The annual mass distributions of Zithromax reduce the high level of trachoma infection in Amhara.  But they only last a few weeks, because fundamentally, the environment still favors the multiplication and spread of trachoma.  The only long-term way to control the disease is through major changes in people’s living habits.

Hygiene… and access to water

This woman travels 5 hours each day to get water, and says that after cooking, there isn't enough left for facewashing.

Facewashing is part of the multi-pronged strategy recommended by the World Health Organization, and is a focus of the trachoma control program in Ethiopia. Children, especially, are the targets of this campaign, because they tend to get dirty faces more frequently than adults.  Musca sorbens, the swarming flies found in northwest Ethiopia, feed off of discharge from the nose and eyes. In so doing, they often transmit the trachoma-causing microorganism from infected people to others.  Keeping one’s face clean can greatly reduce the risk of being infected.  In many parts of Amhara, the cleanliness of students’ faces has become a part of their daily evaluations, and children are taught to wash their faces thoroughly and regularly.

INTERACTIVE FEATURE

Children at the Wuchale Primary School in Amhara, Ethiopia demonstrate the facewashing exercises they are taught in class.

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(Video by Odette Yousef; production by Eric Durban)

Early morning, a line of plastic, yellow jerrycans at a water pump, waiting to be filled.

But even something as simple as regular facewashing can be a challenge.  In rural Ethiopia, less than a quarter of the population has access to safe water — one of the lowest rates in the world.  In Amhara, getting water to drink and use for the day’s cooking is a deliberate and often time-consuming daily activity, which may involve as many as 6 hours of walking to a nearby public pump, waiting in line to fill jugs, then hauling them onto one’s back for a weary trek home.

INTERACTIVE FEATURE:

Women and children gather water at a pumping station early one morning.

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(Video by Odette Yousef; production by Eric Durban)

The World Bank, the African Development Bank, and UNICEF are among the many groups that are trying to improve access to safe water in Ethiopia.  In the meantime, Paul Emerson, director of the Carter Center’s Trachoma Control Program, says villagers can at least benefit from lessons about how to use water efficiently:

“What we are promoting are things like ‘leaky tins,’ which are quite often gourds or plastic jerry cans, with a small hole stuck in the bottom of it plugged with a straw or a stick. Pull out the stick and you get a fine jet of water no more than an eighth of an inch across. You can use that little stream of water to wash your hands and wash your face. You can use one liter of water for about 20 kids, or 20 people, or 4 people in a household can wash their faces 5 times each with a liter of water.”

Sanitation and Latrines

Another long-term solution to trachoma is to reduce the population of flies that spread it.  In Amhara, the tactic is to eliminate their preferred breeding ground: human feces in the open field.  In 2006, only 8% of rural Ethiopia had access to improved sanitation facilities, according to the WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation.  The Carter Center estimates that more than 700,000 household pit latrines were built with its assistance in Amhara between 2002 and 2008. Latrines also have the added benefit of keeping children from getting common diarrheal diseases.

A typical household latrine in Amhara.

“Just the fact that you create in a village maybe 100 latrines, maybe that cost $1 each, and we taught them how to do this, that improves the quality of life of everybody in the village, as well as getting rid of trachoma.” - Fmr. President and Carter Center founder Jimmy Carter

Health Extension Workers show rural households how to construct, maintain, and use the latrines.  The pits are usually covered with a cement slab, and families often build a small structure around it of branches and a straw roof.

…through Children

“Now the importance of this message is that it’s the kids themselves who are empowered to protect themselves, they don’t have to wait for a benefactor to come along and do it for them.” - Paul Emerson, director of The Carter Center Trachoma Control Program

Where trachoma is highly endemic, children are often the most heavily infected group. They pass it on to the adults in their households, putting elders at risk of blindness.

Children serve as trachoma’s reservoir of infection, and it is often from them that adults get the disease.  But children are also one key to stopping trachoma’s spread.  The Ethiopian government and the Carter Center have created a curriculum that promotes facial cleanliness and awareness of trachoma in schools. Every morning, teachers inspect students’ faces for cleanliness. Those that are unclean are shown in the mirror, and then made to wash up.

Paul Emerson, director of the Carter Center’s Trachoma Control Program, says children are required to bring the lessons home, and to become effective educators in their own households:

“The kids will go home, and as part of the school health package one of the homework assignments is to find out if there’s anyone in their family or neighborhood with trichiasis, and to go and interview them. And then to report that back to the class, and to advise that person, how trichiasis is caused and that there is a free surgery available that can reverse the condition.”

One challenge of the endeavor has been to tie the relatively benign condition of sore eyes that children experience when they get trachoma, to the debilitating, blinding phase that can set in many years later, after repeated infections.  Some schools try to make that connection through games that underscore the value of eyesight, such as “pin the tail on the donkey.”

In Amhara, nearly two-thirds of the children are estimated to have active cases of trachoma.

Emerson says the curriculum also helps debunk a notion that is common in many places where trachoma is hyperendemic: that blindness from trachoma is an inevitable part of aging.

INTERACTIVE:

Narration by Fmr. President and Founder of The Carter Center, Jimmy Carter; and Dr. Paul Emerson, director of The Carter Center Trachoma Control Program.

Countering the Urban Rumor Mill

“One rumor is enough to destroy something really built and well-established, even. Because people start doubting and asking.” - Teshome Gebre, Country Representative for Ethiopia, The Carter Center

Although trachoma mainly affects rural areas, The Carter Center and the Ethiopian Ministry of Health expend time and resources educating dwellers of urban and peri-urban areas.  In the two months leading up to Maltra Week, targeted radio ads promoted the campaign, and a touring bus traveled into towns to host education and entertainment film nights.

Paul Emerson, director of the Carter Center Trachoma Control Program, says the target of these urban campaigns is young men, in their twenties.

“If there’s ever going to be a source of rumor or false information about the false campaigns, it always originates in this group of people. and they’re very well-connected, they have cell phones, they have relatives in the rural areas, and if they have a positive experience here, which they clearly are, then you get a very positive message going out, instead of the risk of a negative rumor coming out.”

Emerson says in the past, the program has had to counter rumors that their distribution of Zithromax, a drug that treats trachoma, was really a stealth family planning campaign engineered by the Ethiopian government.