Continuing success – surgery and refusals

25 January 2017


The Trust's Trachoma Initiative has now managed over 60,000 cases of trachoma trichiasis in six countries.

The Queen Elizabeth Diamond Jubilee Trust’s Trachoma Initiative has now managed over 60,000 cases* of trachoma trichiasis (TT) in six countries, with 10,900 cases managed in the last six months.

This means that 22 districts in Malawi, Mozambique, Kenya and Uganda, have reached their elimination goals for TT – having reduced the number of TT cases that are unknown to the health system to less than one in 1,000 of the district population.

Over the last six months, systematic house to house case-finding approaches have been adapted to improve results. This has involved partners breaking a district down into smaller geographical areas, documenting the number of households in that area and, based on that, training the correct number of community health workers or volunteers who will then find cases of trachoma in that specific area.

Through this method they can effectively ‘’sweep’’ an area and be confident that a high percentage of the households have been covered.

Those who undergo surgery are encouraged to go on and counsel other members of their community who might have refused surgery in the past, by sharing the benefits of surgery and addressing any concerns people may have.

Often the reason for people’s apprehension is because of a fear of the unknown, having heard rumours about what TT surgery involves. When they see the results and hear of the experience first-hand from someone they trust, many then seek treatment.

A portrait of Esther Chisebe.

Esther, a lifelong practitioner of traditional medicine in Tanzania, believed western medicine wasn’t beneficial. So when she developed continuous pain in both of her eyes, seeking a medical solution was the last thing on her mind.

After a first meeting with a case finder, Esther’s name was added to a list of those known to be refusing treatment and she was later visited by a community health worker who spent time talking with her. The counsellor gradually gained Esther’s trust and was able to impress upon her the benefits of the trachoma surgery and the significance of what surgery could offer her.

Esther was persuaded and she underwent TT surgery. After the surgery Esther was overjoyed, she said, “I was so stupid denying the eye surgery and lying to other people about the effect of western treatment. I have realised that it was untrue. After the procedure I am now cured and have no eye pains any more”.

Esther was so impressed by the outcome of the treatment that she has since shown willingness to act as a counsellor in her community, advocating treatment to others.

*We use the term ‘cases managed’ to cover anyone with TT who has met and been counselled by surgeons and either had surgery or refused any assistance. In other words, these people are known to the health system.