Atlanta
(2009-06-18)
null
In addition to the debilitation and pain it causes for people who have it, trichiasis also takes a toll on the whole family. But the expansion of free and fast surgeries, with the help of The Carter Center, is restoring hope.
Asnaku Hussein knows she's old... exactly how old, though, is tough to pinpoint.
HUSSEIN: I don't exactly know my age, but my mother told me I was born immediately after the Italian occupation ceased.
That was 1941, so she's not far from 70 years old in a region where life expectancy is 53.
Her bony frame and leather-worn skin are covered with loose layers of dust-stained clothes. Even though we're inside, away from the sun, Asnaku Hussein squints. She can't fully open her left eye because it hurts.
HUSSEIN: Whenever I feel pain in my eyes, I have severe headache associated with it, and sometimes I also feel something bad in my abdomen, my heart, and I feel the pain all over.
Repeated trachoma infections over the years have scarred the inside of her eyelid. And those scars have caused the eyelid to curl inward, so that the lashes scrape against the cornea. Without an operation, Asnaku Hussein will certainly go blind in her left eye. It's a severe case of trichiasis.
HUSSEIN: The pain in my eye is something as if I have foreign bodies in my eyes, and then severe tearing, and that will be followed with severe headache.
In 2003, the World Health Organization estimated nearly 10 million people suffer from trichiasis. One in ten were in Ethiopia; it's the most affected country of the world.
Globally, women are twice as likely as men to have it. In Ethiopia, they're three times as likely.
EMERSON: Nobody really knows the answer to why.
Paul Emerson leads the Carter Center Trachoma Control Program:
EMERSON: We think it's because women are exposed to children, who are the reservoir of infection, much more than men. And so they get more frequent infections than do men. So they're more likely to get the serious form of trachoma, which is trichiasis.
For Asnaku Hussein, the condition makes the tough set of cards that she's been dealt even tougher. The persistent scraping of the cornea makes her eye sensitive to sunlight, to the ubiquitous dust outside in these mountainous highlands, and to smoke from cooking over a fire.
HUSSEIN: I do cook, I do washing, I'm not going to bring water from river nowadays because of my eyes, but I do everything I can at home because I'm taking care of my grandchildren.
She says her daughter is mentally ill and cannot work. Her husband died long ago, and her son-in-law left home for the capital one day, and they haven't heard from him since. But even with the unrelenting physical pain of something piercing her eye, Asnaku Hussein is most bothered by the toll that her condition takes on her three grandchildren:
HUSSEIN: I want my kids to concentrate on their studies rather than to go collect water and firewood.
Paul Emerson says that kind of collateral damage is common, and it's even worse in most other cases, which are typically younger women, of child-bearing age:
EMERSON: In an environment such as this, where for a marriage to work, both partners need to contribute, the marriages often dissolve. So the husband will send the wife back to her parents, or divorce her and leave her with the children to look after her.
Emerson says its toll on women ends up affecting every generation in the family.
EMERSON: the children often have to drop out of school to look after the mother, who's been abandoned by the husband.
On a hot day in late April, about 60 people have shown up at the rural health clinic in Wuchale, a town of 6000 people. The staff nurse has screened them, and found 6 with trichiasis. They wait on rickety benches outside a dim room, furnished only with a desk and an examination table. This is the operating room where, twice a week, surgeries are offered for free.
It's the second time that Asnaku Hussein has come here for eye surgery. Her right eye was fixed several months ago, and she says that's the main reason she's been able to do household tasks. The procedure takes only 15 minutes.
TRANSLATOR: She said she's not feeling the pain, but she's just naturally scared.
The training and equipment were provided by the Carter Center, which, since 2004, has supported 130,000 such surgeries in the country. In 2007, about 40% of all trichiasis surgeries worldwide were in Ethiopia; three-quarters of them were for women.
But just as their interaction with children may account for women's high proportion of the disease, it's that engagement that's spreading the health message on how to prevent it. Asnaku Hussein perked up when she explained how she knew about trachoma:
HUSSEIN: My grandson who is going to 6th grade, he heard from his school that it is due to trachoma that people are losing their sight. So he told me to wash my face everyday, and he told me to wash his siblings' face. Now every day we are using soap and water to wash our faces, including the children and myself, and he taught us about trachoma.
Facewashing helps clear off discharge around the eyes that flies, the main vectors of the disease, feed on, and where, in so doing, they leave the infectious bacteria.
The surgery will take about a week to heal. Asnaku Hussein knows it won't magically solve her family's poverty, but it will make the daily slog a bit easier.
HUSSEIN: I'm the type of person who do not like to give order to children to do things for me. So I prefer to do everything in the house which I have to do. So unfortunately I'm not in a position to perform everything in the house. Once I get my eye fixed I will continue working at home and I'm not going to ask my grandchildren to do things for me, and I will also try to go to market and to sell things to improve my income.
As Asnaku Hussein made her weary walk home, her eye covered with a patch of gauze, and a tube of antibiotic in hand, she, at least, could be crossed off the endless tally of women fated to blindness. Fitting, given that those who work in blindness prevention have designated the theme of World Sight Day 2009 to be Gender and Eye Health.
Odette Yousef, WABE News.
© Copyright 2009, WABE
