From auction to action: battling trachoma in Ethiopia

Philanthropy Age joins The Carter Center and UAE-foundation Noor Dubai as they fight to eliminate the blinding eye disease trachoma

At Dubai Ladies Club, the thick, oyster-coloured carpet muffles the click of women’s heels. In an elegant white room, polite murmurs crescendo as the bidding begins in earnest at the annual Art4Sight auction; more than 100 philanthropists and art collectors will vie for ownership of 39 works donated by regional artists.

Meanwhile, in Kosero – a kebele, or sub-district, of the highland Amhara region in Ethiopia – a small group of women in pink, yellow and blue print wraps sit patiently by a golden haystack, amid lush fields. They too murmur and chatter. The community group meets weekly, swapping tips and monitoring each other, to discuss household and personal cleanliness.

Both groups, while worlds apart, are fighting for the same goal: to eliminate blinding trachoma. The proceeds of Art4Sight’s auction – an initiative of the Noor Dubai Foundation – are part of a greater effort to keep Kosero’s families healthy and their children in school.

While trachoma – estimated by the World Health Organisation (WHO) to affect 21.4 million people globally – was eliminated in the UAE in the 1980s, Ethiopia is one of 50 countries where it remains endemic. The fly-borne eye disease is most pernicious in the country’s northern Amhara region, where 60 per cent of the population is at risk. Children are most likely to contract the bacteria first, transmitting it to their families.

The infection causes inflammation of the inner eyelid, treatable with antibiotics. But repeated infections prompt a build-up of scar tissue, causing the eyelid to turn inwards, where the eyelashes rub against the cornea. The advanced stage, called trichiasis, eventually leads to blindness.

Seid Hussein, 78, knows only too well the excruciating pain this causes. “It itches and it’s most painful at night,” he says, pointing to his left eye. “Because of [trichiasis] I only move around my village. I don’t go far away because if something happens no-one will be there to help.”

“In a country like ours, somebody losing their vision, especially a breadwinner or caregiver, is a big blow to the whole family”Hussein is queuing outside Kosero’s one-room local health centre, for surgery to return his vision. The 20-minute procedure is part of US-based The Carter Center’s (TCC) trachoma control programme in Amhara, active since 2000. TCC and its partners, including Noor Dubai, fight the disease using a combination of preventive measures and treatment, which includes antibiotics and trichiasis surgery. So far, more than 300,000 people have had the operation.

The impact of trachoma is significant. As primary caregivers, women are more likely to get the disease from their children, restricting their ability to farm, or collect water. The burden shifts to their children who leave school to help out at home. “In a country like ours, somebody losing their vision – especially a breadwinner or caregiver – is a big blow to the whole family,” says Dr Zerihun Tadesse, TCC’s country representative in Ethiopia. “It is not a mere health problem, it is a socio-economic problem.”

Neglected tropical diseases such as trachoma are not high on typical donors’ lists because they are not big killers. Yet successes such as these have attracted the international community’s attention to what the trachoma control programme director, Kelly Callahan, calls “low-hanging fruit” in terms of impact.

Every year since 2008 TCC has organised two weeklong campaigns to treat the infection, called MalTra Weeks. Held in spring and autumn – straddling the rainy season – each week covers five of Amhara’s 10 zones. In May, the 12th such campaign, in the east of Amhara, reached close to 9 million people in six days, powered by 25,000 government health extension workers, two covering each kebele. It distributed the antibiotic Zithromax in tablet form – four per adult – and syrup for young children, all donated by pharmaceutical major Pfizer Inc. The two weeks together target 18.2 million people.

A winding 10-hour drive from the capital, the region’s mountainous terrain requires health workers to walk its vertiginous hillsides to alert communities to the campaign and administer the treatments. The scale of its organisation is remarkable. “We spend over $1m on each [campaign] just on logistics and operations, such as vehicles and daily allowances for the drug administrators,” says Dr Tadesse.

Resource-intensive though this approach might be, it works. When TCC first started its MalTra Weeks, the trachoma prevalence rate among one-to-nine year olds in Amhara ranged from 12 to 60 per cent, with seven of the 10 zones touching 30 per cent or higher. “[Even] 12 per cent is considered a public health emergency,” notes Callahan.

“Trachoma is a symptom of poverty, a lack of access to the infrastructure for safe water and latrines” By 2012, all 10 zones had registered prevalence below 30 per cent, and today six districts are below the UN health agency’s 5 per cent threshold for active trachoma. Now a celebratory occasion, the campaign is kicked-off with a raucous display of music and dancing.

Still, prevention is better than cure – something the programme has learned well. “We cannot prevent trachoma by only giving treatment to the community,” cautions Mulat Lemu, TCC’s regional malaria and trachoma project manager in Amhara since 2007.

“[Trachoma] is a symptom of poverty, a lack of access to the infrastructure for safe water and latrines,” explains Callahan. This lack of access forces households to allocate water for the basics, such as drinking or cooking. Poor sanitation allows the musca sorbens fly to breed and carry the disease, spreading the bacteria those without clean water cannot wash from their faces.

For their part, TCC supports community groups – like the women in Kosero, whose group is trachoma-free – and the health extension workers assigned to each kebele to raise awareness of good hygiene, and encourage households to build toilets using indigenous materials.

Eleni Teshome, a health extension worker in Kosero, has seen the fruits of this advocacy first-hand: “Eight years ago trachoma was a big problem, there were only 70 latrines [for 6,000 people].” Now the burden of trachoma is decreasing, she says.

It is this lifestyle change that is key to eliminating the disease – and keeping it that way, emphasises Dr Tadesse. The programme wants to ramp up its efforts with communities, including working with more schools in the region such as Haik Elementary School. “It is important to develop the idea [of prevention] from an early age,” says Reta Kassa, one of the school’s teachers who already works with the programme. “The students develop a play on keeping clean, which they go out and perform in the community.”

The Noor Dubai Foundation sees this multi-faceted approach as a good investment of its philanthropic dollars. The foundation gave $400,000 this year, part of a three-year commitment. “We’re working in a place where people are accepting change, which is a very difficult thing,” says the foundation’s CEO, Dr Manal Taryam.

Still, the battle isn’t over. “If we could simply focus on face-washing and latrine usage, we could reduce blinding trachoma and virtually eliminate it within the next year and a half,” says Callahan. “Getting the message out there is extremely important.”

Seeing the difference your dollars can make is a motivating factor to keep giving, enthuses Dr Taryam, who would like to bring some of Art4Sight’s contributors to the dramatic highlands of Amhara to see their donation in action. “We could have easily just built a hospital,” she advises, nodding towards the picturesque scenery around Kosero. “But that wouldn’t provide the value that such programmes give in the long-term.”