The members of the after-school club in Salima are aged between 13 and 16 years old. The club meets once a week to learn life skills, including the importance of hand and face washing to prevent the spread of diseases like trachoma.

“We have learned how to prevent trachoma and how we can fight against it,” says Nathan, one of the club members. “We can defeat it by washing hands and washing the face. I am so excited because trachoma has been eliminated. It was troubling us, and we were failing to see clearly.”

Another student, Grace, shares her joy that trachoma has been eliminated, and her hopes for the future, saying: “I am feeling so happy that trachoma is gone [from Malawi]. When I grow up, I want to be a nurse so that I can serve the people who are sick.”

The students split into three groups to write letters to Gladys, an ophthalmic clinical technician; Gervazio, a health surveillance assistant; and Senior Chief Maganga, the village chief.

Gladys was one of three surgeons performing operations for advanced trachoma (known as trichiasis) in Salima during the Sightsavers-supported trachoma elimination programme. Trichiasis is the later stage of trachoma that can cause blindness, but if caught early an operation can prevent sight loss.

Gladys was inspired to work in medicine at a young age by her grandmother, who was a hospital maid and encouraged her to get an education and become a nurse.

“I’ve been an ophthalmic clinical technician for eight years now. I specialised in ophthalmic care after seeing eye conditions in the hospital and studying ophthalmology. It’s because of that passion and the love of eye care,” explains Gladys.

From 2016, Gladys carried out roughly 125 trachoma operations. “Since trachoma has been eliminated here in Malawi, I feel happy. I feel satisfied and I also feel hopeful. We have worked very hard in trachoma elimination and reached the hardest places to reach. I feel like I’ve really taken a major role in this elimination.”

For her letter, Gladys wrote to the Salima community where she had worked as a trachoma surgeon.

Achiwa is an 82-year-old grandmother and great-grandmother, and a member of the Salima community Gladys chose to write to. To earn a living, she farms maize and weaves mats. She knows all too well what a huge achievement trachoma elimination is, as she experienced the pain of advanced trachoma for many years.

“My eyes hurt and felt like they had sand in them. At first, the hospital gave me eye droplets. Then someone said I should buy razor blades to cut my eyelashes,” explains Achiwa.

Shaving her eyelashes helped for a short while, but in a month the eyelashes would grow back and continued to scrape against her cornea. During this time, Achiwa relied on her granddaughter, Zainabu, to help her cook, farm and earn a living. On an outreach visit, a community rehabilitation assistant for a Malawian disability agency met Achiwa and identified her eye issue as trachoma. The assistant, Mariam, encouraged Achiwa to go to hospital for surgery.

“They picked me up in an ambulance. We went to hospital and they did an operation on me. That same evening, they put me in a car and dropped me right here at my house,” Achiwa says.

“The first thing I saw [once I recovered from surgery] was my house with people seated at the door and my husband. My joy was telling my husband that after the trip to the hospital, now my eyes can see.”  

Achiwa’s message was for Mariam, the community rehabilitation assistant who encouraged her to seek treatment. 

Mariam works for the Malawian governmental disability agency MACOHA and is a well trusted and respected member of her community.

“At MACOHA, we work with people with disabilities,” says Mariam. “We don’t just look after those with an existing disability, but also prevent diseases that can lead to disability.

“We worked hand in hand with the district health office and went from one village to the other to have meetings with those who had trachoma.

“What makes people trust me is that when I arrive in the village, I make sure I explain to the locals so that we understand each other and why I am visiting. Because if we don’t get down to the same level, they will not open up to me. So, I join them and act as if I am one of them.

“If they are eating, I eat with them. And when they see me do these things, they know I will help them. That is why people trust me.”

In her letter, Mariam thanked the donors who funded the trachoma elimination programme, and the health workers at the hospitals.

Health surveillance assistants played a crucial role across Malawi in the fight to eliminate trachoma. One of their main roles was to distribute treatment for the disease during the yearly mass drug administrations and teach the community how to prevent trachoma.

Gervazio was one of these health workers and has been in the role since 2007. “I am like a bridge between the local villagers and the hospital,” he says. “I work in four villages and am responsible for over 1,700 people. So, if we split up the mass drug administration over five days, I’d have to reach 400 people [in a day].

“To be a good health surveillance assistant, you have to keep confidentiality. You should also respect people’s opinions in the village, be able to integrate with the community and respect the leadership of the village. Do not show off or act as if you’re above the community. You also have to be devoted.

“I am happy we have eliminated trachoma and am confident that I did a satisfactory job here to help. I am also happy because when we are reducing the numbers of disease infection it means development will take place in that area.”

Gervazio wrote his letter to the community of Salima, to advise anyone with signs of trachoma to report immediately to the health facility for treatment.

The trachoma elimination programme worked closely with village chiefs such as Senior Chief Maganga to help inform their communities about the dangers of trachoma, how to prevent it, and how to influence community members to go to a health facility if they had signs of trachoma.

“As a traditional leader, I’m also a role model to the community here,” explains Senior Chief Maganga. “What I can say is that as members of the community in my area, they have to look after themselves. Always try to be clean because some of these diseases [are spread] because we are lacking cleanliness. So, once we are observing cleanliness, our life will be good.

“My vision is to see people in Malawi living healthy lives. So my message to my fellow chiefs, my fellow traditional leaders and my fellow community is that I urge them: let us work hand in hand, so that we can live a healthy life.”

Senior Chief Maganga chose to write his letter to his community and the Salima district health office, to encourage them to continue hygiene and sanitation measures that will prevent the spread of disease.

When we first met Saphira, in 2018, she was a trachoma champion at her school in Kasungu, in central Malawi.

“I learned about trachoma at primary school when I engaged in a club where we were discussing trachoma,” she told us back then. “It was cool to me to understand it so that later I could be educating my friends.”

We caught up with Saphira in 2022 – she’s happy and proud that Malawi has reached its goal of trachoma elimination.

“Now I have peace of mind because the dangerous disease which tormented our country has been eliminated and we are free,” she says. “I want to celebrate with my sister and we will continue to raise awareness on how to prevent the dangerous disease.”

Saphira recently graduated from school and will soon begin studying agricultural education. She wrote her letter to her older sister, Taona.

Francis is the head teacher at a primary school in Salima, Malawi. He has been a teacher for seven years.

“The mission for our school is teaching and learning for sustainable livelihood,” he says. “With this, we want to teach learners and even the community that once they learn something this should not only be for education but to sustain their lives when making decisions in their families and communities.

“My hope for the students is that one day they will be pioneers in fighting a disease outbreak that can affect people in the future. I hope that the knowledge they have gained today, they will use in the future.

“For children, the elimination of trachoma is a celebration. If one disease is gone, it means that the learners will grow up without trauma of being affected. The environment will be free for them and they can play freely.”

Francis wrote his letter to Lazarus McCarthy Chakwera, President of Malawi, to celebrate the good news of trachoma elimination in the country.

Michael Masika works for Malawi’s Ministry of Health to coordinate eye care services in the country.

“The key element in the trachoma elimination programme in Malawi has been working together in collaboration,” says Michael. “We all know the main approach to eliminate trachoma is the SAFE strategy. So there are some partners that are just doing the facial cleanliness and environmental improvements, while others are doing the surgeries and antibiotic distribution.

“There are a few people who really encouraged me to keep working [towards the elimination of trachoma], like Dr Teshome Gebre, the Africa regional director for the International Trachoma Initiative. He first came to Malawi when we were setting up the trachoma action plan. I remember it vividly – he said: ‘Trachoma is not an easy disease to eliminate, but you are going to make it.’ With that, I know I’ve made it, we have made it.”

Michael wrote his letter to Dr Gebre to thank him for his encouragement and advice throughout the trachoma elimination programme.