By Douglas Steinberg, HKI’s Deputy Regional Director for West Africa.
I have visited several of Helen Keller International (HKI) programs to control Neglected Tropical Diseases (NTDs), and blogged about them here. Among the main NTDs that HKI works to control is trachoma, one of the leading causes of blindness in the world.
Trachoma is an infection that manifests itself on the inside of eyelids and the disease can be eliminated through a strategy called SAFE: Surgery for trichiasis, Antibiotics, Face-washing, and Environmental measures such as access to latrines and clean water.
Trachoma can be cured early on with Zithromax, a drug produced by Pfizer. Repeated infections, however, scar the inside the eyelid causing the eyelashes to curl inward and rub against the cornea resulting in constant pain as well as permanent damage that eventually leads to blindness or trichiasis. Trichiasis surgery consists of a fairly simple operation on the eyelid to bring the eyelashes back to their normal position. The procedure impedes further damage to the cornea and, if caught in an early stage, prevents blindness.
In a recent visit to Mali, I visited HKI’s Trachoma Control Program, and saw my first trichiasis surgery. HKI’s program is being funded by the Conrad N. Hilton Foundation and our staff work closely with the Ministry of Health. HKI supports mobile teams that canvass rural areas to identify suspected cases of trachoma, and to provide the appropriate treatment, either antibiotics or, in the event of a case of trichiasis, surgery. The mobile teams travel in 4×4 ATVs carrying kits and they screen people wherever they find them, usually in the village square, although they will stop in the bush. When people with trichiasis are discovered, they are referred back to the local health post to receive their sight-saving operations.
The procedure is fairly low-tech. Operations are done by the light of day since there is no electricity in most rural health posts. I observed Daouda Coulibaly, a registered ophthalmology assistant who has been trained to perform this simple surgery. Despite the basic infrastructure, he scrupulously follows the protocol including: carefully explaining the steps of the operation, getting verbal consent from the patient, sterilizing the materials, and administering a local anesthetic to the eyelid. I saw Daouda operate on a woman named Yayé Tounakar from the Sanafara village who had traveled almost 2½ miles to get the treatment. Daouda skillfully hooks Yayé’s left eyelid and draws it back. He makes a simple incision in the eyelid, quickly stitches it up, and patches the area. The soft tissue quickly heals, and Yayé is given antibiotics to prevent infection and a lot of aspirin for pain.
The whole surgical procedure only takes around 20 minutes. But it’s not for the faint hearted! I was amazed at Yayé’s courage – her eye was open as the scalpel cut and stitched her eyelid. Although, she squirmed a bit during the first procedures, she agreed to proceed with the second eye.
Another woman, Djokosan Sidibé, who had recently received the operation, came by to greet Daouda. She reported 100% satisfaction: “It hardly hurt at all, and now I don’t feel any of the discomfort of the trichiasis. I am completely recovered!”
I feel confident that Yayé will have the same positive results.