Ending suffering from trachoma, one surgery at a time

15 Dec 2016 
by John Uniack Davis
| Regional Director, Helen Keller International, West Africa
John Uniack Davis Regional Director, Helen Keller International, West Africa
Before the surgery, I was always in pain and I couldn’t see properly. I was afraid to go outside. I rarely socialized. We had a good rainy season this year, but I wasn’t able to harvest anything.
Christine Korogo was describing the effects of trachoma, an infectious eye disease caused by the bacterium Chlamydia trachomatis. In the final stage, scarring causes the eyelid to turn inward and the lashes to scrape the cornea. If untreated the condition, called trichiasis, leads to blindness – and, all too often, loss of livelihood.
When I met Christine, her face was covered in a sterile blue drape, just one eye showing through. As a surgeon delicately operated, Christine conversed and laughed.
Yaaba (grandmother) Christine is 67 years old and lives with her disabled husband, a co-wife, and elderly relatives in a village in Burkina Faso. Her five surviving children have grown and moved away. She and her husband scrape by on remittances from their migrant children, but making ends meet is a struggle. The prospect of seeing more clearly and being able to farm filled Christine with hope.
Surgery for trichiasis involves restoring the eyelid to the normal position. Christine’s surgery was provided by the Burkina Faso Ministry of Health, with support from the Morbidity Management and Disability Prevention (MMDP) Project, a multi-country project funded by the United States Agency for International Development and managed by Helen Keller International.
The MMDP Project helps countries provide trichiasis surgery for populations in need. But even more important than the number of surgeries done is the quality of the surgeries.
The MMDP Project’s mission is to ensure that patients receive the highest quality surgery possible. It does so by supporting rigorous training and certification for trichiasis surgeons, ensuring that surgical practices meet World Health Organization (WHO) standards, and by checking surgical outcomes to assure that quality controls are working.
Christine undergoes trichiasis surgery. The drape over her face and the surgeon’s gloves, robe, face mask and cap help maintain the sterility of the surgical field.During surgery campaigns, medical teams set up temporary operating rooms close to affected populations, whether in local clinics, schools, or special tents. The surgeon is typically a local Ministry of Health technician who has been trained by a national expert.
Trachoma, the world’s leading cause of preventable blindness, has long plagued areas where sanitation and water for washing are scarce. Today, 1.9 million people are blind or visually impaired because of trachoma, and 42 countries need interventions to eliminate the disease, according to WHO.
But a major battle against trachoma is making progress. In one of the largest public health endeavors in human history, WHO is leading an international alliance of Ministries of Health, nongovernmental organizations, research institutions and donors working to eliminate trachoma by 2020. Since 2011, the number of people at risk of trachoma has fallen nearly 40%, from 325 million to 200 million.
Through a national program that combines mass treatment with the antibiotic azithromycin and surgery for individuals with trichiasis, Burkina Faso – with support from USAID -- has dramatically lowered trachoma prevalence and is well on its way to meeting WHO criteria for elimination. In the process, the country’s health system is growing stronger, with a newly trained cadre of health professionals prepared to provide high-quality, sight-preserving surgery for emerging trichiasis cases.
In her village of Basnéré, Christine got the news that a surgery team was coming from a town crier. The next day, inside a tent in a shady grove, Christine had the simple, quality surgery that will prevent her from going blind – and move her country and the world one step closer to ending the age-old scourge of trachoma.
John Uniack Davis gathered impressions for this blog while observing a trichiasis surgery campaign in Burkina Faso in October 2016. Photos were taken by staff from the HKI Burkina Faso office.

Villagers in Basnéré, Burkina Faso, are screened for trichiasis. Those found to have the blinding condition were offered free surgery.

Christine rests after her surgery. The bandages will be taken off the next day. Stitches in her eyelids will remain in place for a week.The tent in which Christine’s surgery took place. Inside is a simple operating room with a small table for instruments, an operating table, equipment for sterilizing instruments, and a surgeon’s stool.