The first time I saw a trichiasis surgery to correct blinding trachoma I almost passed out. It was pretty embarrassing to have someone sit me down and bring me a Fanta for my blood sugar after seeing me wobble. It was even worse when that someone was waiting for her own surgery.
I have been working with Helen Keller International’s trachoma control program in Tanzania for almost three months. A little background: trachoma is a blinding disease that often infects children. Without treatment, the eyelid inverts, the eyelashes begin to scratch the cornea, and the patient eventually goes blind. To treat trachoma and prevent blindness, patients can either take the drug azythromycin or, in the later stage of the disease, they can undergo a fairly simple surgical procedure. The outpatient procedure prevents the eyelid from inverting.
In Tanzania, nearly one third of the population is at risk of contracting trachoma and the surgical backlog in the Mtwara and Lindi regions of Tanzania alone is estimated to be 67,500 people. Living in Mtwara, I see tons of older people walking around blinded by this wretched disease.
The real problem with trichiasis surgery is recruiting patients who deal with a variety of challenges in getting the surgery. They often have to wait for months for a surgical camp to come to their district or travel long distances to get to the camp. In addition, there are misconceptions about the procedure that circulate which deter people from getting the surgery.
Women make up the majority of trachoma patients, but many of them choose not to go for surgery because they are concerned that they will be unable to perform their household duties and care for their dependents They mistakenly think that a patient could be out of commission for weeks after surgery which is problematic for women, who typically have homes to clean, meals to cook and children to care for. In reality, women can resume their typical schedule after a few days.
An even worse rumor is that it is not the trachoma that makes a patient blind, it is the trichiasis surgery itself. The village health workers are utilized to address these misconceptions and spread the truth: it is the surgery that prevents blindness – and the pain associated with the disease.
This project illustrates how important the auxiliary health-care workforce is here in Tanzania. In addition to their key role in communicating with potential patients, many received specialized training to perform the field surgeries. The procedure is simple enough; two weeks of specialized training suffice to prepare surgeons.
What I’ve learned in the last few months is that to fight such a sickening blinding disease here in rural Tanzania, we don’t need fancy equipment, hundreds of thousands of dollars in medical school bills, or an insurance system rank with red tape. We need to address the underlying issue of why people are not coming for the surgery. This behavioral change is quite challenging and will take years to achieve. In the meantime, we can still provide the surgery to those who will take advantage. I have my Fanta ready at hand.
Helen Keller International has been working in southern Tanzania for the past four years to address the large trichiasis backlog in the region. We train technicians to perform trichiasis surgery, as well as work to correct misconceptions about the disease itself.
Hannah Godlove is a public health intern from Columbia University’s Mailman School of Public Health working with Helen Keller International’s Trachoma Control program in southern Tanzania. This post originally appeared on the blog, Global Health at Columbia University’s Mailman School of Public Health.