For centuries Mali has been known for the mythical city of Timbuktu. Unfortunately, events in the last two years have also made it known for terrorism. In public health circles it has long been known as a major part of the trachoma belt – a band of Africa where the leading infectious cause of blindness is concentrated. Our trip up North made us hope that Timbuktu will be resurgent and that the days of terrorism will be but distant, if painful, memories. Today’s trip also gave great hope that trachoma, which has caused so much suffering for generations of Malians, will be consigned to the past and that the country can look forward to a future free of this scourge.
We are accompanying a columnist from The New York Times, Nick Kristof, and his annual “Win-A-Trip” participant, Erin Luhmann and their videographer, Ben Solomon during their West Africa visit. Today we left the capital of Mali, Bamako, to head to the Kita district.
We made it to the village of Mambiri where the national blindness control program is being supported by HKI to undertake trichaisis surgery outreach. Trichiasis is the end-stage of trachoma – people who have had recurrent infections of the trachoma bacteria build up scarring on the inside of their eyelids. This leads to the eyelashes turning inwards and grating against the cornea. This repeated scratching is extremely painful and leads to scarring of the cornea and eventually to blindness.
Today’s activities focused on screening patients who presented with eye problems and those who had trichiasis immediately had eyelid surgery. This simple technique is done under local anesthetic and turns the eyelashes back upwards so they no longer scrape against the eye. While Nick, Erin and Ben were observing surgery on two patients I spoke with Adama Sangaré who had the surgery a year ago. She had been suffering for two years and reported that it felt like something was always stuck in her eye. Her eye was always watering and it was so painful she could not go out in the sunlight. She learned about the surgery from the local health worker during an outreach activity. Even though it was daunting to undergo surgery on her eye, she trusted the head of the health center enough to undergo the surgery and has been very happy with the result. Her eye no longer hurts and she sees properly. She says lots of other women in her village suffer from trichiasis and she encourages them to go visit the health center and get the operation.
This success is being repeated at large scale. In 2005 it was estimated that the backlog of trichiasis cases in Mali was over 80,000. The latest estimates are that 29,000 people still need the operation. Even more remarkable is the upstream work of combating the infection so that trachoma never progresses to the blinding form – distribution of the antibiotic Zithromax® to break the cycle of infection. Based on surveys of active trachoma infection it was necessary to undertake mass distribution of Zithromax® and tetracycline in 51 of the 60 health districts in Mali. Results have been remarkable – the program has been so successful that trachoma prevalence is now so low in 43 of these districts that Zithromax® distribution has been stopped at the district-level – efforts are currently underway to collect data at the sub-district level and conduct post-endemic surveillance to guard against any recrudescence of the disease.
This success is a testament to a broad partnership led by the Ministry of Health’s national blindness prevention program, with long-term support from the Conrad N. Hilton Foundation, assistance by HKI, The Carter Center and Sightsavers, donation of Zithromax® by Pfizer, Inc. and the International Trachoma Initiative and funding for antibiotic distribution from the United States Agency for International Development (USAID). Mali is facing a lot of challenges – but with this leadership and partnership – the challenge of blinding trachoma is one that it is poised to overcome forever.