ATLANTA, GA (WABE) – The Atlanta-based Carter Center has been fighting neglected tropical diseases like river blindness and guinea worm all over the world. In our week-long series “From Georgia to Ethiopia”, WABE’s Odette Yousef focused on the Center’s fight against another disease, called “trachoma.” Trachoma is the leading cause of preventable blindness in the world… and the most affected country is Ethiopia.
In April, the Center’s launched a major new part of its health initiative: to treat and educate 5 million people in one region of the country, in just one week.
But trachoma is not exclusive to countries far away. It was once a health concern right here… in Georgia.
In 1921, the U.S. Public Health service dispatched a certain Dr. John McMullen down to Camilla, in southwest Georgia, to investigate reports of an outbreak of an eye disease. McMullen, who ten years earlier had found trachoma endemic in parts of Appalachia, was greatly concerned about what he found, and wrote about it in a report.
McMULLEN: A subsequent examination some months later showed many more trachoma cases, some of whom had lost both eyes from trachoma; others had been blinded in one eye, and a considerable number of others had had their vision greatly reduced as a result of this disease.
A temporary clinic was opened in the neighboring town of Pelham to focus on what McMullen termed an “epidemic”. In the four-and-half months that it operated, the hospital recorded 200 cured cases of trachoma, and McMullen declared the venture a success.
McMULLEN: Mothers have been restored to their places in their families, fathers resumed their work as bread winners, and children returned to school as a result of this public health endeavor by the United States Public Health Service, the State of Georgia, and the local authorities.
At the time, U.S. Public Health officials were not only worried about the endemic trachoma that was found in Georgia and Appalachia, but from other sources, too.
KRAUT: But there was also a major concern about trachoma being brought from abroad by immigrants entering the US.
Alan Kraut, professor of medical history at American University in Washington, says that U.S. officials began examining immigrants for trachoma when they offloaded at Ellis Island and other depots. They’d flip up immigrants’ eyelids, to see whether they were red, grainy, and irritated on the inside — the tell-tale signs of trachoma. Those who had it were sent back.
KRAUT: Imagine yourself standing on line, waiting to be assessed by a physician, hoping that nothing goes wrong so you can enter the US uneventfully, and someone comes along and everts your eyelid, and not just everts your eyelid, but uses for want of a better instrument, a buttonhook.
Chlamydia trachomatis is caused by a bacteria that irritates the inside of the eyelid. If untreated, repeated infections over the years can cause blindness. The only thing that can save someone from blindness in later stages, is surgery.
But what once was a major health concern is now more likely to draw blank stares…
HARPER: Tell me what kind of hospital it used to be? Trachoma. Which is an eye disease, right?
Tom Harper and his family live in the building in Pelham, Georgia, that served as the temporary hospital in the early 1920s. The one-story complex is now a neutral beige, and has a car port in the back, but it still looks institutional, with a very plain exterior.
HARPER: If you actually look at the inside of the house, you can tell that each of the rooms was definitely designed for hospital rooms. The doors are much larger than typical doors, and inside the rooms you can tell that the closet doors are much smaller because obviously the patients would only be there for a short period of time.
There’s a skylight in the kitchen, which once served as the light source for the operating room. And perhaps most revealing about the structure’s former use
HARPER: Almost every one of the rooms has its own individual sink, sink and mirror where they can stand and wash their hands, or the patients can wash their hands. Yeah, you can tell there are a lot of features inside the house that still remain that were for a hospital.
Hand-washing, and face-washing, are key components in controlling the spread of trachoma… and health officials at the time promoted that type of basic hygiene.
Paul Emerson, director of the Carter Center’s trachoma control program, says the disease can be found anywhere, but it thrives where people are poor.
EMERSON: Where slum conditions exist, or where there’s poor access to water, where there’s poor access to sanitation, where people are living in high densities close to one another, without washing their clothes, without access to hygiene and sanitation facilities, that’s where you find trachoma.
As western countries developed, the conditions that favored trachoma disappeared: housing became less crowded, easy access to water became the standard, and trachoma went away. Now the battleground has shifted to places like China, India, Sudan and Ethiopia — a landlocked country roughly twice the size of Texas, in the Horn of Africa.
Experts say that Ethiopia is the most endemic country in the world for trachoma. Out of a population of roughly 80 million, more than 1 million have been blinded by it already. Eighty-five percent of Ethiopians live in places where they’re at risk of getting it. Former President Jimmy Carter says the magnitude of the problem is what convinced the Carter Center to work there:
CARTER: We are demonstrating to others who are working on the same disease the techniques that can be used.
And one of those techniques that the Center has recently ramped up is the wide-spread use of antibiotics. In late April, nearly every one of the 5 million people in the eastern part of the state of Amhara got the medicine, in just one week. The same was done in the western half in November, and it will become an annual feature of the project.
Paul Emerson says that helps to relieve people’s irritated eyes, but it’s no long-term solution
EMERSON: The antibiotic is a great kick, and really accelerates the process. But antibiotic alone is never going to be the answer.
Still, the attention and resources poured into the massive treatment campaigns will bring attention back to trachoma, which often lies in the shadow of bigger-name, fatal diseases that also afflict the country, namely, malaria and HIV. The trick is, how to spread the messages of hygiene and sanitation, the habits that will ultimately defeat trachoma, where the prospects for development are decidedly dimmer than they were in the U.S. in early 1900s.