The aim of the Commonwealth Fund trachoma work, supported by the Foreign, Commonwealth and Development Office, was to assist ministries of health and local communities in 10 countries in their efforts to eliminate trachoma as a public health problem.
In the last two years, the Commonwealth Fund supported nearly 32,000 operations for people at risk of going blind from advanced trachoma, as well as antibiotic treatment to clear infection for over 10 million people. In addition, 114 trachoma surveys were commissioned to gain an up-to-date picture of where trachoma was a public health problem and behaviour change interventions were carried out to promote healthy hygiene and sanitation practices.
But as well as helping vast numbers of people, we made concerted efforts to reach those commonly left out of health initiatives in three ways.
Reaching ambitious numbers of people as part of health initiatives in densely populated cities is quite a challenge. But it’s a different challenge altogether to travel to and set up an operating theatre outdoors in a drought-prone, sparsely populated area with very limited infrastructure, as the Fund enabled us to do with a mobile team in Turkana County in Kenya.
Despite being one of the largest counties in Kenya, Turkana has only around two per cent of the country’s population, meaning people are spread out over miles of land. Because of this, they tend to be left out of healthcare plans and people seldom receive the treatment they should.
Ten years ago, the rates of trachoma in Turkana were one of the highest in the country. However, following a decade of concerted efforts, including going door-to-door to find and treat cases of advanced trachoma through the Commonwealth Fund, some areas of the county now have such a low level of the disease that large-scale work, like mass drug administration (MDA), is no longer needed.
If someone has trachoma multiple times, it can develop into advanced trachoma, or trachomatous trichiasis. At this stage, surgery is the only known way to stop their pain and prevent their sight from worsening.
However, experience has told us that not everyone can or will undergo surgery when it is first recommended to them. There are a variety of reasons for this: some people are afraid of surgery, especially if it is not a practice their community is accustomed to. And others might not be able to physically travel to their appointments because they are elderly, poor, have a disability, or because they have children or other family members to care for.
Through the Fund, we achieved low surgery refusal rates by pre-empting these issues and taking planned actions to overcome them.
First, we always spoke to community leaders before teams travelled to their villages. This made sure that influential community members were clear on the work we were doing so that they could encourage people with advanced trachoma to go for surgery.
Second, the volunteers we worked with were always known in the community, meaning patients were advised by someone they knew and could trust that surgery would help them.
Finally, to overcome the issue of travel that many faced, we arranged for transport to and from surgery appointments. We also offered the option for a family member or volunteer to accompany patients to reassure and comfort them.