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Global Health Thought Leadership

Trachoma Teams Persevere Despite Adversity

Health workers wearing masks visit a home in the Amhara region of Ethiopia to check a resident for trachoma and deliver medication and health education. Because of the COVID-19 pandemic, mass drug administration in Amhara could not take place in the customary large community settings. Instead, health workers visited one household at a time. (Photo: The Carter Center)

By Kelly Callahan, M.P.H., Director, Trachoma Control Program, The Carter Center

Public health work is always challenging, but some seasons are more challenging than others. And wow, have the last three years been challenging — especially in the part of Ethiopia where the Carter Center’s Trachoma Control Program works.

The Amhara region of Ethiopia is very large and heavily populated. It is also the most endemic known place in the world for trachoma, an infectious eye disease that can lead to blindness. We have been working with our partners there for decades and making excellent progress. Every year, The Carter Center assists the Ethiopia Federal Ministry of Health extension workers and the all-female, all-volunteer Health Development Army with the distribution of millions of doses of the antibiotic azithromycin (donated by Pfizer under the brand name Zithromax®). The mass drug administration (MDA) normally would take place at a centralized community location like a school or a clinic; it can be quite a spectacle, with huge crowds gathering to receive the medication, along with crucial education about trachoma and how to prevent its transmission.

However, as the COVID-19 pandemic gained momentum in early 2020, those gatherings had to be halted to avoid becoming super-spreader events. With significant Carter Center support, the Ministry of Health and the Amhara Regional Health Bureau pivoted to distributing the medication door to door, household by household, a much more labor-intensive and time-consuming method, but one that would not contribute to the spread of COVID-19 while ensuring the people received their annual azithromycin dose. 

On top of that unwelcome complication, a devastating armed conflict erupted in Ethiopia’s Tigray region, immediately north of the Amhara region. The violence seeped into Amhara, adding mortal danger to medical difficulty brought on by the pandemic. 

The people of Amhara and in-country Carter Center teams and ministerial partners persevered. The Trachoma Control Program constantly monitored the security situation. When an area was deemed safe, the teams would do as much as possible to ensure the program maintained consistent assistance in all aspects of preventing blinding trachoma. Working around evacuations and constant risk, the program continued to provide sight-saving surgery, hygiene instruction, and the vital annual dose of azithromycin household by household. Unfortunately, we could not do everything we had planned to do, but we did more than many might have thought possible under the circumstances. 

During this period of COVID-19 and great additional upheaval caused by the insecurity in and around Amhara, over 30,000 surgeries were performed and more than 14 million doses of antibiotics (Zithromax and tetracycline eye ointment) were distributed. In the most difficult of times, The Carter Center, the Ministry of Health, the regional health authorities, and our amazing donors persevere. This perseverance and resilience are born out of a compassionate desire to stop this terrible disease and ensure a world free from trachoma.

I could not be prouder of each individual fighting trachoma in Ethiopia — whether Carter Center staff, health extension worker, Health Development Army volunteer, ministry staff, or community member, who all work together to help eliminate trachoma as a public health problem in their community. Together we are stronger, and we continue to demonstrate our resilience through compassion in the face of adversity. For this, I am filled with gratitude. Undoubtedly, not all heroes wear capes, as the saying goes, but a great many of them wear surgical gloves and deliver sight-saving medications.     


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