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Innovative Campaign Aims at Eliminating Trachoma in Morocco by 2005

Nearly six million people worldwide have been blinded by trachoma. The World Health Organization calls the disease the leading cause of preventable blindness, and estimates that it threatens one tenth of the world's population, almost exclusively in the developing world. But Morocco expects to be rid of the disease by 2005. The WHO hopes to use a strategy tested in Morocco to eliminate the disease worldwide within two decades.

Southern Morocco, on the edge of the Sahara Desert. Tiny, blocky villages of dried mud and straw are scattered sparsely across the vast, rust-colored emptiness.

Trachoma strikes hardest in remote places like these. Water for washing faces is scarce, and medical care is far away. Trachoma begins as a bacterial eye infection. If left untreated, the infection scars the eyelid, turning the eyelashes inward. The lashes rub painfully up against the eyeball with every blink. Over time, the rubbing scars the cornea, clouding vision and leading to blindness.

Abdullah, a 70-year-old farmer, has suffered with trachoma for much of his life. His right eye is visibly clouded with trachoma scarring. "Whenever it's hot, it pricks my eyeball and causes me a lot of pain," he said. "I'm a poor man, and I've let myself go."

Trachoma causes financial as well as physical pain. Loss of vision means loss of work, for the victims as well as their caretakers. The disease costs the world an estimated $2.9 billion a year in lost productivity.

Trachoma is treatable. At local clinics throughout rural Morocco, like this one in Tata province, health care workers perform a simple, inexpensive surgery that gets the eyelashes off the eyeball.

The procedure can prevent blindness if performed early. But ophthalmologist Mohammed Belmekki says the farmer Abdullah's right eye is too far gone. "He knows if we perform the surgery, he will not be able to see," he said. "But he will suffer less."

But thousands of people in Morocco have been operated on in time to save their vision. A bright spot in the global fight against trachoma, Morocco is one of three pilot countries testing a World Health Organization strategy designed to eliminate the disease worldwide by 2020.

Surgery is just one part of that strategy. Another part involves delivering antibiotics once a year to each resident in high-risk areas. Adults get tablets. Children get a squirt or two of cherry-flavored liquid.

Another element is improving water supplies, like these taps in a Ouarzazate province village.

Washing faces cuts the risk of trachoma. And water to flush solid wastes keeps away flies that can spread the disease. Four years ago, only 14 percent of Ouarzazate residents had access to fresh water. Now, three-quarters do.

Morocco's efforts to fight trachoma are paying off. In the hardest-hit province of Zagora, for example, active trachoma rates have fallen from more than 50 percent in 1997 to less than four percent today. Morocco's trachoma elimination program director, Dr. Youssef Chami, points out that the country could not have done it without the solid support of the government.

"One of the major assets is commitment and political will. Political will is, first of all, the commitment of the Ministry of Health," he said.

The WHO would like to see that same commitment to eliminate the disease in 45 other trachoma-stricken countries. But in many of these countries, trachoma will have to get in line behind other pressing health issues like AIDS, tuberculosis, and meningitis. Morocco has more money to spend on trachoma than many poorer developing countries. And the disease was already on its way out when the current campaign began in 1997.

But experts say even countries without these advantages can learn from Morocco's efforts. Morocco gets a lot of help from international non-governmental organizations. According to Silvio Mariotti, with the WHO's blindness and deafness prevention program, the country's political commitment made these partnerships much easier.

"What is complicated is to bring in resources, international partnerships, when the political commitment is only expressed in speeches, and does not translate in transparency in the way the resources are used, consistency with the expressed political commitment, and the investment countries do in their own health system," he said.

Dr. Mariotti also says that investors are willing to help in countries with good accounting practices which invest in health care. He adds that's how Morocco has made such good progress in fighting trachoma.

And Dr. Mariotti says if other countries can muster Morocco's will to fight trachoma, their children may be singing the same song by 2020.