies in my eyes, and then severe tearing, and that will be followed with severe headache.”
Yousef: Asnaku Hussein suffers from trachoma. It’s a bacterial disease that irritates the underside of the eyelid. Over the years, repeated infections have caused her left eyelid to curl inward. Now her eyelashes scrape against the cornea. Her eye is extremely sensitive to light, to dust, and to smoke from cooking over a fire, which makes it hard to do household chores.
Hussein (through translator): “Yes, I do cook, I do washing, I’m not going to bring water from river nowadays because of my eyes, but I do everything I can at home because I’m taking care of my grandchildren.”
Yousef: But Asnaku Hussein may not be able to care for her grandchildren much longer. She’s going blind.
In this part of Ethiopia, one in twenty adults suffers from the same, debilitating condition. Ethiopia has the greatest number of people in the world who’ve gone blind from trachoma.
But until a few years ago, the disease was low among the Health Ministry’s priorities. The priorities at the top of that list, here and elsewhere, are the so-called “Big Three” killer diseases: malaria, HIV, and tuberculosis.
And that’s been frustrating for people who focus on so-called neglected tropical diseases like trachoma.
Paul Emerson (right) & Teshome Gebre (left)
Paul Emerson: “For every $100 that goes into HIV, there’s about $1 that goes into the neglected tropical diseases. There’s this huge inequity.”
Yousef: Paul Emerson is director of The Carter Center’s Trachoma Control Program. Former U.S. President Jimmy Carter launched it in 1998.
It’s a shoestring operation, funded largely by the Lions Clubs International Foundation. Emerson says the tight budget forces the organization to be efficient.
Paul Emerson: “The trachoma program, and NTD programs in general offer much greater returns than the big 3, although I could get in trouble for saying that. It’s not very popular.”
Yousef: The trachoma program benefits from free antibiotics, donated by the drug company Pfizer. And at a cost of $20 per patient, it gives free surgery for severe cases of trachoma.
They’re mostly done at bare-bones, rural health clinics like this one, where Asnaku Hussein has come.
She lies on an examination table. The only other furniture in the room is a wooden desk. A nurse covers her face with a sheet of paper.
A hole goes over the affected eye. The nurse injects anesthetic into the eyelid.
Hussein (through translator): “She said she’s not feeling the pain, but she’s just naturally scared.”
Yousef: The nurse makes an incision in Asnaku Hussein’s upper eyelid. She pulls the skin up so that the eyelashes once again face outward. Then she stitches it up and covers the eye with a patch of gauze. It takes just 15 minutes, and in a week, it will be fully healed.
But for The Carter Center, merely offering the surgery isn’t enough. Convincing patients to undergo it can be a challenge.
This villager says he won't get free eye surgery
In one village, The Carter Center’s Paul Emerson found an elderly man suffering from advanced trachoma. The man said he knew about the free surgery, but wouldn’t get it.
He said it would mean looking for someone to walk him to and from the clinic, and another person to tend to his livestock — too much trouble. For Emerson, it was a moment of disheartening reality.
Emerson: “We never seem to exhaust the problem. So no matter how much we do, it’s never enough.”
Yousef: Ideally, Emerson and his team would like to keep people from getting trachoma in the first place. The disease is spread by flies that land on people’s faces. So health workers encourage villagers to wash frequently. The flies breed in human waste, in areas where people relieve themselves in open fields.
So The Carter Center and other development groups have built hundreds of thousands of outhouses in Ethiopia. But even this simple intervention can be hard to sustain.
In a small village called Kalchaka, a cluster of three mud huts stands on a hill. The ruins of a fourth structure sit nearby. The circular straw roof has collapsed on top of branches that once supported it.
The family says the outhouse has been like this for months
This is the outhouse.
A man who lives here says it’s been like that for months. He claims his family still uses the outhouse, but that’s clearly impossible. The roof is basically on the ground.
Teshome Gebre, head of The Carter Center’s field office in Ethiopia, lost patience.
Teshome Gebre: “I said you are lying, you are not using this because I can see there is no access for you. He said yes, these days we are not making use of it. For now we are using the open field, he said. Back to square one.”
Yousef: It’s slow progress, but there are successes. Last month three nations joined the list of countries that have eliminated blinding trachoma. Mexico, Ghana and Saudi Arabia used the same approach that the Carter Center is using in Ethiopia.
But Ethiopia faces a much bigger challenge than those countries did. More than 1 million people need immediate surgery to keep from going blind.
The small victories are people like Asnaku Hussein. For her, the surgery is not just about her vision. It gives her hope that perhaps she can start to climb out of poverty.
Asnaku Hussein post-surgery
She says once her eye heals, her grandchildren won’t need to help her with household chores. Instead, she says, they’ll go back to their schoolwork, and looking to their own futures.
With a tube of antibiotics in hand, she leaves the health clinic, and begins the tired trudge home.
For The World, I’m Odette Yousef, Amhara, Ethiopia.
Odette Yousef received funding for her trip to Ethiopia from the Kilimanjaro Centre for Community Ophthalmology. All pictures by Odette Yousef.
Is anybody interested on implementing/ supporting the WHO mnemonic policy over there?
I can do little but just to send this info to a good friend Josh Colston working in Washington as he work as specialist /research of tropical diseases..
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