Science
(2009-06-17)
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In late April, the Center and the Ethiopian government undertook the rapid, one-week distribution of trachoma-fighting medicine to nearly 5 million people. The campaign's success depended largely on an army of young women, government workers, who are responsible, year-round, for spreading health education. These boots on the ground do their work, particularly in Ethiopia's northwest state of Amhara, in the face of many challenges.
For comparison's sake, take the state of Georgia, home to nearly 10 million. Here, the risk of going blind is small. And the Georgia Society of Ophthalmogists has at least 450 members.
Ethiopia, on the other hand, has eight times the population, 85% of which is at risk for trachoma, a potentially blinding bacterial disease. But there are fewer than 100 ophthalmologists.
That's why people like 23-year old Hawa are so important:
HAWA: I hope that we'll bring change in the community and we understand this is how we are important.
Hawa is one of nearly 30,000 young women that Ethiopia's Ministry of Health began mobilizing in 2003. They deliver basic health messages and treatment to the 65 million Ethiopians in rural areas, often door to door. They're up against a lot, like poor water infrastructure and poor sanitation.
At 6:30 in the morning, young girls and women are gathered at a water pump off a main road that runs through the mountains of northwest Ethiopia. They take turns at the pump handle, filling plastic, yellow jerrycans, and heaving them onto each others' backs.
Any hour of the day, people can be seen bent over at the waist under the weight of these heavy jugs, trudging along the dusty terrain. In 2006, less than a third of Ethiopia's rural population had access to safe water. One woman we met at an out-of-the-way health post said it's a big problem:
WOMAN: We have to travel 5 hours, round trip, to get water.
Health workers tell her to clean her children's faces, and to wash clothes and sheets that the family shares. This will prevent the spread of trachoma, they say. But after cooking and feeding the animals, she says there's not enough left:
WOMAN (translated by Teshome Gebre): I can just carry a very small amount, therefore I even have to go twice a day. Twice a day. Because of the small amount that she can carry at a time. So I am telling her you are spending your whole day just collecting water. She said yes.
The government and its development partners have long-term plans to improve water access, but in the meantime, health workers are stuck with the reality.
There's also the matter of stubborn villagers.
In the small village of Kalchaka, a cluster of three mud huts sits atop a hill, overlooking a valley. Each belongs to the same extended family. The ruins of what appears to be a fourth structure is nearby. The circular straw roof is crushed down on top of branches that once supported it. It's the latrine.
MAN: Now we are really planning very soon to repair it and start making use of it. We know we have really benefited a lot, and it's not because we didn't really realize its importance, but it's lack of time
A man says it collapsed months ago, and health workers have urged them many times to fix it. He claimed the family still use it, but that is clearly impossible. The roof was basically on the ground. Teshome Gebre of the Carter Center lost patience:
GEBRE: I said you are lying, you are not using this because I can see there is no access for you. He said yes, these days we are not making use of it because it is collapsed and we will repair it very soon. But for now we are using the open field, he said. Back to square one.
Health workers teach families how to construct, use, and maintain latrines. Over the last ten years, hundreds of thousands have gone up in the region. Latrines are an essential weapon in the battle against trachoma. They reduce the population of flies that spread it. That's because they help eliminate an important breeding ground for the flies: human stool in open fields.
We headed down to the valley below, where we had spotted a health post. We hoped to find an extension worker in action, setting out to distribute medicine for trachoma door-to-door. It was deserted. A helpful teacher at the school next door told us they had left much earlier.
TEACHER: In this direction.
GEBRE: Up there?
TEACHER: Yes.
EMERSON: And does he know what they've gone for?
GEBRE: He's telling me they went to give trachoma tablets.
Finding them would mean an hour's hike up the mountainside in 80-something degree heat, then searching for them in the hundreds of huts in each village up there. In other words, doing what they do nearly every day of the year. We had better luck seeing them earlier in the treatment campaign, when villagers went to the health posts where the workers are based.
Remember the woman who described how hard it was to get water? We met her at a tiny, 2-room health post where dozens of people crowded on the stoop.
WOMAN: we are told by our community leaders that there will be mass treatment today.
Inside, people lined the walls. One by one, adults were called up, and given 4 tablets of the antibiotic Zithromax. Children were measured against a ruler to determine their dosage.
The Health Workers kept meticulous logs of who was there and what they took. Those who didn't show up for treatment early in the campaign would be tracked down on foot later. But Teshome Gebre of the Carter Center noticed that they weren't marking down whether children were showing up with clean faces.
GEBRE: They were not aware if they should do it today, so we are reminding them. Maybe I am not sure if they were given through the training
While the antibiotic treats trachoma, prevention is the more sustainable solution. Facewashing and latrine usage are keys to that strategy. The only way to gauge whether those habits are taking root is through the health workers' records.
Still, Paul Emerson of the Carter Center was pleased:
EMERSON: The Health Extension Worker knows exactly what to do, she was able to explain to me how to how measure the people, how to give the correct amount of drug, so everything looked like it was going exceedingly well.
Emerson believes something similar to Ethiopia's health extension program can be done in any country where the trachoma is endemic:
EMERSON: In Ethiopia we're blessed because they have been trained, and they're enthusiastic, and they're young, and they're paid. In the absence of that, there are key people in every small community in every African village, who have leverage within the community, who would like to see the living standards and the health of their village improve
In a way, it's fitting that women in Ethiopia have been enlisted as the footsoldiers in the fight against trachoma, because as it turns out, they are also bear the brunt of the blinding disease.
Odette Yousef, WABE News.
