The Gambia’s journey to trachoma elimination

Sarjo Kanyi is national eye health programme manager at the Sheikh Zayed Regional Eye Care Centre.

“Trachoma used to be a big problem in The Gambia. I recall we had our first survey in 1986. Those days, you could really see that trachoma was in the community. You would see children with sticky eyes, flies all over. So, one of the strategies that the programme used [to tackle the disease] was to integrate eye care into the health care system.

“In 1986, there was only a skeleton staff working on the ground. Sightsavers supported [the ministry of health] providing eye care centres all over the country, providing equipment to screen our patients, diagnose them, and also provide them with surgery if needed.

“We were able to train [eye care] staff at all levels. Then we trained community volunteers, the nyatero – nyatero is a local name meaning ‘friend of the eye’. Anybody in the community who has an eye problem can go to the nyatero, receive proper advice and be referred to the nearest health centre.

“Since then, we’ve been focusing on the SAFE strategy to prevent the spread of trachoma. We had to do a lot of awareness in the community. Community involvement is very, very important.

“Trachoma elimination will have an impact on the social and economic development of the country because people will be independent, be able to work, be able to go to school, learn a trade. That’s good for the country.”

Lamin Camara is a community ophthalmic nurse at Brufut health centre in Banjul.

“I was involved in the trachoma problem way back, since I graduated. At school they taught us about trachoma, how it’s a very contagious disease and it steals sight.

“When I started in 2014, in a month I was able to get about 50 patients with TT [trachomatous trichiasis, the advanced form of trachoma]. I have had to do surgeries in the field, because people were too old to come to the clinic and the road is very bad. My village health workers provided a place in a classroom, so I arranged all my things, went there and I operated.

“After the trichiasis surgery the patients feel safe and they are not feeling pain.

“Cases dropped because of the eye health messages – I told people these things depend on the way we live, how we take care of our eyes, cleanliness and environmental sanitation. It helped them take ownership of these things.

“Gambia eliminating trachoma has a positive effect on our healthcare: the country can move on to other areas within public health concerns. Working with my patients is an honour, it’s a profession that I have passion for so I feel really great whenever I go to the community and I don’t see anyone with trichiasis.”

Ebrima Busia Drammeh is a nyatero (community volunteer).

“Any time I see people with eye problems I don’t feel comfortable. Whether I know them or not, I will always talk to them and tell them where they can go to get help.

“I have been a nyatero for more than 15 years. We used to go for screening at the community, to see if there is anyone with trachoma. Normally I go to where there is a gathering, for example, when there is a naming ceremony.

“There was a screening where we saw one child had trachoma – that was a long time ago. We informed Lamin, who also informed the relevant authorities. The whole village was screened and given medicine. Since then, I’ve never heard of another trachoma outbreak.

“I always try to educate them to take care of their eyes. We advise them to keep their environment clean because a filthy environment encourages [the spread of] trachoma. And I tell the children that when they wake up in the morning, they have to wash their hands and face so that their eyes are always clean. Once that started happening, I realised that nobody is reporting a problem to me any more.

“When trachoma is not here, we feel great. When there is no trachoma in our small country, that means the chance of children excelling academically is very high. Because all their eyes are okay, they can see, they can learn.”

Sarjo Gibba, 58, is a former trachoma patient. She was already blind in one eye, and later developed advanced trachoma.

“My eye started hurting and the eyelashes were turning inwards. It was difficult for me to play with my grandchildren because I was feeling pain in my eye. I couldn’t open my eye to see. I missed playing with them. If I had lost the sight in this other eye, that would be the end of my life. I was definitely worried – I wondered how I could get the solution to this eye problem.

“I decided to go to the hospital so I could have my eyes checked. I was told that my eye needed an operation. I wanted to see – I had no hesitation. After the operation I was very happy.

“My grandchildren are always by my side now. We are back again as friends – I was very happy when I saw them. Any time they come to me, I welcome them. I carry some; some will be holding my hands. Now we are all together, every time.”

Fodey Kandeh is a former trachoma patient.

“Before I had surgery, even to open my eyes was difficult. I used to feel pain – I used to remove the lashes, cut them off, but they came back again. My vision in one eye was reduced.

“I realised that if I did not listen to the health worker’s advice I was going to experience more problems. So I feel I took the right decision – I came here and was operated for free. Now my eyes are wide open, I can see clearly.

“I work as a night watchman. Good sight is very important for my job. With my torch I can see everywhere within the compound and I’m confident that I can see clearly what I’m doing. I can earn a living. If I hadn’t had the operation, I wouldn’t have been doing my job now. It would have been impossible.”