In Mali, the Public Health Threat of Trachoma-Induced Blindness Is Over

Fatima’s world was growing darker.

With each blink, her in-turned eyelashes scraped her corneas, causing excruciating pain. She pulled out her eyelashes to temporarily alleviate this pain, but her sight was failing.

A Malian mother in her mid-30s, Fatima was living with trachomatous trichiasis (TT), the result of multiple trachoma infections over time. These infections create scars that force the inner eyelid to turn inward and the eyelashes to scrape the cornea. This can lead to blindness if left untreated.

Two decades ago, Fatima would have lost her sight.

Instead, a trained health care worker corrected each of Fatima’s in-turned eyelids in less than 60 minutes. By the time she attended her two-week follow-up appointment, not only were her eyelids corrected but her corneal abrasions were almost completely gone, and she beamed with gratitude.

“Now, I get to look into my grandchildren’s eyes,” she said.

Public Health, Person by Person

Fatima’s story has stuck with Kelly Callahan since they met in Mali in 2015. The director of the Carter Center’s Trachoma Control Program, Callahan has 25 years of experience fighting neglected tropical diseases like trachoma. The condition, a bacterial infection that strikes women twice as often as men, has been endemic in Mali for years — in the late 1990s, the prevalence of trachoma in children aged 1 to 9 living in endemic areas ranged from 23.1% to 46.7%.

  • Group of Malian women

    Trachoma, a bacterial infection that strikes women twice as often as men, was endemic in Mali for years. (Photo: The Carter Center)

To Callahan, public health is more than percentages.

“It’s one life. It’s Fatima’s life,” Callahan said. “It’s helping one person by one person by one person.”

Twenty-five years after the Center launched its trachoma program, the condition is no longer a threat to Malians. On April 27, the World Health Organization (WHO) announced that Mali has eliminated the condition as a public health problem, which, according to the WHO, signifies:

  • The prevalence of TT in adults is down to nearly zero.
  • The prevalence of trachoma-related inflammation in children is holding steady at less than 5% without mass antibiotic distribution.
  • The strategic and financial framework to readily manage trachoma infection is in place.

The bacteria that causes trachoma — Chlamydia trachomatis — has not been eradicated, but no one in Mali has to lose their sight to the disease.

A Long Road

President Carter first visited Mali in 1998, when disparate groups vying for political control had been stoking violence for decades. The insecurity made it impossible to train healthcare workers, improve sanitation, and distribute antibiotics in areas closed to outsiders.

“We had to understand the belligerents, and we had to gain trust,” Callahan said. “Slowly, we built bridges to peace through health.”

  • Carter and Toure shake hands

    Twenty-five years after the Center launched its trachoma program, the condition is no longer a threat to Malians. Above President Carter and Jim Ervin, past president of the Lions Clubs International Association, meet with General Amadou Toumani Touré (who later became President of Mali) in 1999. (Photo: The Carter Center)

President Carter’s visit gave them a head start, opening doors and establishing the program’s credibility. After more than a decade of research and relationship building, The Carter Center made inroads, working with community members to combat the disease through a WHO-endorsed SAFE strategy:

  • Surgery: The Center trained local health care providers to correct in-turned eyelids.
  • Antibiotics: It helped conduct yearly mass distributions of Pfizer Inc.-donated Zithromax® to combat active infections.
  • Facial cleanliness: It supported hygiene practices and health-education programs that help prevent disease transmission.
  • Environmental improvements: It built latrines across Mali, improving sanitation and reducing populations of flies that spread the disease.

“The story of eliminating trachoma as a public health problem in Mali shows the power of partnership, most importantly with communities and through trust-building efforts, which are the ethos of the Carter Center’s global health work,” said Dr. Kashef Ijaz, vice president of the Carter Center’s health programs.

Working with partners and the Malian government, the program has helped avert blindness in 5 to 7 million Malians, and the antibiotics distributed to combat trachoma have also helped prevent infant mortality.

“Not only are we stopping the leading cause of preventable blindness in the world and in Mali, but we’re also saving lives,” Callahan said.

She’s deeply aware of the tangible ripple effects of President Carter’s determination to improve lives.

“These diseases affect the poorest of the poor, keeping people locked in a cycle of poverty and making them more susceptible to malaria, HIV, and tuberculosis,” she said. “Eliminating a neglected tropical disease, like trachoma, improves their socioeconomic status, their immune system, and their lives in the long run.”

Looking Ahead

Over the past three years, Callahan has seen optimism increase in Mali’s National Blindness Prevention Program coordinator, Professor Lamine Traoré, as he’s witnessed his country’s progress.

“He can see the impact — not the output, not the number of surgeries, not the number of latrines, not the number of doses of pills. But he can see the impact on his population because they do not have to worry about trachoma anymore,” Callahan said. “They can focus on something else now.”

Fatima and her family can build lives free from fear of blindness and the burdens that come with it. They can continue learning, working, and contributing to their communities, and, together, they can break the cycle of disease and poverty.

“WHO validation means more than 90,000 surgeries, millions of doses of Pfizer-donated Zithromax® — what it really means is that Fatima didn’t go blind,” Callahan said. “Fatima gets to look into the eyes of her grandchildren and doesn’t go blind from a horrible, neglected tropical disease. That’s what it really means.”

Editor’s note: We are grateful to our partners and supporting organizations like the Conrad N. Hilton Foundation, Lions Clubs International Foundation, Lions Clubs of Mali, the OPEC Fund for International Development, Pfizer, Inc., Sightsavers, and Helen Keller Intl — without whom this achievement would not have been possible.