How Mali overcame three big challenges and eliminated trachoma

The government of Mali has just announced that our country has eliminated the infectious eye disease trachoma as a public health problem.

As Sightsavers’ country director for Mali, I am proud that we have achieved this historic milestone. Trachoma leads to a vicious cycle of pain, poverty and disability; without it, more children will be free to learn, and more adults will be able to earn a living. Beating the disease is also a step towards equality, as women are almost twice as likely to go blind from this disease than men.

However, getting to this point hasn’t been easy. We’ve faced some big hurdles across the many years of our fight against the disease. Here, I’ll be revealing the three main challenges we faced, and how we overcame them. I hope this will provide inspiration for other countries that are still on the road to eliminating trachoma.

Challenge 1: Millions of people at risk of trachoma

When a survey was carried out in 1996, trachoma was found in nearly every region of the country, and nearly 10 million people were identified as being at risk from the blinding disease. The task we had ahead of us was monumental. Luckily, the SAFE strategy, adopted by WHO in 1993, gave us the tools that we needed.

SAFE stands for surgery, antibiotics, facial cleanliness and environmental improvements. Together, these elements have been used to defeat trachoma in countries around the world.

We have a saying in Mali – “Dôni-Dôni te-tô-to kola”. It means that if we do something every day, we can overcome any challenge. This is especially true when we are working in partnership with other like-minded organisations.

We benefited from close collaboration with other non-governmental organisations such as The Carter Center and Helen Keller Intl, and together we were able to aid the government of Mali in their fight against trachoma. They were in the driving seat, while we provided technical assistance where it was needed.

Together we supported the government to train 243 trachoma surgeons, carry out almost 90,000 operations for advanced trachoma, distribute 29 million doses of antibiotics against the disease and build nearly 140,000 latrines to improve sanitation and hygiene.

With every eye operation completed and every latrine that was built, we knew we were saving more people from the agony and potential blindness that are caused by trachoma. After nearly 30 years, we are proud to be able to say that we have succeeded in our mission to eliminate the disease.

Challenge 2: Reaching everyone across vast distances

Mali is one of the largest countries in Africa. It’s also one of the hottest places in the world and the country’s northern region includes large areas of the Sahara Desert.

If this wasn’t enough of a challenge, many people in Mali also live in remote settlements, far from the nearest urban centre. This made it more complicated to find these people and treat them with antibiotics.

Instead of asking health workers to travel hundreds of miles to provide treatment, Mali was one of the first countries to trial a community-directed approach to distributing medication. Under this approach, each community selected a few local volunteers who were trained to distribute antibiotics in their local area.

These volunteers played a vital role in the elimination of trachoma in Mali. With their local knowledge, they were able to more easily reach the people who need treatment and encourage them to accept medication. Overall, they helped to distribute millions of doses of antibiotics to people across the country.

This community-directed approach worked so well that it has now been scaled up and is being used by health ministries and their partners throughout Africa.

Challenge 3: Navigating conflict

With the right tools and training, a surgeon can carry out an eye operation to provide relief from the pain of trichiasis (advanced trachoma) in as little as 15 minutes.

By supporting the government to train trachoma surgeons, Sightsavers and our partners were able to vastly reduce the number of cases of advanced trachoma across the country.

By 2015, there were so few cases that the country had to adopt a new approach. Rather than asking people to attend central surgical camps, health workers went door-to-door in order to reach the last remaining patients. This was a time-consuming process, but it was necessary to make sure we were leaving no one behind.

Sadly, the central and northern parts of the country have been hit by a series of conflicts over the past two decades, as various groups have battled for territorial control. In these regions, we knew it would not be safe for staff to go door-to-door in search of trachoma cases, so we relied on different methods.

We identified ‘safe zones’ within these regions where people could travel if they needed a trachoma operation and we reimbursed their transport costs. In some areas, staff at Mali’s National Eye Health Programme were required to negotiate with armed groups to reach people who needed treatment.

Author

Dr Boubacar Morou Dicko is the country director of Sightsavers Mali and is a public health physician by training. He has more than 25 years of experience in team leadership and programme implementation in West Africa.