Innovative Approach Highlights a Neglected Disease KOMBOLCHA, ETHIOPIA (WABE) - Trachoma is the leading cause of preventable blindness in the world. Nearly two-thirds of northwest Ethiopia's 17 million people are believed to have active cases.

In late April, the Ethiopian Government and the Atlanta-based Carter Center launched an ambitious campaign to make treatment accessible to those in the eastern half of that region. But a campaign of that scale and reach may never have happened, had they not piggy-backed trachoma onto a much better-known, and fatal, disease: malaria.

Saturday would normally be market day in Kombolcha, a city of 70 thousand people in northwest Ethiopia. But on this day, thousands are piled together in a field, lured by the promise of music and dance. Local leaders hope they also came for the health message:

HEALTH OFFICIAL: As a living witness, I dare to say that this Kombolcha World Malaria Day celebration is the first of its kind to be very hot.

Hot in the literal sense, too. The shoving crowd sat in the sun for hours as health officials praised the country's progress in tackling Malaria.

April 25th was World Malaria Day, and Ethiopia was marking it here. The ceremony would launch a massive, week-long health treatment and education campaign in the region. And this year, for the first time, it would include more than just malaria. Dubbed "Maltra Week," it would combine the killer disease with a lesser-known ill: trachoma.

That was the idea of the federal health minister, the Carter Center, and the Lions Clubs of Ethiopia, which has funded two-thirds of the Carter Center's program costs through the Lions Clubs International Foundation. Teshome Gebre of the Carter Center says there's an obvious benefit of attaching trachoma to the malaria effort:

GEBRE: We are attempting to really bring this neglected tropical disease to a level of the major killer diseases

But also, Paul Emerson of the Carter Center says there are economies of scale:

EMERSON: You get a return on malaria control, you get a return on trachoma control. The synergistic effect of doing both at the same time means that you can do both for less, for more return.

The numbers bear it out: in one week, health workers would give trachoma-fighting antibiotics to nearly 5 million people in the region. It would not even cost $1 million.

That's largely because Pfizer has donated the drug, Zithromax, for free, and because the health workers are already on government payroll. But it's also because the trachoma program could just piggyback on the logistical and marketing efforts of the malaria campaign. But that isn't to say that it did altogether.

Just that morning, a singing truck came ambling into town, packed solid with giant speakers. It was plastered with pictures of kids with fly-covered faces, and elderly squinting from irritated eyes. A recorded announcement urged people to convene that night for film, music, and health education.

Thousands heeded the call. At a clearing in Kombolcha's city center, they stood in crowds, watching a film projected onto a screen on the side of the truck.

In one skit, two farmers are chatting out in a field. As the Carter Center's Teshome Gebre explained, one man chided the other for not washing his children's faces regularly:

GEBRE: So do you want your child to go blind and to be a beggar, to be just on the streets and so on?" And the man was scared, "Oh no, I don't want my children to have these kinds of problems, and so on."

The messages are tightly packaged: build latrines, use them. Wash your kids' faces. Get your annual dose of Zithromax. This will protect you from trachoma. If you don't, you'll go blind in your old age. The presentation is humorous, and punctuated with pop music videos... people laugh, clearly entertained. Paul Emerson is pleased:

EMERSON: You're raising awareness so that people associate malaria and trachoma with their positive experience and the very key core messages that are coming out.

The truck was deployed two months before Maltra week began. Every night, it hosted one of these education and entertainment nights in a different place. Gebre compares it to a Biblical harbinger.

GEBRE: And these people go as john the Baptist, as the people who would be showing the way. And they would be delivering the good news before the arrival of the team. So they will be preparing the way, the road. And now when the Maltra week comes, there won't be much of a resistance.

In addition, radio ads, and door-to-door visits by health workers, helped to get people ready to receive their dose of medicine during that week. And of course, there's the matter of making sure that four-and-a-half million doses of Zithromax got to the right health centers and posts -- no small matter in the region's mountainous and remote terrain.

But compared to how much the government spends on malaria, HIV-AIDS, and tuberculosis -- the so-called "Big Three" killer diseases -- Ethiopia's trachoma effort is minor. And that can be frustrating for people like Paul Emerson, who spend their lives on trachoma and similar diseases:

EMERSON: What we find is that for every $100 that goes into HIV, there's about $1 that goes into the neglected tropical diseases. It's not a case of one is more important than the other, necessarily, it's that there's this huge inequity between the resources available to control them.

But Emerson believes the Maltra model may, in fact, help to turn that disadvantage into an advantage -- one that other countries with endemic trachoma can copy:

EMERSON: The overlap between trachoma and what they call the "Big Three" - that's malaria, TB, and HIV/AIDS -- is almost absolute. You do not find trachoma in places where people are not afflicted with all the diseases.

And Amhara, Ethiopia is the toughest place to tackle: it's the most endemic region of the most endemic country of the world fighting trachoma. Fortunately for those behind the battle cry, the federal health ministry has assembled an army of thousands of women to do the the fighting, going door-to-door with the health message and medicine.

The Carter Center is aiming to stamp trachoma out of Amhara by 2012. If it does, Emerson hopes other countries will give it a go. And if that means tagging trachoma onto higher-priority, killer diseases, that's fine, too.

Odette Yousef, WABE News.
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