The Biggest Cause Of Preventable Blindness Just Won’t Go Away

January 6, 2018

This article is part of HuffPost’s Project Zero

Tom Gardner On Assignment For HuffPost

 campaign, a yearlong series on neglected tropical diseases and efforts to fight them.TOGA, Ethiopia ― Fresh out of sight-saving eyelid surgery, Bugune sat fragile and exhausted on a bench in the shade, her son Birhane by her side.“I was in such pain,” said the mother of six, wrapped in a shawl and with a thick bandage across her face, as she recalled the agony of recent months. Since 2015, her eyelashes had been curling into her eye, rubbing and scratching against the cornea until it was too painful to lift the lids to see.  “I had tears falling from my eyes, but it hurt too much to wipe them. I had a headache all the time, so I couldn’t do anything. I couldn’t go to the market; I couldn’t go to weddings.” 

TOM GARDNEREwnetu Melesse, an ophthalmic nurse, performs sight-saving eyelid surgery on Bugune, carefully removing the ingrowing eyelashes caused by trachiasis, the advanced form of trachoma.Type image caption here (optional)

Bugune had been suffering from trachoma, a bacterial eye infection that is the world’s leading cause of preventable blindness but that has long been neglected — especially in Ethiopia, which is home to the largest population of sufferers by far.The country is today the last major frontier in the global battle against the disease, but, despite recent efforts, public understanding of the disease and its causes remains poor — pushing the goal of elimination just beyond reach.“I thought I was never going to see again,” Bugane said of the agonizing uncertainty of previous weeks. “I was so scared.”Trachoma has been around for millennia. Traces of it have been found in the eyelids of Egyptian mummies, and it was once common across much of Europe and America.But today the disease is almost entirely confined to the world’s poorest countries, in particular the hot, arid regions of sub-Saharan Africa. Women, as primary caregivers, suffer disproportionately because children are more likely to be infected. And women are four times more likely than men to need surgery.“It is a disease of poverty,” explained Teshome Gebre, the International Trachoma Initiative’s regional director for Africa, in his office in the Ethiopian capital, Addis Ababa. “You don’t find it in the developed world or even the developing world.”Of the 42 countries where trachoma is still present, Ethiopia has more than 30 percent of Africa’s already disproportionate burden. About 75 million Ethiopians — three-quarters of the population — live in trachoma-endemic areas, while the backlog of people urgently needing surgery for trachiasis, the advanced form of the disease, last year reached 693,000, the largest number of any country in the world. 

TOM GARDNERIn Bugune’s village of Toga, trachoma is rampant, but awareness of the disease is still lacking.

Bugune’s village of Toga is in the central region of Oromia, about four miles from the provincial boomtown of Shashamane, where the disease is typically much less common.“The further you go from the main road, the more prevalent trachoma is,” explained Oumer Shafi Abdurahman, former director of Ethiopia’s Neglected Tropical Diseases program and now project manager for Stronger-SAFE, a Wellcome Trust-funded initiative led by the London School of Hygiene & Tropical Medicine that aims to increase understanding of the disease.In some villages in the bushland surrounding Shashamane, where Oumer works, as many as 9 out of 10 children can be infected at any one time.Yet trachoma is easily treatable with antibiotics and simple surgery, and the campaign to eliminate it by 2020, the World Health Organization’s global target, should be attainable, some experts believe.Since 2012, Ethiopia has made significant strides, in particular by pioneering the Global Trachoma Mapping Project, the largest survey of an infectious disease, by using mobile phones and GPS signals to collate the country’s first national trachoma database.The survey found that more than 90 percent of districts in Ethiopia have trachoma at critical levels, a revelation that helped spur the government and its donors to taking more decisive action.


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