Blog | Altering Behavior Can Mean a Change for the Better


Kelly Callahan, M.P.H., is director, Trachoma Control Program.

When COVID-19 appeared, the first thing public health experts advised us all to do was to wash our hands frequently and thoroughly. This is excellent advice, and it’s what the Carter Center’s Trachoma Control Program has been teaching people for 20 years.

As humans, changing our behavior is hard. No matter where we live, which culture we belong to, or how rich or poor we are, it’s always a struggle to change the way we do things, even if we know it’s good for us. (Ever tried to lose weight?) Still, if we can push through that inertia and make needed changes, things can get better.

A boy in Ethiopia demonstrates how face washing can prevent trachoma. The Carter Center Trachoma Control Program supports the Ethiopia Federal Ministry of Health in implementing the SAFE strategy. (Photo: The Carter Center)

Trachoma is a prime example. This infectious eye disease is caused by the bacteria Chlamydia trachomatis. It is easily spread from person to person through hands, clothes, and flies that land on and near the eyes. Repeated infections can cause trachomatous trichiasis, or TT, in which scarring of the inner eyelid makes the eyelashes turn inward, painfully scraping the eye’s surface with every blink. The constant scraping clouds the cornea, impairing the patient’s vision. Many patients pluck out their eyelashes to relieve the suffering, but the lashes quickly grow back to scrape the eye again.

Trachoma can be found in 44 countries; the Carter Center’s Trachoma Control Program works with five of them: Ethiopia, Mali, Niger, South Sudan, and Sudan. Together, with the respective ministries of health, we teach and implement the World Health Organization-endorsed SAFE strategy for trachoma control: Surgery, Antibiotics, Facial cleanliness, and Environmental improvement.

Facial cleanliness means frequently and thoroughly washing the face, especially around the eyes. This action naturally is preceded by handwashing. With support from The Carter Center, local health workers train both children and adults on the importance of hand and face washing and the best way to do it. Maintaining cleanliness is more challenging than it sounds, as many of the areas where trachoma exists have a critical lack of clean, safe water. In some places, even such a basic product as soap can be hard to come by.

That’s why it’s important to implement all four components of SAFE. With our partner health ministries, the Center assists in the distribution of millions of doses of the antibiotic azithromycin (Zithromax®, donated by Pfizer Inc), which is effective against the bacteria. For environmental improvement, we have assisted in the construction of close to 4 million latrines since 2002, helping to keep fly populations down. And for those whose trachoma has advanced to TT, the Center trains, equips, and supports local surgeons to perform a simple, 20-minute operation to correct the inverted eyelids.

Whether the problem is a new coronavirus or an old nemesis like trachoma, cleanliness is the first line of defense. Sometimes that means changing behaviors, and that is hard, but in the end, it’s worth the effort.

Related Resources

Trachoma Control Program »

Profile | Guinea Worm Veteran Tackles Trachoma »

Video | Kelly Callahan at TEDxAtlanta »

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