International Coalition for Trachoma Control

"Co authored by Julian Trujillo Trujillo, Ministry of Health and Social Protection of Colombia with Girija Sankar, Assistant Director of Programs and Communications, International Trachoma Initiative and Tim Jesudason, Communications Specialist, International Coalition for Trachoma Control."

Today is International Day of the World's Indigenous Peoples, an opportunity to reflect on the challenges faced by indigenous people around the world, often including marginalization, poverty and poor health.

All over the world, indigenous communities suffer from disproportionately high rates of health problems. Diseases like trachoma, a bacterial eye disease that affects the world's poorest communities often go undetected and untreated, exacerbating health problems and continuing the poverty cycle. In Colombia, the remaining trachoma-endemic areas all lie in remote Amazonian districts, which are also home to a diversity of indigenous communities. The remoteness of these communities often means they have limited access to formal health care services, posing a significant challenge to trachoma elimination efforts. However, extraordinary efforts by Colombian health authorities have shown that with adequate resources, coordination and local engagement, great progress can be made.

Maximizing efficiency

In a bid to identify all people at risk of trachoma, in 2012-2016 the Colombian Ministry of Health mapped trachoma endemicity in its Amazonian districts. Reaching indigenous communities in these districts proved difficult, presenting major logistical challenges and requiring substantial resources. Contrasting landscapes and limited travel paths often required the use of a combination of air, land and river transport, sometimes requiring flights to be chartered and boats to be carried along trails where rapids or waterfalls interrupted river travel routes.

The mapping showed the scale of the trachoma burden and where interventions should be delivered. To do this efficiently, program managers developed an 'integrated package' of interventions, delivering antibiotics for trachoma alongside treatments for soil-transmitted helminths. Because under-developed areas are frequently burdened by a number of diseases that thrive in areas with poor access to clean water and sanitation, Colombian health authorities also established an intercultural dialogue to educate the communities about the relationship between personal hygiene and good health...

Tailored programming

The cultural diversity of indigenous populations poses unique challenges that require non-standard programming approaches. Community structures, languages, levels of education, migration patterns, environmental conditions and attitudes to health interventions can differ vastly from village to village. Health workers encountered over 50 different languages throughout the region. Furthermore, many indigenous communities also live semi-nomadic lifestyles and frequently cross international borders, making prevention, treatment and surveillance programs difficult to implement and maintain. Ecological calendars, religious and cultural events, and hunting schedules often dictate movement patterns and can result in communities crossing into Venezuela, Peru or Brazil.

To combat migration challenges Colombian health authorities are developing working relationships with neighbouring countries and their health authorities. National program managers meet regularly to discuss trachoma elimination strategies at major events such as the WHO Pan American Health Organization regional meeting, where experiences are shared and relevant courses of action are decided. This regional collaboration has had a positive impact on cross border interventions and has led to new initiatives, including mapping for trachoma and soil-transmitted helminths in Peru along the Amazonian basin near the border with Brazil and Colombia.

Going forward

Despite recent progress, Colombia has plenty to do to eliminate trachoma as a public health problem by 2020 with around 180,000 people still at risk of trachoma in remote and hard to reach parts of the country. The good news is that the country’s experience shows that tailoring programs to fit the needs of indigenous people works. With adequate resources, extensive context-specific planning, extended time frames and strong consultation with a range of stakeholders, from village chiefs to foreign health departments, programs can improve health among indigenous communities. 

This is a shorter version of an article which will be published in issue 99 of the Community Eye Health Journal