Tracking Trachoma: How The Gambia Is Eliminating an Ancient Disease

Awa Jallow first realized that something might be wrong with her left eye several years ago when she was in her mid-20s. Her eye would tear up, and she had trouble seeing the horizon. “I was disturbed when going out into the sun,” she says. The sun was something she could hardly avoid where she lives in sunny West Africa, in an area of The Gambia not far from the capital city of Banjul. Because of her eyes, Jallow found it hard to take care of her children or to work selling firewood. So she went to her local health clinic, a busy place in the middle of a crowded market packed with vendors selling fabrics, vegetables, and fish. The clinic’s ophthalmic nurse explained that she had a condition called trichiasis in which some of her eyelashes were growing inwards and scraping her cornea with every blink. He told her that she would need eyelid surgery to correct the condition. Without the surgery she would go blind in that eye. Jallow’s case of trichiasis was the result of something that happened decades before—when she was a child living in a rural village, Jallow was infected with the bacterium Chlamydia trachomatis and developed trachoma. It takes years for trachoma’s dire effects to reveal themselves. Repeated infections in childhood cause the eyelid to scar and turn inward many years later—as in Awa Jallow’s case. “The more frequently you get infected and the longer [the infection lasts], the more scarring you will have,” says Hugh Taylor, a laureate professor at Australia’s University of Melbourne indigenous eye health group and a 40-year veteran in the fight against trachoma. By frequent, he does not mean every year or even every month. By one estimate, for people to have enough damage to cause inturned eyelashes and blindness, they probably had at least 150 episodes of infection, most of them occurring during the first 10 years of life. Trachoma is the leading infectious cause of blindness in the world. One reason for its reign as a top eye disease is its stealth. A child who comes down with trachoma presents with common symptoms such as watery eyes and a runny nose. “When [the children] are like that all the time, it is seen as normal,” says Taylor, who still does research in the Aboriginal areas of Australia where trachoma persists. The secretions that come from infected children’s watery eyes and runny noses contain the bacterium, which moves from child to child, spreading across entire communities via hands, fabrics, and sometimes flies in a fluid loop of infection and reinfection.