Health

Trachoma & eye health

Trachoma is an infectious eye disease that can lead to blindness. As it is easily treated with antibiotics, trachoma is regarded as a disease of poverty and is now unknown in developed countries—except Australia.

Children are the most susceptible to this disease.

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Selected statistics

0%
Percentage of children aged 5 to 15 who test positive to trachoma in Ghana, Mexico, Saudi Arabia, Iran, Morocco and Oman [1].
25%
Percentage of children aged 5 to 15 who test positive to trachoma in Katherine, Northern Territory, Australia [1]. Without treatment, they'll go blind.
2.8
Times an Aboriginal person is more likely to be vision impaired than a non-Indigenous person [8].
12
Times a blinding cataract is more common among Aboriginal people than non-Indigenous people [8].
1.9%
Percentage of Aboriginal adults who were blind in 2010 [7].
8.2%
The same percentage in 1980 [7].
6
Times an Aboriginal adult is more likely to be blind than a non-Indigenous adult [7].
5
Times an Aboriginal child is less likely to have vision loss than a non-Indigenous child [11].
7
Times an Aboriginal person is less likely to have sight-saving surgery than a non-Aboriginal person [14].
35%
Percentage of Aboriginal adults who have never had an eye examination [8].
95%
Percentage of vision loss which can be prevented in Aboriginal communities through early detection [8].

Detail of a human eye Up to 25 percent of Aboriginal children test positive to trachoma, a disease which causes blindness. Third-world countries around the world have successfully eradicated trachoma. Australia did not. Photo: Flavio Takemoto, sxc.hu

Fact Aboriginal children, especially in remote areas, often have better eyesight than their mainstream peers, but it worsens as they move into adulthood. [9]

What is trachoma?

Trachoma is a disease that starts with an infection but gradually turns the eyelashes inwards so that they scrape the cornea, scarring it, rendering it opaque, causing blindness.

It is a long-term ailment that only becomes a serious medical issue 20 or 30 years after the initial infection [13].

As it is easily treated with antibiotics, trachoma is regarded as a disease of poverty and is now unknown in developed countries. Gambia, Malawi, Nepal, Ghana, Mexico, Saudi Arabia, Iran, Morocco and Oman have all eliminated trachoma [1].

All except Australia.

Trachoma alive in Aboriginal communities

Trachoma was eradicated in the 1920s but remains endemic in many Aboriginal communities [2], with ‘endemic’ meaning that over 10% of the population are infected [3]. The rate among children can be twice as high. 60% of Aboriginal communities are affected [14].

The trachoma infection is mainly spread through poor hygiene and living conditions.

Professor Hugh Taylor, head of the University of Melbourne’s Centre for Eye Research Australia, identified “a lack of government commitment and a lack of targeted resources on the ground” as the main impediments to eliminating the disease among Aboriginal Australians [4], especially in NSW and QLD where the majority of Aboriginal Australians live. Federal and state bureaucrats meet every 3 months only to postpone resolving their differences for another 3 months [12].

“We know how to eliminate the disease,” Taylor says. “If Morocco can eliminate trachoma in 10 years, then [Australia] should be able to.” Experts estimate that it takes 5 years and “proper funding” to eliminate the disease [12].

“Systemic” bureaucratic indifference left “a significant amount” of $16 million set aside by the Rudd government for trachoma eradication in 2008 unspent [13].

“If you look at all these diseases that the Aboriginal people suffer from, they are the same diseases that were prevalent in [white] Melbourne a hundred years ago,” says Professor Jonathan Carapetis, director of the Menzies School of Health Research in Darwin. “The difference is in overcrowded housing, income, hygiene and sanitation conditions.” [5]

The difference between the often-cited ‘third-world’ conditions of Aboriginal people in Australia and people in third-world countries is that theoretically Aboriginal people have access to high-quality medial care in Australia.

Another impediment is that Aboriginal people in remote communities, though highly mobile, are sometimes reluctant to wait for treatment when they have pressing cultural obligations such as sorry business [13].

If we think we can provide medical care and expect people to live healthy lives in communities where there is poverty, and overcrowded housing, and where people don't even finish school then we are kidding ourselves.—Prof Jonathan Carapetis, director Menzies School of Health Research, Darwin [5]

What can prevent trachoma?

To prevent trachoma, just being able to wash faces helps.

Waste management is important to help control the flies that spread the disease.

The Fred Hollows Foundation predicts trachoma could be stopped within five years with campaigns to encourage hygiene, eye-washing and medical intervention [14].

A successful Trachoma health program of the 70s

The National Trachoma Eye Health Program (NTEHP) was set up in 1975 by Fred Hollows and ran until 1979. In a radical departure from previous programs, it was characterised by respect for Aboriginal people and culture. Within the program there was a strong commitment to Aboriginal engagement and leadership [2].

Aboriginal staff were considered to have important knowledge essential to the program.

The NTEHP set benchmarks of community engagement and empowerment that many health programs are still unable to meet 30 years later.

The important thing about the trachoma program was Aboriginal liaison. And the reason we succeeded was we got a good lot of Aborigines working with us who would go ahead of us, tell the people what we were on about, what benefits they would gain and get the people on our side.—Fred Hollows [6]

Over 30 years on, despite the successful NTEHP, Australia is the only developed country to still have the preventable disease [4].

Other eye problems

Apart from trachoma, most Aboriginal vision loss is caused by unoperated cataracts, diabetes, and uncorrected refractive errors, research has found [7]. Cataract and and diabetes-related blindness in adult Aboriginal Australians is about 12 to 14 times higher than in the mainstream.

Eye conditions in Aboriginal communities include:

  • cataracts: a clouding in the crystalline lens of the eye which is responsible for 32% of blindness in Aboriginal communities [10]. Blinding cataracts are 15 times more common in Aboriginal adults, but only 65% of those needing surgery were operated on;
  • refractive error: reduced vision due to an error in the focusing of light (responsible for 14% of blindness),
  • optic atrophy (14% of blindness),
  • diabetic eye disease (9% of blindness),
  • glaucoma which causes irreversible sight loss, and
  • diabetic retinopathy: damage to the retina.

More than 90% of vision loss associated with these eye diseases is preventable and treatable [10].

Footnotes

View article sources (14)

[1] 'A shamed nation turns a blind eye', SMH 16/11/2009
[2] 'Insiders' story of trachoma program', Koori Mail 442 p.54
[3] 'Prevalence of trachoma in Aboriginal communities in the Katherine Region of the Northern Territory in 2007', The Medical Journal of Australia, 2008; 189 (7): 409
[4] 'Trachoma programs fail Indigenous Australians', http://www.abc.net.au/science/articles/2007/12/19/2114236.htm
[5] 'Working towards good health', NIT 6/8/2009 p.30
[6] 'In the outback', Fred Hollows Foundation, http://www.hollows.org.au/fred-hollows/about-fred/outback, retrieved 8/10/2014
[7] 'Eye health still lags', Koori Mail 472 p.46
[8] '$780,000 eye care boost for Victorians', Koori Mail 483 p.46
[9] 'Thurston backs eye campaign', Koori Mail 483 p.49
[10] 'Eye health is in focus', Koori Mail 502 p.48
[11] 'Blindness taking toll', Koori Mail 461 p.3
[12] 'Eye disease effort undermined by 'glacial' leadership', SMH 29/12/2012
[13] 'In spite of Hollows, the dark goes on', SMH 29/12/2012
[14] 'Blind, but soon they'll see... Australia's first indigenous eye doctor goes to work', SMH 4/10/2014

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www.CreativeSpirits.info,
Aboriginal culture - Health - Trachoma & eye health, retrieved 11 December 2018