LCIF Tackles Trachoma with the Carter Center

What is Trachoma?
Trachoma is one of the oldest known infectious diseases. A bacterial disease, trachoma is spread easily through contact with infected individuals. After years of repeated infection, the eyelid turns inward and the lashes rub on the eyeball, scarring the cornea, resulting in a slow and painful process toward complete blindness.

An Interview with Kelly Callahan
Lions are very active in the fight against trachoma. Lions Clubs International Foundation’s (LCIF) SightFirst program has awarded more than US$29 million to The Carter Center, a leader in combating trachoma for 23 projects in in Ethiopia, Mali, Niger, and Sudan. Ethiopia alone has received more than US$21 million in funding since it is the most endemic country in the world for the disease.

Kelly Callahan is director of the Carter Center’s Trachoma Control Program. She also is a Lion. In this interview, Callahan explains how she got involved in humanitarian work, her thoughts on the progress of the fight against trachoma thus far, and how it has impacted her.

Lion Kelly Callahan speaks with a woman in Ethiopia about the pain caused by trachoma.

  1. You’ve spent most of your life working to help people and animals. When did you know you wanted to dedicate your life to humanitarian work?

    I grew up knowing I wanted to help – my mother taught this from a very young age; actually she lived it, and I was a witness to the joys of helping others… I didn’t know if I want to help animals or people – so I spent three summers during my undergraduate degree assisting studies on Orcas (killer whales) in British Columbia and then I went on to volunteer in the United States Peace Corps. I had helped animals, and the Peace Corps was a way to test the waters on helping people… I was assigned to Cote d’Ivoire, a French-speaking country, but I spoke only English and Spanish. After three months of training, I was still unsure of how this would work.I was assigned with one other volunteer to work on Guinea worm disease, a painful parasitic infection spread through contaminated drinking water. On my second day on that assignment, a man lifted his shirt to show me the Guinea worm growing just under his skin in his adbominal area. I could see the entire worm just beneath his skin and I was fascinated. I had understood the disease to be painful and disabling – and in that moment I was struck with the notion that that no one should have to suffer from such a horrible disease, and thus began my commitment to neglected tropical diseases. That was January of 1996. 
  2. How did you get involved in the fight against trachoma? 

    During my time in the Peace Corps, we created a filter frame that proved to be extremely useful; we saw a 47% reduction in cases of Guinea worm disease the first year. Then we saw virtually zero new cases. I was asked to represent the Peace Corps at two international Guinea worm conferences. In the fall of 1996, I met representatives from The Carter Center. I met them again in summer of 1997, and they asked if I wanted to work with Guinea worm disease in southern Sudan. That fall, I went to visit. I fell in love with the possibility of helping millions of people rather than tens of thousands. In 1998, I accepted the offer and began working on Guinea worm and onchocerciasis [river blindness]. In 2001, a colleague and I carried out the first surveys for trachoma in southern Sudan. I saw a young boy about 5 years of age who needed surgery in both eyes from trachoma. It was absolutely horrendous. I knew I could do something; I knew I could help. The Carter Center was willing to assist the people of South Sudan, not only in Guinea worm eradication and onchocerciasis control, but also toward controlling trachoma. So, we started interventions to control trachoma in some of Sudan in 2001.In 2004, I transitioned to The Carter Center offices in Atlanta, where I supported the Trachoma Control Program as well as the other health programs of The Carter Center for 10 years before becoming director of the trachoma program. 

  3. What do you think have been the biggest barriers to overcoming this disease? 

    The hardest thing to do is to change our own behavior. Imagine you grow up a certain way, with no access to water or sanitation. These concepts are later introduced to you but you don’t understand why they’re important. We need to help people overcome barriers to changed behaviors so they wash their faces, wash their children’s faces, build and use latrines.Beyond that, these are environmentally challenging areas. Piped water and sanitation are huge challenges for governments. How do these infrastructure developments take place? How are these large-scale systems funded in very challenging areas?

  1. In your opinion, what has been the most pivotal advance in fighting trachoma? 

    I think partnership has made the biggest difference. In 1999, we were the single entity looking at this in a big way. Our partnership with the Lions Clubs International Foundation (LCIF) and local Lions Clubs in endemic countries helped us move into more countries, expanding our scope. Then the Alliance for Global Elimination of Trachoma by the year 2020 (GET 2020) and the International Trachoma Initiative brought partnership, coordination and collaboration to the forefront. The International Coalition for Trachoma Control was created, and this brought partnership into greater focus. These partnerships and their formation have been pivotal in advancing a global program. It was sporadic at first, but it is now becoming a global program with multiple sectors working toward a common goal. 

  2. LCIF and The Carter Center first teamed up in 1999. What is your fondest memory of Lions and The Carter Center working together? 

    I have so many! There are two that really speak to me. First, the Lions Clubs of Uganda have a very strong female presence. The neglected tropical disease coordinator for the Federal Ministry of Health, Dr. Edridah is a Lion. The Carter Center country representative, Peace Habomugisha, is a Lion. Being with these women and other Lions, including Lion Night Ndyarugahi, and it is unforgettable seeing them strategize on how to work together to control trachoma,. These are empowered women working toward ending blindness from trachoma in their country.Second, in 2016, I attended a mass drug administration launch ceremony of Pfizer-donated Zithromax® (azithromycin), the antibiotic used to control trachoma, in Amhara, Ethiopia. In attendance were Past International President Joe Preston, his wife Joni, and Past District Governor, Hon. Dr. Med., World Laureate Tebebe Y. Berhan and Carter Center CEO, Ambassador (ret.) Mary Ann Peters. PIP Preston’s face just lit up when saw how a single dose of medicine makes so much difference. He was seeing how our partnership saves lives. PIP Preston even sang to the joy of the crowd – I cried.

  1. Trachoma is one of the oldest known infectious diseases. How close do you think we are to eliminating it? 

    The elimination of blinding trachoma is within reach. I believe we can eliminate blindness due to trachoma in the very near future in many countries… However, because of the scope of the problem in Ethiopia and some other few countries, like South Sudan, we may need a few more years, but I’m more than confident that together with the Lions we will reach our goal.  

  1. Is there anything else you would like to share with Lions? 

    President Carter became a Lion when he left his US Navy service. His desire to help the poorest of the poor, coupled with Lions’ desire to be Knights of the Blind and look at diseases over the long term have made a lasting impact on me and my choices. I look at what we can do through the noble efforts of Lions- Carter Center partnership and I am energized. What an effective partnership! Over 400 million treatments and over 600 thousand sight-saving surgeries. I’m honored to be part of this.

Progress
SightFirst has achieved the following accomplishments in fighting trachoma in partnership with the Carter Center:

  • 538,000+ trichiasis surgeries completed
  • LCIF and local Lions have helped to distribute more than 152 million doses of Zithromax© (donated by Pfizer)
  • 3 million latrines and water wells have been built in Ethiopia, Mali, Niger and Sudan.

Declining Prevalence

Maps provided by the Carter Center

These maps show the prevalence of early-stage trachoma in children ages one through nine in Amhara, Ethiopia, in 2007 (top) compared to 2016 (bottom). The LCIF-Carter Center partnership has made tremendous strides in reducing the burden of this disease in Ethiopia and elsewhere.

Effective Treatment
International efforts to treat and eliminate trachoma follow the WHO-developed “SAFE” strategy. This evidence-based strategy has four components.

S: Surgery, to reverse trichiasis (the late, blindness-causing stage of the disease when the eyelashes turn inwards and rub on the cornea);

A: Antibiotics (Azithromycin, Zithromax©), to treat active infection of the disease;

F: Facial cleanliness, to increase personal hygiene and thus reduce the opportunities for disease transmission; and

E: Environmental change, to improve access to water and sanitation.

The SAFE strategy has proven to be an effective and judicious intervention for millions of people. Nyuking Galwak is a living testimony to the power of this intervention strategy. At only 30 years old, Galwak’s situation was dire. She has lived with her infant son in a refugee camp in South Sudan since 2014. Poor sanitation within the camp and lack of access to clean water had led to blinding trachoma in both of her eyes.

Lions supported the outreach clinic that provided Galwak’s sight-saving surgery and taught her about the importance of washing her hands and face. The pain has subsided and Galwak is no longer in danger of losing her vision because Lions stepped in when she needed them most.

Nykong Galwak was overjoyed after her trichiasis surgery

The Role of Sanitation
Antibiotics and surgeries are only part of the solution to the trachoma problem. Another key component is environmental change. Providing household latrines helps to control fly populations. Increasing access to clean water encourages personal hygiene. Separating animal and human living space and safe handling of food and drinking water also are important improvements that impede the spread of trachoma.

Galwak washes her face to prevent the spread of trachoma

The Future for Mali and Niger
The SAFE strategy has been championed by Lions and the Carter Center in both Mali and Niger since 1999. As a direct result of surgeries, antibiotic administration, health education training and environmental improvements, both countries are on track to eliminate blinding trachoma by the year 2020.

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