Now in middle age, Ekeno is blind in her left eye. Her sight loss is the result of trichiasis, the most severe form of trachoma, which occurs when the infection goes untreated. Also known as blinding trachoma, trichiasis causes the eyelashes to turn inwards where they will scratch against the eyeball, slowly and painfully robbing people of their sight. The only way to treat trachoma when it gets to this stage is through surgery.
“I see dancing colour,” says Ekeno, who is from Kamnuyaep, a village in the remote county of Turkana in Northern Kenya. “Sometimes my eyes itch so badly I can’t do anything; all I can do is sleep.”
One day when Ekeno was resting, she caught the attention of her neighbour, Susan Lokale, who wondered why her friend was sleeping during the day.
Until recently, trachoma was endemic in Turkana, and through Kenya’s national trachoma elimination programme, Susan had been recruited as a community health worker. Her role involves identifying those with trachoma-like symptoms to link them to treatment, and teaching others how to clean their faces, hands and clothes to prevent the disease from spreading.
As Ekeno’s discomfort became clear to Susan, the penny dropped.
“I knew what was wrong because of my job,” explains Susan. “When I found her sleeping, I felt sad because she was feeling pain. It made me weep. She is very close to me and often helps look after my children.”
Susan encouraged Ekeno to seek treatment the next time the travelling trachoma team were in the area. Turkana is a vast county full of open desert, so reaching remote villages such as Kamnuyaep is not easy. Health teams must make long, hazardous journeys, carrying all the equipment they need with them. On arrival they will set up a makeshift operating theatre wherever they can, under the shade of a tree or in a school or church.
Kenya’s national trachoma programme, with support from international partners such as Sightsavers, is putting the systems in place to ensure people in remote areas such as Turkana no longer miss out. It also shows what can be achieved. The Kenyan government is now close to eliminating trachoma from the county – an impressive achievement given that, less than 10 years ago, 9% of adults there needed trichiasis surgery to protect them from permanent sight loss. Kenya is on course to eliminate trachoma as a public health problem within the next few years, with the gains made in Turkana making a significant contribution to this success.