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4 - 2005 Fall - Tackling Trachoma in Niger

By Karen Homer

NEVER HEARD OF TRACHOMA? Take a closer look at this eye disease that has robbed more than 6 MILLION PEOPLE–including countless children–of their sight.

In many ways, Adamou Sitou is a typical 12-year-old. He loves soccer; he loathes chores. He enjoys hanging out with friends after school; he dislikes homework. But unlike most
Adamou Sitou (with traditional scarring on his face) recovered his sight.
kids his age, Adamou faced a devastating disability. Three years ago, this boy went blind.

“I remember what it was like before I lost my sight,” says Adamou, sitting in the cool darkness of his family’s adobe hut in Daudari, a remote village in Niger, West Africa. The simple home offers a welcome escape from the punishing, 112-degree heat outside. “My eyes were so itchy and sore that I thought my eyelids would fall off. When I woke up in the morning, I could see, but by noon everything became dark. Then gradually after a few months, I couldn’t see at all. It hurt even to open my eyes.”

Sick with worry, Adamou’s parents, Mahamadou and Nana, took their son to the village clinic. Sadly, they had waited too long. Adamou became yet another victim of trachoma, or amadari, as the dreaded eye disease is known in the local Hausa language.

Trachoma is the world’s leading cause of preventable blindness, according to the International Trachoma Initiative, a World Vision partner agency that is also fighting the disease. The disease generally occurs in poor countries where people have limited access to water and health care. It can be prevented by keeping one’s hands and face clean, using as little as one quart of water daily. But people living in drought-prone Africa, including Niger, consider even that amount too precious to waste on washing when they struggle to find enough to drink.

Adamou lives in Zinder—the most endemic region in the world for trachoma. An estimated 68,000 adults and more than 1 million children under age 10 are infected with the disease here, according to a study conducted by Niger’s National Blindness Prevention Program in 2000.

It’s a tragedy for anyone to lose their sight. But the blind in Africa face extraordinary challenges. Social assistance and services for the disabled are almost nonexistent. The blind become a social and economic burden on their already impoverished families and communities. A woman who is blind can no longer cook or gather firewood. With no means of income, many blind men leave their villages and move to the cities, where prospects for street beggars are better. They congregate at traffic lights, weaving dangerously between cars and pleading drivers for a few coins to buy a bowl of rice.

When Adamou contracted trachoma, he had to drop out of school. He sat alone in his family’s hut while friends went to class and played soccer. He could do little to help his family. He managed to pound grain, wielding his mother’s long, wooden pestle, but he was ashamed of doing what’s considered girl’s work.

A community in Mali gathers as a World Vision drilling rig hits water.
The devastating rate of trachoma in Adamou’s community is directly linked to lack of water. The one well in this 700-member village often runs dry between rainy seasons. Likewise throughout landlocked Niger, 41 percent of the country’s 12 million people lack access to sufficient water. “It’s easy to tell people, ‘Youneed to wash yourselves and your children regularly to prevent trachoma,’” says Aboubakar Maman, a World Vision program manager based in Zinder. “But how can they do this when they only have one pail of water a day for the whole family? They are forced to choose between drinking and washing.”

Most Nigeriens - up to 80 percent of whom are illiterate - don’t understand that trachoma is both preventable and treatable. “It’s God’s will. If you are born with this disease, you are born with it,” says Adamou’s father, Mahamadou.

World Vision’s response to trachoma relies on a strategy known as SAFE: surgery to correct advanced cases; antibiotics to treat active infection; face washing to reduce disease transmission; and environmental improvement to increase access to clean water, hygiene, and sanitation.

But like water, health care is a luxury for Amadou’s family, as it is for most people in Niger. His father, Mahamadou, is a subsistence farmer who struggles to support his two children, Adamou and 1-year-old Zeinabou, on the $100 he earns monthly on average.

“There are many cases of trachoma out in the villages that we never see,” says Salifou Alio, head nurse at a World Visionsupported health clinic near Daudari. “These patients don’t come for treatment because they know they can’t pay the 3,500 francs (US$7) for the operation. It’s shocking to see a child condemned to blindness by a disease that can be prevented with a small amount of clean water.”

Thankfully, Adamou, a World Vision-sponsored child, was among the 50 fortunate children in Zinder who had eye surgery in 2003. The subsidized operation was performed at Salifou’s clinic. Adamou—usually timid—describes his surgery enthusiastically, punctuated by bold, brave smiles. “It wasn’t too bad. The pain wasn’t any worse than when I went blind with the eye sickness. I wanted to see more than anything.”

When Adamou recovered his sight, he returned to school and joined his friends on the soccer field again. And he saw his baby sister’s face for the first time.

Adamou goes for follow-up treatments, covered by World Vision. The nurse peels back Adamou’s eyelid and snips off scar tissue from his inner eyelid with a small pair of scissors. He uses no freezing, but Adamou doesn’t cry or flinch. He leaves the clinic smiling, thankful to have his sight back. It’s moving tosee a child so full of joy—and crushing to realize that he could contract the disease again tomorrow without enough water to maintain proper hygiene.

“It is good to do surgeries to treat those who have trachoma, but meanwhile, more and more people are being infected. We’ve got to focus on prevention,” says Arlette Yepdjuo, manager of World Vision’s water and health project in Niger.

World Vision combats trachoma in Niger through the West Africa Water Initiative, a partnership with the Hilton Foundation and 12 other organizations that will drill 825 borehole wells—175 in Niger, 200 in Mali, and 450 in Ghana—by 2008.

Drilling in Niger began in April 2004. Heavy-duty rigs extract groundwater locked in aquifers up to 280 feet below the sand-and-rock surface. Each borehole is equipped with a manual hand pump that makes it easy for women to draw water from such a depth.
Women’s work is never done—but with this well in Niger, it’s easier.
World Vision staff members are teaching villagers how to maintain and repair the pumps and organizing public-health education campaigns about trachoma prevention.

Adamou is excited about the borehole installed in Daudari. “I don’t want any of my friends to get trachoma. I’m praying that this new well will stop this eye sickness in our village forever.”

As head of the water program, Arlette has a vision: to stop more children from losing their sight to trachoma—and get them battling the disease. “I want to have children on the local water-management committees, including some of the 2,500 sponsored children in this area. They need to have a say in how their community uses the new water source,” she says, her dark eyes flashing with enthusiasm.

Face washing is a key way to prevent trachoma.
“I want to get children to dream about becoming a driller or a hydrologist themselves one day, just like kids dream about being a fireman. It’s one way to ensure that the next generation is involved in wiping out trachoma.”

Arlette plans to outfit the water-committee kids with yellow hardhats and blue jumpsuits—just like the drill rig operators wear. Adamou wants to wear one of those uniforms. And he can even see himself becoming an engineer—an impossible dream had trachoma permanently claimed his sight.

Karen Homer is the West Africa communications manager for World Vision.

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