Sunday, October 18, 2009

Fieldnotes: Trachoma in Ethiopia

There are an estimated 38 million blind people in the world, and 28 million of them unnecessarily. Trachoma is the world’s leading cause of preventable and treatable blindness. Spread by flies, this ancient disease of poverty and poor sanitation is pandemic in the Soddo and Gurage districts of Ethiopia. As trachoma progresses, often for decades, the eyelids turn inward, and scratch the eyeball causing unbearable itching, infection, and scarring that inevitably leads to blindness if not treated, early, with what amounts to a dollar’s worth of antibiotics, or, later, with surgery.

Melesech Achiso’s is 15 years old and her eyes have been infected many times. Her eyelashes have turned in and scarred the corneas. Her early symptoms were not treated, the follicles swelled into gray pimples, and small blood vessels grew inside her corneas. The only possibility for restoring her sight is a cornea transplant. She is here to see the ophthalmologist who annually comes to Soddo, from Addis Ababa, for one month. "This list is just too long for one surgeon," says Dr. Getenet. She has no chance of receiving the surgery.

Sister Genet Bogala is a nurse and has performed over 30 trichiasis operations this week at her one-room tin-roofed health post located in the middle of a cow pasture 150 km from Soddo. Two years ago she was trained at a one month-long course to perform the surgery that arrests trachomatous trichiasis. She operates for 20 minutes to fix one eye on Sherefa Ali, 30, while Keddr Mengi, 45 waits outside for his turn. Nearly 2600 such surgeries were performed in Gurage district in the last 10 months.
Amaredtt Turq, 41, undergoes the procedure which involves making a one-half inch incision through the upper eyelid, and then suturing it together in a way that "flips" the eyelashes away from the cornea. Sister Bogala performs the surgery when she sees more than five eyelashes scratching the cornea. Up to that point she suggests antibiotics and epilation until more severe trachomatous trichiasis develops. Her patients return in one week to have the sutures removed.
At a school near Alaba, children regularly have their eyes tested by teachers or a visiting district nurse to detect and determine if any diminished eyesight is due to a refractory problem or an infection. Homemade “pinhole glasses,” an eye chart, and eyelid examinations, are the tools. The children are told about the importance of washing their hands and faces.

Asra Tsakik, a Field Health Coordinator checks the eyes of Workete Gujama. He is looking for the presence of follicles, inflammation, or scarring. For the early stages of trachoma, a six-week course of antibiotics (with tetracycline, erythromycin, or sulfonamides) is prescribed, or a single dose of azithromycin. Children are infected the most and women more than men, because they spend more time with children. Surveys show that 34% of the children in these villages suffer from active trachoma. Water shortages, poor hygiene, and crowded living conditions are at the root of trachoma.

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