Christian Mission Aid

 Trachoma Control Program

Pictorial Report Upper Nile, South Sudan 
September 2002  

Trachoma: "... usually begins in early childhood; but does not cause blindness until much later in life, as repeated infections cause inflammation and scarring on the inside of the eyelid Trachoma, caused by chlamydia trachomatis, is spread easily from person to person. Through the discharge from the eyes of an infected child, trachoma is passed to others by hands, on clothing, or by flies that are attracted to faces and runny noses. Repeated infections eventually cause eyelashes to turn inwards (Trichiasis) and rub against the cornea, which causes pain and the scarring that eventually leads to corneal opacity (blindness). The tragic later stages of the disease occur in adulthood; when people are in their most productive years.”
 (The Carter Center, June 2002).

Conditions in Upper Nile…

Understanding conditions in Upper Nile is essential for a full appreciation of the health challenges, and helps explain why trachoma has persisted, and remains such a serious challenge.

Upper Nile is a vast plain, with savanna grassland and forest, drained by large rivers and interspersed with seasonal swamps and marshes. Before the current civil war (1983 to 2002) Upper Nile was economically strong, with livestock, agriculture, fishing, trade in dried fish, and thriving river traffic, enabling the indigenous Nuer people to flourish.

By now, upper Nile is one of the most challenging places in which to operate health services, yet at the same time, is one of the areas of greatest need. Some of the challenges are as follows:

Photo: The CMA clinic, Lanken, Upper Nile, July 2002. A blind mother with her child. The child is malnourished, and registered for supplementary feeding. The mother cannot work or care fully for her family. Trachoma is the main cause of blindness in Sudan, and affects over 50% of people in Upper Nile. This mother is a typical case. After several years of painful deterioration, her vision fails completely at about thirty-five years of age. The trachoma control program prevents blindness.

Trachoma Control

CMA works with the support of the Carter Center Global 2000, to control and eliminate trachoma in Upper Nile South Sudan. Other active partners in this work are CBM (Christobel Blinden Mission), MAF (Mission Aviation fellowship) and UNICEF.

Trachoma is the leading cause of blindness in Sudan. Surveys by CMA and the Carter Center have shown that over 50% of people in Upper Nile are infected by Trachoma, making this the most highly endemic trachoma zone in the entire world.

The challenge of preventing blindness is addressed using the SAFE strategies, which were introduced by the Carter Center Global 2000 in 2000. This approach is appropriate due to its emphasis on local solutions and simple preventive measures. SAFE includes the following:

Photo: Keew, November 2001. When advanced cases are seen, surgery is often the only response. This picture shows local Sudanese health workers trained in trachoma surgery operating at the CMA rural clinic. 

Surgery for severe and advanced cases. CBM and CMA undertake this, with support from the Carter Center, and air access through MAF. CMA has four nurses trained and experienced in trachoma treatment, and in minor trachoma surgery. One is based at Lanken, the other three at Keew. CMA also has doctors and nurses who diagnose, treat, or refer trachoma cases. Mass trachoma surgery campaigns are mounted every year, with help from CBM, the Carter Center, and MAF.

Antibiotic treatment for cases that can be addressed by the application of tetracycline ointment or the use of Azithromax. The Pfizer Corporation conducts Mass dosage campaigns of Azithromax with free donations of the drug. Antibiotic treatment is given to control and eventually eliminate trachoma. CMA treated 23,000 people with these valuable antibiotics during year 2001 alone.

Facial cleanliness is the best way to avoid trachoma. Health education for mothers and children, as well as community leaders and other adults, is slowly bringing behavior change, improved hygiene, and clean faces. The importance of facial cleanliness is strongly emphasized, using visual teaching materials developed with the Carter Center.

Environmental improvements reduce the number of flies, and create cleaner living conditions. This remains the most challenging aspect of this work. Communities are conservative, maintaining traditions, which have become outdated in many other areas (often resisting the introduction of pit latrines for instance). The slow and expensive work of improving clean water supply has been started. CMA is working to show the community how blindness is directly caused by poor hygiene.

Photo: Lanken School, October 2001. Health education is a key activity in reducing trachoma. Children and teachers are given health education alongside conventional classroom teaching. This emphasizes that blindness can be prevented through simple local solutions.

It will take many years of concerted effort, with strong partnerships, and significant behavior change before trachoma is defeated. Eye diseases are so common in Upper Nile (and adjacent provinces) that many families consider them a normal part of their lives. Blindness is also accepted, and treatment for eye ailments was often not sought until CMA started this program.

The Trachoma Control Program has progressed despite several constraints, and the difficulties of working in Upper Nile. Community awareness is improving, SAFE interventions are reaching the communities, and are being understood, and eventually the incidence of Trachoma will decline, and numbers of blind people will be greatly reduced.

Photo: Lanken, Upper Nile, June 2002. The Trachoma Control Program, working alongside CMA's mother and child health care services, is creating a better environment for children, and reducing blindness. Mothers are the main recipients of health education.