In Ethiopia, a multipronged approach to tackle avoidable blindness

JUBA, South Sudan — Danny Haddad will never forget his first trip to Ethiopia more than 20 years ago. One of his patients was experiencing such excruciating eye pain that she applied margarine underneath her eyelids every morning in search of relief.

The woman’s agony, which felt like having eyelashes scratch against her eyeballs on a constant basis, was caused by trachoma, an infectious and debilitating eye disease caused by bacteria, that can result in blindness. Often referred to by medical professionals as a disease at “the end of the road,” trachoma is prevalent in some of the world’s least-developed regions and is the No. 1 cause of infectious blindness.

“Hearing the story of the patient and understanding the pain she was going through daily, it’s indescribable to hear that and know there’s not much you can do to give back her sight,” said Haddad, an experienced ophthalmologist and current chief of programs for international eye care NGO Orbis.

Today, while Haddad sits at the helm of Orbis, an eye care NGO focused on fighting avoidable blindness, he says the disease’s impact on that patient remains ingrained in his mind.

When the Dutch native visited Ethiopia in 1996, he found an absence of global trachoma programs and a lagging eye health industry, especially when it came to combating infections. Since launching its first program office in Ethiopia in 1998, Orbis has been working to strengthen the country’s eye health capacity.

Over the past 20 years, the sight-saving organization has opened almost 280 eye care units and conducted more than 2 million eye screenings and examinations, and 180,000 eye surgeries for both adults and children, according to Orbis. It also established an eye bank, one of only two facilities like it on the African content, which harvests tissue and serves as a storage facility for the cornea.

While Haddad calls the group’s progress incredible, he says there is still a long way to go to eliminate avoidable blindness, especially in countries such as Ethiopia.

Tackling trachoma

Five million people in the East African nation are blind or suffer from vision loss, according to Ethiopia’s first national blindness, low vision, and trachoma survey in 2006. While cataracts are the country’s leading cause of blindness, affecting approximately 1.7 million people, the nation has the largest burden of trachoma cases globally. Thirty-seven percent of the world’s cases are found in the country. Almost 360,000 people are currently at risk of going blind if their infection is left untreated. But with less than 150 trained ophthalmologists living in the country, the challenges of reining in the disease remain immense.

To date, Orbis has been successful in reducing the spread of trachoma infection in three major regions of the country with a high burden of cases, but there are several other areas that haven’t yet seen significant progress. In order to meet the goals laid out by VISION 2020, a global initiative to eliminate avoidable blindness, Orbis has made tackling the disease top priority.

Caused by a treatable bacterial infection that spreads through flies and human contact, trachoma is most common and easily spread among children. Using a multipronged approach called “SAFE” — which combines surgery, antibiotics, facial cleanliness, and environmental improvements — the organization is targeting rural areas where more than 80 percent of Ethiopia’s population resides and where the disease is most prevalent. Orbis is also angling its strategy to focus on women since they have more interaction with children and are prone to both contracting the disease and becoming reinfected.

One way the NGO is able to regularly provide patients with free surgeries is via its one-of-a-kind Flying Eye Hospital. This converted MD-10 cargo plane has been converted into a pristine medical center, including an accredited ophthalmic teaching hospital. Each cordoned-off space caters to a specific area of care, and the Flying Eye includes an observation room, patient care room, as well as a pre- and postoperating rooms.

The 46-seat plane is used worldwide as a teaching hospital, broadcasting training lectures to eye care professionals in real time. It usually plans projects at least one year in advance on a needs basis and stays between 2-4 weeks wherever it lands. The aim in each location is to train approximately 300 eye care professionals, examine 250 patients, and operate on more than 100 people, Haddad explained. Last year, the Flying Eye traveled to Peru, Barbados, Mongolia, and Ethiopia. In early 2019, it will take off to Jamaica for its first clinical training project.

The next generation of eye health professionals

While the Flying Eye generally lands in cities, Orbis’ other programs — such as consultations and lectures through online training and mentorship service Cybersight and its hospital-based trainings — ensure that doctors in rural areas receive guidance and that patients have access to care.

“The transferring of technical skills is crucial,” said Richard Lewis, a United States glaucoma specialist, co-founder of Sacramento Eye Consultants and Capital City Surgery Center, and former president of the American Glaucoma Society.

After a recent trip to Ethiopia, Lewis noted that the country has talented doctors, but it could benefit from training more ophthalmic staff with broader surgical specialties. Ethiopia’s few eye doctors are concentrated in urban areas, while the majority of the population lives in rural areas.

“We need to create more home-grown opportunities to train the next generation of eye health professionals,” said Lewis, who has been volunteering with Orbis for almost 30 years.

Over the past 20 years, Orbis has conducted more than 77,000 trainings of health care professionals including optometrists, nurses, biomedical engineers, and other associated health care workers in an attempt to build capacity and transfer skills throughout the country. Many of the doctors Orbis trained have now become teachers.

While the prevalence of blindness and visual impairment is decreasing globally, according to a new report by the Vision Loss Expert Group, blinding diseases are still on the rise due to a growing population. Unless access to eye health services improves, the number of blind people will triple to 115 million by 2050, according to the report. In developing countries specifically, where 89 percent of the world’s visually impaired people reside, the effects of losing one’s eyesight are far-reaching.

“When a person goes blind, a child gets taken out of school to help guide the person around and another child might be taken out to help with the duties, so it’s not just impacting that single individual,” Haddad said.

In 2013, Ethiopian mother of seven, Aylito, found herself in an impossible situation when she contracted trachoma in her right eye after already going blind in her left.

“It started with some pain, then the pain became severe like a sharp object was planted inside my eye … I could not carry out the household chores. When the pain became intolerable, I would stop doing anything at all,” said Aylito, who preferred to be identified by her given name.

At the time, Aylito was barely able to care for her children. It wasn’t until she underwent surgery that she felt she could once again contribute to her family. Five years later, Aylito remains trachoma free and spends time teaching proper hygiene practices to her children so they don’t suffer as she did. But Aylito is one of the lucky ones, Haddad said. When trachoma strikes, it usually doesn’t just impact one person in the family, and it isn’t just one family in the community.

“It’s a vicious cycle that we have to break through,” Haddad said.

In the future, Haddad hopes to expand Orbis’ fight against trachoma in Ethiopia and leverage its technology to reach more eye health teams and improve access to care for women and children around the world. In the meantime, however, he acknowledges the steps that have been made while remembering the woman he met more than two decades ago.

“We have the opportunity to do surgery and we’re not getting to that stage where someone has to put margarine under their eyelids,” he said.

Devex, with financial support from our partner Essilor, is exploring challenges, solutions, and innovations in eye care and vision. Visit the Focus on: Vision page for more.