The COVID-19 pandemic has meant that pausing essential work on neglected tropical diseases like trachoma has been unavoidable. With social distancing measures in place, normal activities such as administering drugs to protect whole communities from trachoma, and bringing groups of people with trichiasis into centres for surgery, are difficult to carry out safely.
However, patients – likely in terrible pain from the symptoms of trichiasis, where the eyelashes turn inwards and scratch the eye – still need help during this challenging time.
So, where it has been safe to do so, and in line with country government and WHO guidelines, trained personnel like Babacar have continued to work.
Babacar is the head nurse in the village of Thiawene in Senegal. As trachoma patients came to his clinic seeking help during the country’s lockdown, he was determined to continue performing surgery safely. Babacar has been working in eye care since he graduated from nursing school in 2005 and has been performing TT surgeries since 2011.
“My big brother was a nurse and TT surgeon and was very appreciated by the communities because of the eye care he offered them,” explains Babacar. “As soon as I finished my nursing training, I went to him to do my internship. And it was during this period that I started to love eye care.”
But shortly after, Babacar’s brother died. That was when Babacar decided that dedicating his working life to eye health was the best way to remember his brother.
Because of the pandemic, Babacar’s team has had to adapt day-to-day work at the health post in Thiawene.
To keep visitors to the health post safe from COVID-19, Babacar has had to conform to general restrictions, similar to those in place all around the world: “On a daily basis the restrictions are social distancing, suspension of travel between departments and between regions, limitation of people in mosques, a ban on assembling in groups, curfew from 11pm to 5am and avoiding shaking hands.”
In addition, the post is limiting the number of appointments to 20 each day, with only one session a week for surgeries. These limitations have meant an increased waiting time for patients but are important to follow to minimise risk to all those involved.
Before the pandemic, Babacar would travel to remote communities to treat people who couldn’t easily access the clinic. But under the restrictions, this hasn’t been possible and so many of those affected can’t receive the treatment they need.
As well as limiting the number of appointments, the team quickly put further sanitation measures into place inside the health post, as Babacar explains: “We require people to wash their hands with water and soap or rub them with gels, and wear the masks. Health workers must follow the same instructions… as well as use other protective equipment depending on the pathology to be treated.”
While these new measures are essential, they bring their own challenges, including ensuring people wear masks correctly, and even sometimes having to convince people that COVID-19 exists.
Babacar rapidly responded to these challenges and has reassured people that it is still safe to seek healthcare at this time. He has also been raising awareness of COVID-19, the correct use of masks and updated health facility measures.
During the month of May, Babacar held 576 consultations and carried out 36 TT operations. While some might believe that health centres shouldn’t open during the global pandemic, Babacar would argue that not opening them at all could potentially pose a greater threat.
In addition to people’s conditions worsening and even going blind during the lockdown period, there is a risk of disengaging them from accessing treatment more permanently. Babacar thinks that closing health posts could even increase the spread of the pandemic: “If people are rejected, they will no longer trust the health workers and they will go to the traditional healers, which could complicate their state of health and increase COVID-19 risks,” he says.
In Senegal, the end of trachoma as a public health problem is in sight over the coming years. But Babacar worries that the additional costs of COVID-19 protection measures, and a wariness of some to attend health facilities, could potentially put the target trachoma elimination date back further.
However, he is also hopeful that the communications around the global pandemic can reach villages where diseases spread easily because of their limited access to water, sanitation and hygiene. COVID-19 communications might even “help to reduce the risk of infections of illnesses linked to dirty hands including trachoma and airborne diseases”, speculates Babacar.
In coordination with ministries of health, we are now making plans to resume activities safely in the countries we work in as soon as possible. To keep health workers and patients protected from COVID-19, we have developed a risk assessment mitigation action tool in close collaboration with governments, partners and donors. This ensures that decisions made to resume work on neglected tropical diseases outweigh the risk of spreading COVID-19 in targeted areas. This tool also factors in the health system’s capacity to effectively conduct safe and high-quality health interventions in the context of the COVID-19 pandemic.