Tanzania 
From witches to treated trachoma patients

Misanet.com / IPS, 2 August - In the northern Tanzanian district of Shinyanga, it has become a common practice to lynch old women with bloodshot eyes, usually on suspicion that they are witches. Now, newly introduced teaching of communities on how to fight trachoma reduces the withhunt.

In the local community, bloodshot eyes are associated with witchcraft, but Tanzanian health officials believe the phenomenon could be a result of irritation caused by trachoma, a leading public health problem and a cause of preventable blindness in much of Tanzania's northern and eastern regions.

The disease is aggravated by poor living conditions, often in poorly ventilated thatched huts, where the old women's eyes are irritated by smoke, and lack of sleep. When they wake up in the morning their eyes are blood-shot.

- It is a deep-rooted belief, explains Gabriel Ukunda, Tanzania's chief medical Officer. "The communities there believe it. It is difficult to get people out of their beliefs." 

Tanzanian medical doctors are endeavouring to combat the disease in the districts, through the United States based International Trachoma Initiative (ITI), a project partly funded by US drug company, Pfizer.

The project, which seeks to prevent transmission of the Chlamydia trichiasis bacteria, responsible for 80 percent of blindness in the developing world, is each year donating Zithromax, an antibiotic found to be effective against trachoma, in some nine districts in central and eastern Tanzania.

The project is currently concentrated in the central region of Dodoma, where so far, severe trachoma has been reduced by 50 percent and awareness about the diseases has reached at least 70 percent of the local population, according to health officials. "We are working faster so we can reach Shinyanga, and save a lot of lives," says Ukunda.

Trachoma, a disease caused by the bacterium Chlamydia trichiasis, is closely related to personal hygiene. It occurs in much of the East African country's northern and eastern regions, which lack access to clean water.

The chlamydia parasite thrives mainly in arid areas, where children often wake up in the morning and go to school without washing their faces. "It is normally very difficult to convince people to wash their faces with soap, when there is no water," says Dr Peter Kilima, the ITI regional representative in Tanzania.

For women, it's much easier to contract the disease, by up to three times more than men, because they are the ones that mostly interact with children, he says. Repeated infection that starts in childhood leads to trichiasis and blindness by the age of 30 if untreated.

- The problem was so pervasive in the community that the people didn't even know that the disease was there, notes Kilima. "It was difficult for us to confront the community with the problem. We were forced to invent new words in the local language for them to understand."

This explains Edna Mukuta's dilemma, when she recently turned up for a dose of Zithromax, although she doesn't know what trachoma is and how it is transmitted. "We were just told that the medicine is good so we came to get it," the 37-year-old mother of three told IPS at one of the treatment centres in Kongwe in Dodoma region.

Violet Chalenzi, 70, who began suffering from the disease some five years ago, is among the eleven patients in Mpwapwa whose eyes were operated on last week. She says she could no longer carry water, or firewood on her head due to sharp pain on the left side of her head, but had never sought treatment because it is generally thought in the village that such problems are a result of ageing. "I couldn't do any kind of work, even walking. I have been depending on my children for help," she says.

Through ITI-SAFE programme, an integrated strategy that stands for Surgery, Antibiotics, Face washing and Environmental change, ITI Tanzania, despite the challenges, has become the model of a successful multidimensional trachoma intervention, through research, treatment and health education.

The SAFE project runs in at least nine districts in the northern and eastern parts of the country, with infection rates ranging between 12 and 60 percent.

In 1999, the project reached some 70, 000 people, 210, 000 in 2000 and hopes to cover even wider ground by the end of this year, according to Kilima. Face cleaning messages are being dispersed through the radio, television and posters.

The "Usi Safi" (Clean face in Kiswahili) slogan also has gained popularity in schools in the region, where teachers, and community leaders use it as a greeting. "The faces of young children I saw in 1999 are different from the faces I see today," Kilima explains.

Simon Katenga, an eye-care expert with the Tanzanian health ministry, attributes much of the projects success to the leadership in the villages. "It is not easy for a programme manager to convince people. It is up to them to target community leaders, who are respected by the people," he says.

By Judith Achieng', IPS

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