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Fighting the painful but preventable eye disease

Fighting the painful but preventable eye disease

The Fred Hallows Foundation is an Australian NGO involved in helping end avoidable blindness in the world, including in Ethiopia. The organization marked a milestone 100,000 trachoma trichiasis surgery in the country earlier this year. Alison Hill, the Global Lead Communications Head of the organization reflects with The Reporter’s Samuel Getachew on the work of the organization, on the progress so far, on the challenges faced in helping curb the disease that she is hopeful can be eliminated in the nation and on the importance of the Neglected Tropical Diseases NGO Network Conference that she is due to attend in Addis Ababa starting on Monday. Excerpts:

The Reporter: Tell us about the Fred Hollows Foundation?

Alison Hill: The Fred Hollows Foundation is an international development organisation focusing on ending avoidable blindness.

The Foundation works in partnership with governments and partner hospitals and organisations in more than 25 countries, including Ethiopia, where we are delivering the largest trachoma initiative in the world.

Our work is driven by the example of our founder Professor Fred Hollows, who dedicated his life to ending avoidable blindness and training local eye doctors, nurses and support staff to build stronger eye health systems.

In Ethiopia our commitment to date has focused on the elimination of trachoma from the Oromia region. We are also exploring opportunities to support initiatives targeting other eye health challenges, like cataract, as we reduce the numbers of people at risk of trachoma in Ethiopia.

The Foundation was established in Australia 26 years ago and is now one of the leading international eye health non-government organisations (NGOs).

Your group has been involved with trachoma trichiasis surgery in the Oromia region; in fact you marked the 100,000 surgery milestone earlier this year. Tell me about that?

The Fred Hollows Foundation works in partnership with the Government of Ethiopia, the Oromia Regional Health Bureau and NGO partners and donors to tackle blinding trachoma.

In July, The Foundation supported its 100,000th trachomatous trichiasis surgery in the Oromia Regional State.

The 100,000th surgery was performed on an 80-year-old woman, Kemeru Abdela, in the East Hararghe Zone of Oromia. In Oromia region, 27 million people are at risk of developing the disease and 150,000 are in danger of losing their sight without surgery.

It is also known to lead a strong effort to eliminate the disease. What have been some of the progress?

Ethiopia has the world’s highest burden of trachoma, a painful but preventable infectious eye disease, with more than 76 million people living in trachoma endemic areas and up to 800,000 people at risk of blindness.

The Foundation’s biggest project is in Ethiopia and through our partnershipswith the Government of Ethiopia, the Oromia Regional Health Bureau we are making strong progress, saving the sight of hundreds of thousands of people and reducing the national surgical backlog by two-thirds.

When The Fred Hollows Foundation started work in Oromia about sixyears ago there were 150,000 people desperately waiting for surgery. We have made massive inroads into the problem and will continue our efforts to ensure everyone who needs surgery gets it and that together with our many key partners we can eliminate trachoma in Ethiopia.

As well as government agencies, in Ethiopia The Foundation is proud to partner with The World Health Organization, The US Agency for International Development (USAID), The UK Department for International Development (DFID), RTI International, Helen Keller International, Sightsavers, Caritas, SNV, The Wellcome Trust Sanger Institute and Monash University Australia. Nothing is possible unless we work closely with our generous partners.

You will be in Ethiopia next week to attend the Neglected Tropical Diseases NGO Network conference. What do you think are to be the highlights, the pressing issues at the conference?

Since 2009 the Neglected Tropical Disease NGO Network (NNN) has provided a global forum for non-governmental organisations working to control diseases including trachoma.

It’s really important that the Neglected Tropical Diseases (NTDs) community comes together to learn from each other because we share many common strategies to treat the diseases, especially in the area of community-based health activities.

It is critical to share experiences about what works and what doesn’t, coordinate efforts to scale up interventions within countries and across shared borders andfoster conversations between funders, the World Health Organization and the NGO community.

NTDs are treatable and preventable diseases that affect more than one billion of the world's poorest people living in remote communities. NGOslike The Fred Hollows Foundation play a key role in the fight against these diseases. The diseases are often a marker of poverty and investments in NTD control initiatives underpin the strengthening of existing health systems and services to reach the most marginalised members of every community. 

More than 500 people are expected to attend the meeting in Ethiopia to learn and share strategies to achieve the vision of a world free from NTDs.

We need to continue to find new and creative strategies to target the diseases and raise awareness and funds to continue the fight.

I am looking forward to sharing what The Fred Hollows Foundation is doing and our progress and learning what other people are doing, both in Ethiopia and globally, so we can look at ways to make our work more effective.

This year's theme is “Reaching the Last Billion” – which is outlining how we reach those people who are still at risk of these diseases through tackling personal behaviors, environmental factors, social inclusion and treatment. We know that the last billion are the poorest, most marginalised people who are often invisible to functioning health systems. They includewomen, who in the case of trachoma are blindedfour times more often than men, people living in areas of insecurity or displaced as a result of it, people living with disabilities, Indigenous and nomadic people.

One of the issues your group has highlighted within Ethiopia is the lack of surgeons, especially in the rural parts of the country. How is Fred Hollows Foundation filling the gap?

Our founder Fred Hollows always maintained that it was important to teach the teachers – and that philosophy drives our work in Ethiopia and the rest of the world.

While we work with our partners to deliver surgery and treatments to improve people’s sight, The Foundation trainslocal surgeons, eye care workers, community health workers and teachers.

That’s how we can make a lasting impact oneliminating blinding trachomafrom Ethiopia.

In 2017, The Foundation trained 24 integrated eye care workers in Ethiopia in trachoma surgery techniques. We also trained more than 53,000 community health workers and teachers who play a critical role in our efforts to eliminate trachoma.

By training eye care workers in surgery and performing the operations in communities, we have been able to cut the backlog of surgeries much more quickly while still focusing on quality training and supervision. Giving the eye care workers proper training is the only way we can ensure people get good vision outcomes.

Tell me about the SAFE program?

The World Health Organization (WHO) has endorsed the SAFE Strategy for trachoma treatment and elimination. SAFE involves providing Surgery (for people who have trichiasis), A (antibiotics to treat the active infection), F (facial cleanliness) and E (environmental improvement) to improve health behaviours and reduce transmission of the disease.

Last year, as part of delivering the WHO SAFE strategy, The Fred Hollows Foundation and the Oromia Regional Health Bureaudistributed more than 17 million doses of the antibiotic Zithromax®, donated by Pfizer.

But public awareness and education is vital. At the community level, people need to make sure they look after their eye health and take the opportunity to have their eyes checked at health posts and outreach clinics.

Countries also need to make environmental improvements like building water points and latrines.

With all the challenges that exist in the country with the lack of trained medical professionals and equipment, is it possible to eliminatethe disease and as well, your group’s slogan is a lofty dream – “Treating people with trachoma is relatively cheap and simple, and while eliminating it is difficult. It’s within our reach”. Is that true in Ethiopia?

The number of people at risk of trachoma throughout the world has been more than halved since 2011, thanks to the huge international efforts by the World Health Organization’s Global Elimination of Trachoma alliance (GET2020) and stakeholders including The Fred Hollows Foundation.

The number of people at risk of trachoma has continued to fall to 157.7 million people in 43 countries. On current projections, we will see an end to trachoma globally in less than 10 years.

In Ethiopia, working with Government of Ethiopia, the Oromia Regional Health Bureau and NGO partners we have made significant inroads. There is a real determination both within Ethiopia and throughout the world to eliminate trachoma and we are seeing impressive results.

Ethiopia still accounts for 44 percent of the burden of trachoma globally, but there is a huge international effort to work with the Government of Ethiopia to overcome the problem.

In 2017, almost 75 percent of surgeries undertaken globally to reduce the burdenof blinding trachoma were performed in Ethiopia and 60 percent of doses of antibiotics distributed worldwidewere in Ethiopia.

There is no doubt that we still have a lot of work to do, but it is an achievable goal. There is a significant amount of strategic and coordinated effort to ensure this does happen. We have seen trachoma eliminated in other countries, most recently Ghana, so it is an achievable goal.

One of the complaints within Ethiopia, with charity organizations is that, most offer band aid solutions and there are no capacity buildings among local citizens. However, your group is different. It trains the health care extension workers that are helping change the narrative of the nation. Tell me about that?

The Fred Hollows Foundation is built on the belief that we should teach the teachers – training local people to deliver local services.

That philosophy drives our work in Ethiopia and the rest of the world.

Importantly, this philosophy is also one of the key drivers underpinning the trachoma elimination program globally – sustainable interventions which enable treatment to be addressed within the existing health architecture of the country.

When trachoma is eliminated,these skilled people will turn their attention to other critical health initiatives, whether that be in eye health or other health areas, because they have highly transferable skills.

The Foundation supports the training of local surgeons, eye care workers, community health workers and teachers so that we help strengthen the health systems in the countries where we work.

That’s how we can make a lasting impact on eliminating blinding trachomafrom Ethiopia.