By Hannah Godlove, MPH ’11 in Sociomedical Sciences
The first time I saw a trichiasis surgery to correct blinding trachoma I almost passed out. It was pretty embarrassing to have someone sit me down and bring me a Fanta for my blood sugar after seeing me wobble. It was even worse when that someone was waiting for her own surgery.
I have been working with Helen Keller International’s trachoma program in Tanzania for almost three months. A little background on trachoma: trachoma is a blinding disease that often infects children. Without treatment, the eyelid inverts, the eyelashes begin to scratch the cornea, and the patient eventually goes blind. To treat trachoma and prevent blindness, patients can either take azythromycin or, in the later stage of the disease, they can undergo a fairly simple surgical procedure. The outpatient procedure prevents the eyelid from inverting. In Tanzania, nearly one third of the population is at risk of contracting trachoma and the surgical backlog in the Mtwara and Lindi regions of Tanzania alone is estimated to be 67,500 people. Living in Mtwara, I see tons of older people walking around blinded by this wretched disease.
Counter-intuitively, the real problem with trichiasis surgery is recruiting patients. Though the surgical backlog consists of so many people, patients deal with a variety of challenges in getting the surgery. They often have to wait for months for a surgical camp to come to their district, they often have to travel long distances to get to the camp, and, as mentioned above, the recovery time sometimes prevents people from getting the procedure.
Though women make up the majority of trachoma patients, many women choose not to go for surgery because they are concerned that they will be unable to perform their household duties and care for their dependents. There are misconceptions among many people about recovery time with some people spreading rumors that a patient could be out of commission for weeks. This is particularly problematic for women, who typically have homes to clean, meals to cook and children to care for. In reality, women can resume their typical schedule after a few days. An even worse rumor is that it is not the trachoma that makes a patient blind, it is actually the trichiasis surgery.
Trichiasis surgery can also illustrate the important role of the auxiliary healthcare workforce here in Tanzania. The surgery is simple enough that two weeks of specialized training suffice to prepare surgeons to substantially reduce the trichiasis backlog. In addition, village health workers are utilized to address misconceptions and spread the truth about the surgery—that it can prevent someone from going blind.
Basically, what I’ve learned in the last few months is that to fight such a sickening blinding disease here in rural Tanzania we don’t need fancy equipment, hundreds of thousands of dollars in medical school bills, or an insurance system rank with red tape. We need to address the underlying issue of why people are not coming for the surgery. This behavioral change is quite challenging and will take years to achieve. In the meantime, we can still provide the surgery to those who will take advantage. I have my Fanta ready at hand.