From Nov. 5-11, 20,000 health workers and volunteers will walk the countryside of western Amhara region, Ethiopia. Their quest: treat every person at risk-approximately 10 million-for trachoma control and screen as needed for malaria. In this Q&A, Paul Emerson, director of the Center's Trachoma Control Program, explains the remarkable results of these "Maltra"-malaria and trachoma-weeks, a collaborate effort between the Lions Clubs International Foundation and The Carter Center.
Q: What is a Maltra week?
Over the course of two Maltra weeks each year, one each for western and eastern Amhara, we aim to treat the entire regional population for trachoma with the antibiotic Zithromax®, donated by Pfizer Inc--that's a population approaching 20 million people. At the same time we screen every person we see for malaria. If they have fever, we test them with the best rapid diagnostic tests available and provide treatment on the spot for anyone who has parasites. It's also an opportunity to reinforce the ongoing health education messages for preventing the two diseases.
Q: Why this region of Ethiopia?
The Amhara region is the most endemic state in the most endemic country-the ground zero of trachoma. We are trying to eliminate trachoma as a source of blindness in this most difficult place. If it can be done there, it can be done anywhere in the world.
Q: What makes this area so endemic?
It's a difficult question to answer. We know that trachoma affects people who are living in fairly crowded living conditions, are nutritionally compromised, have problems with sanitation and hygiene, and these characteristics fit the Amhara region today.
Q: How do you pull together the manpower required for this semiannual campaign?
It is a logistical nightmare. We have 4,633 teams each time, and most of the work is done on foot. The challenge is to make sure that each team in advance has logbooks, stationery, a height stick to measure the participants, the drugs that they need, plus the diagnostics for malaria and the forms for malaria and the correct medication for malaria and promotional caps and T-shirts all in the right quantity, in the right place, at the right time. Fortunately, Ethiopia may be resource poor but it is capacity rich, and our staff is extremely capable of organizing all of this.
Q: Maltra campaigns began in 2008. How have they evolved?
In the beginning we were not sure how the campaign would pan out, but we were amazed at the enthusiasm of the Ethiopian people. And, frankly, it's just been maintained. Now people have it on their mental calendars, and they're expecting to receive the Zithromax. In addition to trachoma, the medicine treats many other bacterial infections such as pneumonia, diarrheal disease, and skin diseases. The people have seen the benefits for themselves and don't need convincing. They come out in the millions.
Q: Do any particular Maltra weeks stand out in your mind?
One thing that I really have enjoyed seeing in the recent Maltra weeks, now everyone is primed for it, is the village fanfare. As a team is winding its way through the fields of crops coming into the village, boys with bugles will come out and blow their horns. At that sound, everyone will stop what they're doing, gather their families, and come marching to the medication distribution point. By the time the team has entered the village and put its boxes on the ground, families are already assembling.
Q: How does this high penetration in Amhara region fit into the global goal of eliminating blinding trachoma?
Our trachoma program in Amhara, which operates 52 weeks a year, targets 18 million people. Yet there are 100 million more people worldwide that would benefit from a comprehensive trachoma control program.
Q: Can the Maltra week model of drug distribution, testing, health education, be applied to other diseases besides malaria and trachoma?
Definitely. The concept of Maltra could be applied anywhere there is a strong health service and a strong public health system with the infrastructure to do it.