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Kathmandu Saturday January 26, 2002 Magh 13, 2058.
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Arresting trachoma
By DR R P POKHREL
In Nepal when I organised the first eye camp in
the far western Terai belt of Nepal at Dhangadi in December 1972, I observed an extensive
member of active and complicated cases of trachoma mostly in the Tharu community where the
approximate number of cataract and entropion surgeries were almost equal. My constant
touch with the different people in the various eye camps in different districts of Nepal
(approximately 72 eye camps between 1971-80) gave me a true picture of our economy and the
problem of blindness. This motivated me to go to community ophthalmology instead of
specialised ophthalmic practice in Kathmandu.
I wrote several articles in Nepali and English
in the various daily newspapers such as Gorkhapatra, The Rising Nepal and Yeti Digest
during the year 1972-78 in order to generate awareness of the problem of blindness among
the people.
In March, 1978, I attended a WHO workshop at New
Delhi on "Prevention of Curable Blindness" where I explained the problem of
blindness in Nepal and how I am struggling alone without any support. This motivated many
experts and donor agencies who came forward to give support to Nepal. Dr Nicole Grasset
came in with a WHO and HMG-Nepal sponsored programme for the prevention and control of
blindness.
The first wise decision we made at that time was
to conduct the HMG/WHO national blindness survey in 1980/81. This gave a true picture of
blindness in Nepal where cataract was the major cause of blindness and the second leading
cause of blindness was trachoma and approximately 900,000 people were suffering from
trachoma in a population of 15 million in 1981. Trachoma was prevalent mostly in the Terai
belt but it was endemic in 5 districts of Nepal i.e Banke, Bardia, Kailali,
Kanchanpur and Surkhet.
Swiss Red Cross provided tremendous community
eye care services, which was repeatedly followed and monitored for nearly 10 years in
Bheri zone. This included regular use of Tetracycline eye ointment, health education for
face washing and surgery for complicated cases. After the follow up survey by Dr GP
Pokharel in the recent past there seems to be decline in trachoma in Bheri zone but the
prevalence rate of trachoma is almost the same in Kailali and Kanchanpur districts as in
1981. There are still some pockets even in the hills of Jajarkot, Dailekh, Nawalparasi and
Chitwan districts as well where trachoma cases are found.
Now Zithromax has been made available through
Pfizer and International Trachoma Initiative - a tax-exempt charitable organisation in the
US which is coming forward to help eradicate trachoma in Nepal. We had a series of
workshops in Kathmandu, Kailali and Chitwan in the last two weeks of July 2001 where we
brought together all the implementing partners working for trachoma eradication with the
initiative of ITI, all working in close collaboration with central NNJS and Department of
Health Services.
WHO advocates SAFE strategy to control trachoma.
"S" stands for surgery for the complicated cases of trachoma like entropion and
trichiasis. "A" stands for antibiotic but the effective antibiotic was not
available in Nepal till four years ago and Zithromax was too costly. So the average poor
people could not afford it. But now this new antibiotic has been made available by Pfizer
at the initiative of ITI. This single dose therapy of Zithromax for the active trachoma
will be launched from February 2002 in the districts of Kailali and Kanchanpur as pilot
studies and if proved effective, it will be launched in all the districts of Nepal where
trachoma is still a public health problem.
"F" stands for face washing. We have
to motivate the people to wash their faces in the early morning as well as in the night
before they go to bed. Water has been made available but it must be fresh or free from
pollution. "E" stands for environmental changes, i.e. improvement in hygiene and
sanitation. This calls for health education, awareness among the illiterate people,
improvement in the economic conditions of the general mass which needs development, social
security and proper planning of the government in developing infrastructure in the
country. This is possible only when there is political stability in the country and when
the dedicated politicians work with a vision in order to develop the country. The control
of trachoma needs more awareness, availability of water and improvement in the economic
conditions of the people. Given the lack of commitment of the authorities concerned, it
may take several years to solve pressing health problems.
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