At Chelanko Lola Primary School in rural Ethiopia children and parents gather to learn about hand and face washing.
Until recently the 1215 students shared one tiny tap that would only work after it rained, when water was flowing in nearby streams.
There was no way they could wash their hands or faces and there were only four pit toilets for all of the teachers and students.
These are the conditions where the painful and potentially blinding eye disease, trachoma, flourishes. Trachoma is estimated to be responsible for the visual impairment of about 1.9 million people, of whom 1.2 million are irreversibly blind, with 137 million people living in trachoma-endemic districts.
Trachoma is one of 20 neglected tropical diseases (NTDs) which affect more than 1.7 billion people globally, usually the most vulnerable.
Thanks to the partnership between The Fred Hollows Foundation and Caritas a 5000 litre storage tank has been installed and the school now has a constant supply of running water.
A new set of taps and a trough, as well as new latrines, mean the students can be taught about the importance of facial cleanliness and sanitation.
Improved access to safe water and adequate sanitation, and good hygiene practices (or WASH), are essential for trachoma prevention and control. They are one important element of the World Health Organization’s (WHO) SAFE Strategy: Surgery to treat the blinding complications of the disease; Antibiotics to treat the active infection; Facial cleanliness to reduce the spread of the infection; and Environmental improvements to reduce the spread of the infection.
At the school and hundreds of others like it across Oromia, The Fred Hollows Foundation is supporting programs where family members are taught hand and face washing by their children.
It is not possible for eye health organisations like The Foundation to work with governments to eliminate eye conditions like trachoma without the support and partnership of the Water, Sanitation and Hygiene (WASH) sector.
Trachoma thrives in crowded living conditions where there are shortages of water, inadequate sanitation and where eye-seeking flies are present.
Trachoma can destroy the economic well-being of entire communities, keeping affected families trapped in a cycle of poverty as the disease passes from one generation to the next.
While children are the most susceptible to infection, the blinding effects of repeated infection do not usually develop until adulthood. Women are twice as likely than men to develop trichiasis, the blinding stage of the disease, in part because of repeated exposure to their children’s infections.
Some of the key independent predictors for children contracting trachoma include a greater time to source washing water, open defecation, and lower annual rainfall.
While most of the funding for trachoma control and elimination are directed at the S and A (surgery and antibiotics) elements of the SAFE Strategy, the F and E components that deal with personal hygiene and environmental improvement are the key to sustainably eliminating blinding trachoma once and for all.
These components involve a daunting but essential task of the development of water, sanitary facilities and bringing about behavioural change.
Face washing and environmental improvement are fundamental to achieving The Fred Hollows Foundation’s ultimate goal of eliminating blinding trachoma as a public health problem.
We know that access to safe water, adequate sanitation and hygiene is a key intervention in the new WHO NTD road map.
It is critical in the prevention of not just trachoma, but all NTDs.
While 40% of the world’s population does not have access to handwashing facilities at home, 47% of schools lack handwashing facilities and 16% of healthcare facilities have no functioning toilets or handwashing facilities at points of care where patients are treated, we will continue to see NTDs like trachoma thrive.
In a world impacted by the global pandemic Covid-19, we have seen the importance of hand hygiene for everyone making global headlines. Covid-19 threatens to disrupt the significant progress made to date towards eliminating trachoma as a public health problem.
In Ethiopia and worldwide, the necessity to link WASH efforts with trachoma programs has been broadly acknowledged, but it is only now that the potential for doing so is being tapped in current programs and the policy frameworks that support them. A joint approach that addresses the causes of trachoma and responds to the basic needs of the affected communities is likely to be more cost effective and sustainable.The strong link between WASH and trachoma means that elimination will not be possible without collaboration and action on WASH. So projects like the one at Chelanko Lola Primary School are at the forefront of eliminating this painful and debilitating disease.