Treating blindness in Africa

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JEB SHARP: I'm Jeb Sharp, and this is The World. Health problems that afflict the world's poor have received unprecedented attention in recent years. Governments and foundations are pouring billions of dollars into the fights against AIDS, malaria, and tuberculosis. But medical workers who focus on lesser known diseases say their efforts remain as difficult as ever. Reporter Odette Yousef, followed the struggles of one American organization that's fighting a leading cause of blindness in Africa.


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: [TRANSLATED TO ENGLISH] 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.

ODETTE 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.

ASNAKU HUSSEIN: [TRANSLATED TO ENGLISH] 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.

ODETTE 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: What we find is, for every hundred dollars that goes into HIV, there's about one dollar that goes into the neglected tropical diseases. There's this huge inequity.

ODETTE 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 Neglected Tropical Disease in general offer much greater returns than the big three, although I could get in trouble for saying that. It's not very popular.

ODETTE YOUSEF: The trachoma program benefits from free antibiotics, donated by the drug company Pfizer. And at a cost of 20 dollars 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.

ASNAKU HUSSEIN: [TRANSLATED TO ENGLISH] She said she's not feeling the pain, but she's just naturally scared.

ODETTE 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.


ODETTE YOUSEF: 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.

PAUL EMERSON: We never seem to exhaust the problem. So no matter how much we do, it's never enough.

ODETTE 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.


ODETTE YOUSEF: 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. This is the outhouse. A man who lives here says it's been like that for months:


ODETTE YOUSEF: 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, nowadays, these days we are not making use of it. For now we are using the open field, he said. Back to square one.

ODETTE 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 one 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.


ODETTE YOUSEF: 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.

JEB SHARP: Odette Yousef is a reporter for WABE, Atlanta. She received funding for her trip to Ethiopia from the Kilimanjaro Center for Community Ophthalmology. You can see pictures of Asnaku Hussein, and some of the other people we met in that report at the-world-dot-org.